KNEE 2 Flashcards
patellofemoral pain syndrome patellar tendinopathy patellar dislocation/subluxation
synonyms for patellofemoral syndrome
RUNNERS KNEE
chondromalacia patella
retropatellar pain syndrome
anterior knee pain syndrome
patellofemoral pain syndrome is due to
repetitive, overuse activities
causes increased force at patellofemoral joint, resulting in pain during FLEXION AND EXTENSION
so many factors leading to abnormal patellofemoral joint compression… listed:
Decreased knee extensor or gluteal muscle strength
Pes planus or pes cavus
Excessive foot pronation
Wide Q angle
Increased tibial torsion or femoral anteversion
Decreased flexibility of quadriceps, hamstrings, or ITB
Genu recurvatum, genu valgus, or genu varus
Lateral retinaculum tightness
Patella alta or patella baja
Patellar instability
too much joint loading secondary to abnormal patellofemoral joint mechanics in flexion/extension results in _______
pain and inflammation
*due to increased stress on undersurface of patella as it goes up and down the trochlear groove
To minimize patellofemoral stress, greatest amount of patellar contact should be when compressive loads are at their ______
highest (increased compressive loads at patellofemoral joint as knee moves into flexion)
What is the most common problem involving the knee? (25% of knee injuries)
patellofemoral pain syndrome
patellofemoral pain syndrome most commonly occurs in young or older people?
young (adolescents, young adults, especially ACTIVE)
*also more commonly FEMALES
patellofemoral pain syndrome is due to one specific mechanism of injury (true or false)
flase: combo of multiple factors! results in abnormal patellofemoral joint mechanics
pathology or altered biomechanics in the ___ or _____ are major factors contributing to patellar femoral pain
hip or ankle
so many other contributing factors of patellofemoral pain syndrome: listed
(basically hams/glutes, foot stuff, q angle, tightness, patellar stuff)
Decreased knee extensor or gluteal muscle strength
Pes planus or pes cavus
Excessive foot pronation
Wide Q angle
Increased tibial torsion or femoral anteversion
Decreased flexibility of quadriceps, hamstrings, or ITB
Genu recurvatum, genu valgus, or genu varus
Lateral retinaculum tightness
Patella alta or patella baja
Patellar instability
true or false: there is a referral pattern for patellofemoral pain syndrome
false (just like meniscal tears)
common symptoms of patellofemoral pain syndrome include:
pain (increases w repeated activity)
swelling
crepitus
“theatre sign/movie-goers knee” or prolonged sitting is a sign/aggravating activity of
patellofemoral pain syndrome
*also any activities like running, walking, squatting, biking, stairs are aggravating activities
what makes patellofemoral pain syndrome feel better?
avoiding knee flexion activities/long flexed postures
The main goal of patellofemoral pain syndrome is to address ________
primary contributing factors (like foot alignment, dcreased flexibility of lateral hip/knee, weak hip abductors or external rotators)
What should you avoid in rehab of patellofemoral pain syndrome?
deep squats
stairs/step ups
last 30 degrees of extension
open kinetic chain: 0-30 degrees of flexion
closed chain: limit knee flexion range up to 60-90 degrees
what helps in rehab of patellofemoral pain syndrome?
medial patellar glides
stretching lateral hip muscles
taping
orthotics for foot malalignments
quad strengthening in stress min range
knee extension (avoid terminal knee ext)
seated/supine leg press (avoid flexion more than 60 degrees)
what is another name for patellar tendinopathy?
jumpers knee
patellar tendinitis is acute or chronic?
acute inflammation of patellar tendon
patellar tendinosis is acute or chronic?
chronic, degeneration of patellar tendon
patellar tendinopathy is from what? (trauma or overuse)
overuse activity (usually sports related)
tendinosis is due to
chronic histopathological changes
repetitive strain of tendon, leading to microtrauma of tendon
Tendons have a low metabolic rate, thus the demand for collagen and matrix production exceeds its reparative capacity.
In tendinosis, collagen fibers repair into a disorganized pattern, marked by ___ and _____
variable fibrosis and neovascularization
what is mechanism of injury of patellar tendinopathy?
repetitive jumping, running, ECCENTRIC loading of tendon
list of contributing factors to patellar tendinopathy
(at hip, knee, muscles, patella, footwear)
Excessive training intensity or duration
Increased Q angle
Genu valgum/varum
Decreased muscle flexibility
Abnormal patellar alignment
Improper footwear
Muscle weakness
There is no referral pattern for patellar tendinopathy, just like ___ and ____
patellofemoral pain syndrome, meniscus tears
common signs and symptoms of patellar tendinopathy
localized pain, swelling (most often at prox insertion of inferior patellar pole)
pain during and after activities
insidious onset of symptoms
true or false: patellar tendinopathy symptoms may improve during activity only to get worse after activity stops
TRUE
true or false: eccentric training is recommended for rehab of chronic tendinopathy
true
what else is rehab protocol for patellar tendinopathy?
correct risk factors, activity mod
improve quads and ham flexibility
correct biomechanical stuff like ps planus/excess pronation/wierd patellar tracking
REST EMPHASIS and stopping activities that aggravate pain
cryotherapy
eccentric exercises
synonyms for patellar dislocation/subluxation
patellar instability
patellar dislocation is ______
no contact between patella and trochlear groove
patellar subluxation is ______
temporary, partial dislocation of patella from trochlear groove
first time dislocations with history of prior subluxation are most observed in what population?
girls 10-17 years
subluxations/dislocations are most often observed in what population?
young, athletic people (younger children/preadolescents have higher rate of recurrence)
Acute dislocations can occur with direct trauma like fall/blow to knee. However most occur from _______
noncontact (frequent exposure to primary MOI)
most dislocations/subluxations occur medially or laterally?
laterally (patella slides over lateral part of trochlear groove)
dislocation/subluxation most often results from
noncontact, lower extremity INTERNAL ROTATION + knee valgus stress on fixed distal extremity
contributing factors for subluxation/dislocations:
age
gender
increased or decreased Q angle?
genu _____
patella _____
increased femoral _____
coxa _____
age: young, active
gender: female
icnreased q angle
genu valgum
patella alta
increased femoral anteversion
coxa valga
other contributing factors to patellar sublux/disloc
Family history of dislocation
Trochlear dysplasia
Abnormal foot mechanics: Excessive foot pronation that leads to genu valgum
Weak hip abductors and external rotators may lead to genu valgum.
Gross ligamentous laxity
Excessive foot pronation
If a patient presents with vague anterior knee pain, swelling, giving way with jumping/running/quick changes in direction, the patient prob has ____
patellar sublux/dislocation
*in recurrent instability, symptoms episodic and long term
interventions for patellar sublux/dislocations are similar to patellar tendinopathy. What are they?
Quadriceps strengthening exercises in ranges that place the least amount of stress on the patellofemoral joint.
Proper footwear and assess the need for orthotics if excessive pronation or pes planus is present, contributing to genu valgum posture.
Hip abduction and external rotation strengthening exercises to minimize femoral adduction and internal rotation, which may contribute to increased genu valgum posture in squat positions.
Patellar taping to assist in normal patellar tracking during exercise.
Improve ITB flexibility to decrease lateral pull on patella.
Medial patellar glides to stretch lateral patellar retinacular soft structures.
Surgery is recommended for what kind of patients?
recurrent sublux/dislocations or for patients with anatomical abnormality
