Patellofemoral dysfunction Flashcards
What are diagnoses that are related to patellofemoral dysfuntion?
- Patellofemoral Pain Syndrome
- Chondromalacia Patellae
- Plica Syndrome
- Patellar Malalignment
- Extensor Mechanism Dysfunction
- Patellar Tendonitis (jumper’s knee)
- Patellar subluxation or patellar dislocation
What is patellofermoral pain syndrome?
- insidious onset
- comes on gradually pain with stairs and squat
What is chondromalacia patellae?
- chunks can break off and get bone on bone
- can be caused by immobliziation because joint not getting proper nutrients
What is plica syndrome?
- remnants of embryonic synovial fluid
- white connective tissue around knee that change how patella tracks
What is patellar malalignment?
-VMO weakness
What is extensor mechanism dysfunction?
- Q-angle
- muscle imbalances
What is patellar tendonititis (jumper’s knee)?
- over use injury
What is patellar subluxation or patellar dislocation?
- often structural
- can be overstretched and weak medial muscles
What are possible causes of patellofemoral disorders?
- Direct trauma
- abnomral stress on patellar/femoral joint surfaces
- anatomic/bony structre
- soft tissue imbalances- IT band tightness, weak VMO
How do you manage patellofemoral disorders non-operatively in the acute stage?
- modalities
- rest
- gentle ROM
- muscle setting
- stay in pain free ranges
- splint patella with tape or brace to unload the joint
How do you manage patellofemoral disorders non-operatively in the subacute stage?
- 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
How do you manage patellofemoral disorders non-operatively in the chronic stage?
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
What are common patellofemoral surgeries?
- Lateral retinacular release
- Extensor mechanism realignment
- Chrondroplasty/Abraision Arthroplasty
- Synovectomy
Why do a lateral retinacular release surgery?
-for chronic later subluxation/displacement, abnormal tracking and excessive tilting of patella
What do you need to be sure of if a lateral retinacular release surgery was performed? *
Need to know if chondroplasty or abrasion arthroplasty performed also
Describe the maximum protection phase of a lateral retinacular release.
- bracing used to prevent excessive lateral tracking
- 4-way SLR
- QS
- AAROM
- May start stretching Gastroc and IT band
Describe the moderate protection phase of a lateral retinacular release
- Precautions
- want full ROM
- open chain- submaximal contraction
- closed chain- partial lunges, small step ups
- look at the entire chain mechanics
Describe the minimum protection phase of a lateral retinacular release.
About 6-8 weeks
- isokinetic
- closed chain- nordic track
Why perform an extensor mechanism realignment?
- 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
Describe the exercise program for an extensor mechanism realignment
- Exercise program is similar to that for lateral release through ROM, WB, Strengthening
- progressed more slowly for 6-8 weeks (need bone to heal)
Describe the maximum protection phase for an extensor mechanism realignment
- Immoblized 10-??? days (braced)
- only allowed 40-60 degrees of PROM flexion
- TTWB post op
Describe the moderate protection phase for an extensor mechanism realignment
- 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
How long is the minimum protection phase for an extensor mechanism realignment?
20-24 weeks (same as an ACL surgical repair)
What is a chondroplasty/abrasion arthroplasty?
- for patellofemoral pain and creptitation due to degenerative patellar articular surface
- trying to illicit a healing process to get a better surface
