Chronic Knee

Question 1

patellofemoral pain syndrome
1. biomechanism of injury
2. associated factor
3. symptoms

Answer 1

1. quadriceps line of pull follows orientation of femur, pulls patella laterally due to natural valgus of the knee, quadriceps tendon and patellar tendon put compression and shear force due to high load on tissue beyond tolerance
2. weaker hip abductor and LR of hip (contribute to greater valgus) weaker knee extensors, greater adduction and MR when running, increased contralateral pelvic drop (weak abduction) and rearfoot eversion (greater valgus)
3. pain around and behind kneecap, grinding or clicking sounds of knee. pain during downward slope

Question 2

patellar tendinopathy
1. suspectable pop
2. symptoms

Answer 2

1. volleyball and basketball; court sports with jumping
2. pain at apex of patella, decreased hamstrings and quad flexibility, decreased DF ROM

Question 3

iliotibial band syndrome
1. training causes
2. anatomical factors
3. clinical presentation of symptoms
3. sex differences

Answer 3

1. common in endurance athletes such as runners or cyclists, possibly due to changes in training such as downhill or banked (one side elevated) running or new bike fit
2. hip adduction, knee int rot, varus knee, and ipsilateral trunk flex (flex towards injured side, sign of weak abductors) stretch IT band; possibly due to lateral femoral condyle fat pad impingement
3. pain with squatting or descending stairs; focused pain at lat femoral condyle to 2-3 cm proximal to lateral joint line, pain when striking ground during gait (ITB is impact absorber at 20 to 30 deg knee flex, same angle on strike)
4. in female runners caused by weak abductors and decreased hip med rot angle; in male runners due to increased tibia; med rot and increased hip adduction due to narrow gait

Question 4

special tests for chronic knee?

Answer 4

1. no special tests with high reliability and validity since pain during sport is cause by complex motion which cannot be replicated by simple tests
2. can use functional tests relevant to sport to check mechanics (single leg squat, vertical jump, triple hop test); look for where pain is, what part is painful, and poor biomechanics

Question 5

patellar femoral pain syndrome treatment

Answer 5

1. focus on hip (abductors and external rotators) and knee (extensors) exercise programs
2. orthotics targeting excessive pronation (due to rearfoot eversion causing valgus) can provide short term benefits for some people
3. patellar taping and exercise can decrease lateral force on patella to help with pain

Question 6

patellar tendinopathy treatment

Answer 6

1. ECC emphasisi protocols, on 25 deg incline and squat to 60 deg only
2. moderate to heavy, slow resistance protocols
3. infrapatellar tendon straps can decrease pain by decreasing peak vertical ground reaction force and reduce localized strain by increase patella-patellar tendon angle (make patella more vertical) to decrease tensile load on tendon

Question 7

ITB syndrome treatment

Answer 7

limited evidence for specific treatment
1. check biomech, correct excessive adduction and knee int rot by strengthening adductors and ext rotators (biceps femoris) of the knee
2. improve flexibilty of the IT band, and strengthen muscles inserting into it (TFL and glute max); strength muscles around it (rec fem, biceps fem)
3. for cyclists bike seat (no excessive knee extension) and cleat (orientation of cleat can change tibial rot) adjustments