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patellofemoral disorders pt 2 - Coggle Diagram
patellofemoral disorders pt 2
patellar dislocation
MOI: ER of tibia combined with valgus stress to knee
-more commonly result of femoral IR
-often result of strong quad contraction
who's susceptible: adolescent women, with recurrence common
-rate of repeat dislocation: 20-43% in first timers treated with immobilization, rate depends heavily on congenital predisposing factors
assessing instability
-static approach: lateral patellar glide >50% patella width over lateral femoral condyle
-dynamic: observation of patella from 30 deg flexion to extension. abrupt lateral motion at knee extension, may be considered unstable. "inverted J sign"
hip weakness and PF pain
-weak ERs at initial contact to midstance can lead to increased lateral facet contact
weak glutes can lead to overuse of Quads and greater PFJ forces. can lead to pain when combined with malalignment
radiologic studies
-can show structural abnormalities contributing to patellar instability
-best views for PF joint: Merchant's view
-congruence angle: normal is +/-6 deg
MRI for patellofemoral pain
-89% accuracy for type 3/4 chondromalacia, poor for type 1/2
quadriceps strengthening for PFP
-single best predictor for outcome
strengthening concerns
-if instability/tracking is concern, avoid strengthening at flexion angles <40 deg
-joint compression is concern, avoid deep ranges of knee fleixon
EMG can be used as supplement for strength training in those with PFP, but should not be primary focus
muscle tightness that can contribute to PFP
-gastroc/soleus, hamstrings, ITB
patellar taping
-many studies report decreased pain, but actual ability of tape to alter position is controversial
bracing
-more likely to be beneficial to those with instability
patellar tendon strap: shown to provide pain relief, but limited data on MOA
foot mechanics and PFP
-studies show relationships between rearfoot varus/valgus but no true cause/effect. more research needed
foot orthotics: depends on cause of PFP
patellofemoral realignment procedures
PF instability
-indications: three-quadrant medial patellar glide, tubercle sulcus angle >0 deg, patella alta with generalized ligamentous laxity and flat trochlear groove
PF arthritis
-indications: sig PF chonrodmalaciaor OA combined with generalized laxity
infrapatellar contraction syndrome
-indications: if after lateral release and debridement of fat pad and infrapatellar tissues there is still no change in patellar height, proximal advancement of tibial tuberosity is indicated.
long term outcomes of nonsurgical management of PF disorder: 75-85% success rate