Management of Patellofemoral Pain Flashcards
What is PFP commonly associated with?
women more than men and associated post ACL or meniscal injury
common in runners
What is likely etiology for PFP?
repetitive micro traumas caused by:
- posture/alignment- Q angle, pronation
- LE Biomechanics- Hip IR, knee valgus
- neuromuscular factors- weak glutes, quad timing
What is a Wiberg classification?
shape of patella
1- normal
2- lateral facet larger
3- lateral facet largest
When is the patella is greater contact with the femur?
90 degrees flexion
least contact at 0 degrees extension
What happens if superficial oblique soft tissues are tight?
there will be a lateral translation of the patella
What happens if the deep transverse soft tissues are tight?
there will be a lateral tilt of the patella
Which soft tissue in the medial compartment is the biggest passive stabilizer of the patella?
medial patella femoral ligament
What are active soft tissue stabilizers of the patella?
quadriceps
What happens if there is swelling in the knee and its effect on the VMO?
only needs 20-30 ml of fluid to inhibit VMO as a result other quad muscles will pull patella laterally
What is the primary role of the patella?
facilitate knee extension , w/o patella quad would have to work twice as hard
What is typical path of the patella during movement?
lateral “C” shape
What are predisposing factors of PFP?
gender, body weight, activity level, type of activity, biomechanical alignment (hips,feet)
What are risk factors of PFP?
- excessive pronation- increases lateral contact surface on patella
- muscle imbalances- quad and hip muscles
- decreased flexion angles-decreases contact area of patella
Why are muscle imbalances a major risk factor of PFP?
” think of the tracks moving under the train”
train is the patella
What is important to remember about most risk factors of PFP?
most of them are modifiable and should be addressed with prevention program
What is typical PP of PFP?
females, insidious onset, anterior, vague, diffuse pain, limited function, quad weakness, joint crepitus, mild swelling, pain with stairs or standing up, “feels like its giving way”
What anatomical features should PT examine during eval?
Q angle, genu valgum, femoral anteversion, lateral tibial tubercle
consider Q angle changes during dynamic activity
How can you determine VMO weakness?
palplate and observe during quad set firing, will most likely be delayed
What is most likely to cause PFP hips or feet?
most likely hips but feet can as well
What is patella alta?
high unstable patella usually found in females, less then 0.8
What is patella baja?
low patella likely in males causing more compression
What is protocol for patella tendinitis?
NSAIDS, ice, restore ROM, restore flexibility and improve strength
What is protocol for patella tendinosis?
active warm up, friction massage, stretch quad, eccentric strengthening (12 weeks)
What is a common diagnosis with similar to PFP?
ITB syndrome - treated in similar ways
What is primary function of ITB?
stabilize lateral hip and knee, resist hip ADD and IR, pure sagittal plane activities
What are keys to success for PFP rehab?
must treat the cause and not the SX, accurate diagnosis, controlled activity and Pt education
What should a comprehensive tx approach include?
strengthening , stretching, taping, foot orthotics
Can you isolate the VMO for strength?
probably not but don’t really need to just improve timing of VMO and must reduce swelling
What muscles are important to stretch for PFP?
rectus femoris, ITB, hamstrings, Gastroc-soleus (compensatory pronation if these are tight)
Why is it important to treat cause and not symptoms?
because if you don’t correct faulty biomechanics all the strength won’t matter as problem will come back over time, strength also must be functional not just on a table
What are indications for a lateral release surgery?
a soft tissue procedure, anterior knee pain, failed long conservative treatment, evidence of lateral tilt
What are contraindications for a lateral release?
hypermobile pts, not for just lateral dislocations
What are indications for a distal realignment surgery?
tibial tube realignment, pateller instability due to Q angle and tibial tubercle malaignment, patellar tilt and subluxations
What are advantages and disadvantages of a distal realignment?
corrects subluxation and tilt and allows for more aggressive rehab
dis: does not address MPFL
What are indications for a MPFL reconstruction?
lateral patella instability due to laxity of proximal medial restraints,
What are contraindications for a MPFL reconstruction?
not performed for malalignment,arthrosis or pain
