patellofemoral dysfunction

Question 1

discuss PF instab

Answer 1

disloc, sublux or maltracking

1. abnormal Q-angle = inc valgus
2. dysplastic trochlea - flat trochlea
3. assoc fx

Question 2

discuss PF pain c biomechanical dysfunction

Answer 2

prob c kinetic chain

1. femoral anteversion = IR of femur
2. external tibial tortion
3. genu valgum
4. hyperpronation

Question 3

discuss PF pain s malalignment

Answer 3

1. soft tissue lesion - prepatellar bursa, fat pad
2. patellar pressure syndrome
3. osteochondritis dissecans
4. traumatic pattelar chondromalacia
5. PF OA
6. trauma

Question 4

local factors that lead to PF sx

Answer 4

infrapatellar fat pad

lax or weak lig

quads tendon

med and lat retinaculum imbalance

subchondral bone

Question 5

distal factors that lead to PF sx

Answer 5

ER foot

subtalar eversion

inc midfoot mob

Question 6

proximal factors that lead to PF sx

Answer 6

inc hip abd and IR

weak hip abd and ER

Question 7

ssx of PF dysfunction

Answer 7

pain
- retropatellar
- patellar tendon
- subpatellar fat pad

crepitus, swelling, locking
altered LE biomech

weak
- hip abd
- hip ext
- VMO

dec flexibility
- TFL
- ITB
- hams
- quads
- gastroc soleus

overstretched
- med or lat retinaculum

dec medial patellar glide and tipping

Question 8

prot phase of PFD

Answer 8

pat mob and modalities

pain free ROM

muscle sets

tape and patellar brace

Question 9

controlled motion to return to function phase of PFD

Answer 9

pat mob and modalities

stretching

NWB ex to CKC
- avoid loading at 60° flexion

pat taping

Question 10

considerations for proximal extensor mechanism realignment

Answer 10

knee immob in ext until
- knee gain control and full ROM

ambu c AD

WB
- 25% to WBAT
- after 4 wks: FWB c immobilizer

Question 11

considerations for distal realignment

Answer 11

knee immob in ext until
- quads control

ambu c

WB
- 4 wks na toe touch
- p 8 wks: FWB s immob

Question 12

prot phase fot patellar instab

Answer 12

~ 4 wks

modalities

cold and compression

PROM-AAROM-AROM
- only 90° knee flex ng 4 wks

quads setting
SLR c knee immob
mini squats - 50% WB

pat mob

gait training c AD and orthosis

Question 13

criteria to progress to mod prot phase for pattelar instab

Answer 13

min pain and swelling
incision healing well
full active knee ext and 90° flexion

Question 14

mod prot phase for patellar instab

Answer 14

4-8 wks

low intensity stretching and gr 3 PJM
- 6 wks: 0-120° flexion
- 8 wks: 0-135° flexion

CKC c pain free range

pat mob

gait training c AD and orthosis pero FWB na

proprio and balance ex

low impact CV ex

Question 15

criteria to progress to min prot phase for pattelar instab

Answer 15

no swelling or ext lag

knee ROM: 0-135° flexion

75% MMT of knee and hip

Question 16

min prot phase for patellar instab

Answer 16

progress mod prot

12 wks: land base jogging
16-20 wks: full activity s sx

activity mod if necessary