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Ortho > Patellofemoral dysfunction > Flashcards

Patellofemoral dysfunction Flashcards

1
Q

What are diagnoses that are related to patellofemoral dysfuntion?

A
  1. Patellofemoral Pain Syndrome
  2. Chondromalacia Patellae
  3. Plica Syndrome
  4. Patellar Malalignment
  5. Extensor Mechanism Dysfunction
  6. Patellar Tendonitis (jumper’s knee)
  7. Patellar subluxation or patellar dislocation
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2
Q

What is patellofermoral pain syndrome?

A
  • insidious onset

- comes on gradually pain with stairs and squat

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3
Q

What is chondromalacia patellae?

A
  • chunks can break off and get bone on bone

- can be caused by immobliziation because joint not getting proper nutrients

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4
Q

What is plica syndrome?

A
  • remnants of embryonic synovial fluid

- white connective tissue around knee that change how patella tracks

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5
Q

What is patellar malalignment?

A

-VMO weakness

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6
Q

What is extensor mechanism dysfunction?

A
  • Q-angle

- muscle imbalances

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7
Q

What is patellar tendonititis (jumper’s knee)?

A
  • over use injury
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8
Q

What is patellar subluxation or patellar dislocation?

A
  • often structural

- can be overstretched and weak medial muscles

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9
Q

What are possible causes of patellofemoral disorders?

A
  1. Direct trauma
  2. abnomral stress on patellar/femoral joint surfaces
    - anatomic/bony structre
    - soft tissue imbalances- IT band tightness, weak VMO
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10
Q

How do you manage patellofemoral disorders non-operatively in the acute stage?

A
  • modalities
  • rest
  • gentle ROM
  • muscle setting
  • stay in pain free ranges
  • splint patella with tape or brace to unload the joint
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11
Q

How do you manage patellofemoral disorders non-operatively in the subacute stage?

A
  • correct or modify biomechanical factors
  • add proximal weakness/tightness, impaired stability and distal malalignment
  • Pt education: avoid stairs, don’t sit with knees flexed for extended time, perform ROM to releave stress
  • increase flexibility of restriting tissues: uqds, G/S, TFL, HS
  • quad set and quad set with SLR
  • watch any movement of 60-90 degrees of flexion
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12
Q

How do you manage patellofemoral disorders non-operatively in the chronic stage?

A

6-8 weeks, up to 3 months

  • bike
  • stair climbing
  • lots of manual therapy
  • work on list of things that hurt when they first see you
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13
Q

What are common patellofemoral surgeries?

A
  1. Lateral retinacular release
  2. Extensor mechanism realignment
  3. Chrondroplasty/Abraision Arthroplasty
  4. Synovectomy
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14
Q

Why do a lateral retinacular release surgery?

A

-for chronic later subluxation/displacement, abnormal tracking and excessive tilting of patella

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15
Q

What do you need to be sure of if a lateral retinacular release surgery was performed? *

A

Need to know if chondroplasty or abrasion arthroplasty performed also

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16
Q

Describe the maximum protection phase of a lateral retinacular release.

A
  • bracing used to prevent excessive lateral tracking
  • 4-way SLR
  • QS
  • AAROM
  • May start stretching Gastroc and IT band
17
Q

Describe the moderate protection phase of a lateral retinacular release

A
  • Precautions
  • want full ROM
  • open chain- submaximal contraction
  • closed chain- partial lunges, small step ups
  • look at the entire chain mechanics
18
Q

Describe the minimum protection phase of a lateral retinacular release.

A

About 6-8 weeks

  • isokinetic
  • closed chain- nordic track
19
Q

Why perform an extensor mechanism realignment?

A
  • for recurrent subluxation/dislocation of patella
  • or for increased Qangle contributing to tracking problems
  • often do osteotomy and reposition tibial tuberosity and change VMO alignment
20
Q

Describe the exercise program for an extensor mechanism realignment

A
  • Exercise program is similar to that for lateral release through ROM, WB, Strengthening
  • progressed more slowly for 6-8 weeks (need bone to heal)
21
Q

Describe the maximum protection phase for an extensor mechanism realignment

A
  • Immoblized 10-??? days (braced)
  • only allowed 40-60 degrees of PROM flexion
  • TTWB post op
22
Q

Describe the moderate protection phase for an extensor mechanism realignment

A
  • partial WB or less
  • still may have orders for limited ROM
  • May be 6 weeks before crutches and brace are discontinued
  • By 6 weeks post-op 110-120 degrees of flexion
23
Q

How long is the minimum protection phase for an extensor mechanism realignment?

A

20-24 weeks (same as an ACL surgical repair)

24
Q

What is a chondroplasty/abrasion arthroplasty?

A
  • for patellofemoral pain and creptitation due to degenerative patellar articular surface
  • trying to illicit a healing process to get a better surface
25
Q

What is the WB status following a chondroplasty/abrasion arthroplasty?**

A

WB may be significantly restricted (non-TTWB) 4-6 weeks and patient may not be allowed FWB for 6-12 weeks

26
Q

Describe the maximum protection phase for a chondroplasty/abrasion arthroplasty

A
  • PROM in pain free ranges
  • Associated areas
  • muscle setting
  • manage edema
  • deep breathing ankle pumps
27
Q

Describe the moderate protection phase for a chondroplasty/abrasion arthroplasty

A
  • precaution: avoid exercise that causes increased compressive forces on patella, crepitation, and pain
  • Multi angle isos
  • AROM
  • Start with open chain exercises and move to closed chain when WB status permits
28
Q

Describe the minimum protection phase for a chondroplasty/abrasion arthroplasty

A
  • progress pt according to what they need to be able to do (their goals)
  • what CC are you eliminating????
29
Q

Why have a synovectomy done?

A

Removal of synovium (80-90%) for patients with chronic synovitis (ie RA, OA, hemophilia)

30
Q

Describe the maximum protection phase for a synovectomy

A

Standard procedure ;)

  • PROM
  • QS, HS, AP, 4 way SLR
31
Q

Describe the moderate protection phase for a synovectomy

A
  • multi angle isos
  • open chain to closed chain
  • initiate stretching
32
Q

Describe the minimum protection phase for a synovectomy

A

return them to function

  • *Open surgery = 6 weeks until return to function
  • *Arthroscopic = normal ROM 7-10 days, normal gait 3-4 weeks

Ortho (17 decks)

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