The Patellofemoral Joint Flashcards
What is patellofemoral pain syndrome? (PFPS)
A softening and/or fissuring of the under side of the patella (which has no sensory nerve endings)
True or False: The underside of the patella is aneural.
TRUE (has no sensory nerve endings)
What 7 structures, around and within the patellofemoral joint, can give rise to PFPS?
- subchondral bone
- infrapatellar fat pad
- quadriceps tendon
- patellar ligament
- synovium
- medial and lateral retinaculum
- medial and lateral patellar ligaments
True or False: PFPS is believed to be the same entity as patellofemoral joint OA.
FALSE
PFPS is believed to be a different entity than patellofemoral joint OA.
What demographic is typically affected by PFPS? (Age? Sex?)
- Prevalent in adolescents age 12 - 17
2. Women more than men
What is one risk factor of PFPS?
Obesity
What are 2 symptoms associated with PFPS?
- Peri-patellar (anterior knee) pain
2. Functional limitations usually include pain with negotiating stairs, squatting and rising from sit to stand.
What 2 conditions are associated with cartilage damage?
- Patella Alta
2. Trochlear morphology
How may patella alta contribute to PFPS?
Creates a condition where the patella is functioning out of the femoral groove more often in tibiofemoral joint ROM than without patella alta
Reduces stability at the knee
What 2 things influence patellar tracking?
- Bony geometry
2. Position of the patella within the trochlear groove
True or False: An increase in the Q angle is a risk factor for PFPS.
FALSE
Q angle is not a risk factor for patellofemoral pain
What 2 things may occur at the knee joint as a result of increasing the q angle?
- A bowstring effect along the length of the quadriceps muscle / tendon
- Increase the tendency of the patella to track laterally.
How is misalignment of the patella typically treated?
Patellofemoral taping
What intervention has been found to provide immediate pain relief in patients with patellofemoral pain?
Medially directed patellar taping
What is the consensus regarding patellar taping as a first line treatment for patellofemoral pain? What does this suggest?
Consensus is unclear
Suggests that greater consideration of individual patient needs may be required
Should emphasis be placed on VMO strengthening in patients with PFPS? Why or why not?
No, VMO strengthening is not indicated.
Why?
- VMO insufficiency has not been consistently documented in this population
- No evidence suggesting that the VMO can be recruited or selectively strengthened independent of other vasti
What should be the focus of exercise when treating patients with PFPS?
Overall quadriceps strengthening
Is there one type of exercise that is favored over others when treating patients with PFPS?
No, exercise therapy is effective, regardless of the type of exercise (eg, in weight bearing or not; targeting hip or knee)
How might quadriceps tightness cause patellofemoral pain?
Could cause an increase in compressive forces at the patellofemoral joint
How might ITB tightness cause patellofemoral pain?
Could cause an increase in compressive forces at the patellofemoral joint, because a portion of the ITB runs anterior to the patella and attaches at the medial aspect of the knee and lower thigh
How might hamstring tightness cause patellofemoral pain?
Could require the quadriceps muscle to contract harder to compensate for tight hamstrings, thus causing an increase in compression forces at the patellofemoral joint.
Female patients with PFPS have altered hip mechanics in what 2 planes an with what 2 movements?
- altered hip kinematics in the frontal plane(excessive hip adduction)
- altered hip kinematics in the transverse planes (excessive hip internal rotation)
There is evidence to support the use of _____ and ______ muscle retraining/strengthening to treat PFPS.
- Hip extension
2. Abduction
True or False: Hip and knee exercises are recommended over just knee exercises when treating patients with PFPS.
True
Hip and knee exercises reduce pain and improve function more effectively than just knee exercises
What orthoses is typically recommended to patients with PFPS?
Foot orthoses are recommended to reduce pain in the short term
What 3 muscles should be targeted with exercise to treat patellofemoral pain?
- Quadriceps
- Gluteus Medius
- Gluteus Maximus
List the 4 general interventions that have been recommended in the treatment of patellofemoral pain.
- Open/Closed Kinematic chain exercises
- Multimodal PT
- Foot orthoses
- Patellar Taping
What 2 structural bony impairments may lead to patellofemoral pain syndrome?
- Decrease in the height of the lateral femoral condyle
- Shallow femoral groove
Cause imbalance in the compressive forces on the underside of the patella
What 3 interventions have been found to be INEFFECTIVE in treating patellofemoral pain?
- Patellofemoral, knee, and lumbar mobilizations
- Electrophysical agents
- Physical agents
According to the evidence, what 3 interventions should be used to treat patellofemoral pain?
- Hip abduction, ER, and knee extension strengthening exercises
- Foot orthotics
- Trial of patellofemoral taping (if indicated)
