The Patellofemoral Joint

Question 1

What is patellofemoral pain syndrome? (PFPS)

Answer 1

A softening and/or fissuring of the under side of the patella (which has no sensory nerve endings)

Question 2

True or False: The underside of the patella is aneural.

Answer 2

TRUE (has no sensory nerve endings)

Question 3

What 7 structures, around and within the patellofemoral joint, can give rise to PFPS?

Answer 3

1. subchondral bone
2. infrapatellar fat pad
3. quadriceps tendon
4. patellar ligament
5. synovium
6. medial and lateral retinaculum
7. medial and lateral patellar ligaments

Question 4

True or False: PFPS is believed to be the same entity as patellofemoral joint OA.

Answer 4

FALSE

PFPS is believed to be a different entity than patellofemoral joint OA.

Question 5

What demographic is typically affected by PFPS? (Age? Sex?)

Answer 5

1. Prevalent in adolescents age 12 - 17

2. Women more than men

Question 6

What is one risk factor of PFPS?

Answer 6

Obesity

Question 7

What are 2 symptoms associated with PFPS?

Answer 7

1. Peri-patellar (anterior knee) pain

2. Functional limitations usually include pain with negotiating stairs, squatting and rising from sit to stand.

Question 8

What 2 conditions are associated with cartilage damage?

Answer 8

1. Patella Alta

2. Trochlear morphology

Question 9

How may patella alta contribute to PFPS?

Answer 9

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

Question 10

What 2 things influence patellar tracking?

Answer 10

1. Bony geometry

2. Position of the patella within the trochlear groove

Question 11

True or False: An increase in the Q angle is a risk factor for PFPS.

Answer 11

FALSE

Q angle is not a risk factor for patellofemoral pain

Question 12

What 2 things may occur at the knee joint as a result of increasing the q angle?

Answer 12

1. A bowstring effect along the length of the quadriceps muscle / tendon
2. Increase the tendency of the patella to track laterally.

Question 13

How is misalignment of the patella typically treated?

Answer 13

Patellofemoral taping

Question 14

What intervention has been found to provide immediate pain relief in patients with patellofemoral pain?

Answer 14

Medially directed patellar taping

Question 15

What is the consensus regarding patellar taping as a first line treatment for patellofemoral pain? What does this suggest?

Answer 15

Consensus is unclear

Suggests that greater consideration of individual patient needs may be required

Question 16

Should emphasis be placed on VMO strengthening in patients with PFPS? Why or why not?

Answer 16

No, VMO strengthening is not indicated.

Why?

1. VMO insufficiency has not been consistently documented in this population
2. No evidence suggesting that the VMO can be recruited or selectively strengthened independent of other vasti

Question 17

What should be the focus of exercise when treating patients with PFPS?

Answer 17

Overall quadriceps strengthening

Question 18

Is there one type of exercise that is favored over others when treating patients with PFPS?

Answer 18

No, exercise therapy is effective, regardless of the type of exercise (eg, in weight bearing or not; targeting hip or knee)

Question 19

How might quadriceps tightness cause patellofemoral pain?

Answer 19

Could cause an increase in compressive forces at the patellofemoral joint

Question 20

How might ITB tightness cause patellofemoral pain?

Answer 20

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

Question 21

How might hamstring tightness cause patellofemoral pain?

Answer 21

Could require the quadriceps muscle to contract harder to compensate for tight hamstrings, thus causing an increase in compression forces at the patellofemoral joint.

Question 22

Female patients with PFPS have altered hip mechanics in what 2 planes an with what 2 movements?

Answer 22

1. altered hip kinematics in the frontal plane(excessive hip adduction)
2. altered hip kinematics in the transverse planes (excessive hip internal rotation)

Question 23

There is evidence to support the use of _____ and ______ muscle retraining/strengthening to treat PFPS.

Answer 23

1. Hip extension

2. Abduction

Question 24

True or False: Hip and knee exercises are recommended over just knee exercises when treating patients with PFPS.

Answer 24

True

Hip and knee exercises reduce pain and improve function more effectively than just knee exercises

Question 25

What orthoses is typically recommended to patients with PFPS?

Answer 25

Foot orthoses are recommended to reduce pain in the short term

Question 26

What 3 muscles should be targeted with exercise to treat patellofemoral pain?

Answer 26

1. Quadriceps
2. Gluteus Medius
3. Gluteus Maximus

Question 27

List the 4 general interventions that have been recommended in the treatment of patellofemoral pain.

Answer 27

1. Open/Closed Kinematic chain exercises
2. Multimodal PT
3. Foot orthoses
4. Patellar Taping

Question 28

What 2 structural bony impairments may lead to patellofemoral pain syndrome?

Answer 28

1. Decrease in the height of the lateral femoral condyle
2. Shallow femoral groove

Cause imbalance in the compressive forces on the underside of the patella

Question 29

What 3 interventions have been found to be INEFFECTIVE in treating patellofemoral pain?

Answer 29

1. Patellofemoral, knee, and lumbar mobilizations
2. Electrophysical agents
3. Physical agents

Question 30

According to the evidence, what 3 interventions should be used to treat patellofemoral pain?

Answer 30

1. Hip abduction, ER, and knee extension strengthening exercises
2. Foot orthotics
3. Trial of patellofemoral taping (if indicated)