The patient's history and clinical presentation provide initial clues to the cause of AKP. Classic symptoms are pain behind the patella brought on by physical activity such as walking up or down stairs . The physical examination should focus on evaluating alignment, range of motion, bursitis, and effusion. Multiple maneuvers can be performed to check for internal derangement. The patella is examined with the knee in extension. If the examiner can displace the patella laterally by 25% of its diameter or more, it is considered to be ''subluxable'' . However, the malalignment often is subtle, and physical exam can be difficult and confusing in many patients. Imaging plays an important role in evaluation, not only in searching for malalignment, but for other sources of pain as well.
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