Knee Lecture - PT528 Patellar Patellofemoral Pain...

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5/2/2016 PT528 – Patellar & Patellofemoral Pain & Iliotibial Band Syndrome I. Patellar & Patellofemoral Pain (K&C, pg 788-795; Dutton, pg 850-919) A. Classification of patellar and patellofemoral dysfunction: 1. Patellar pain and patellofemoral pain with known cause a. Prepatellar bursitis (aka housemaid’s knee) 1) Result of prolonged kneeling or recurrent minor trauma to anterior knee 2) Intervention: activity modification b. Chondromalacia: Dutton, 2012 1) Softening of the cartilage on posterior aspect of patella 2) Four grades: 1 (spongy joint surface), 2(fissures), 3 (“crabmeat”), 4 (full-thickness, OA) 3) Since cartilage has no nerve supply, minor chondral lesions are usually asymptomatic 4) Most common in 12-35 year old age group; more common in females 5) Causes: trauma, abnormal tracking, aging c. Fat pad irritation 1) Irritation of infrapatellar fat pad from trauma (eg, posterior patellar tilt) or overuse 2) Intervention (posterior patellar tilt) taping designed to decrease posterior tilt d. Patellofemoral instability: subluxation/ dislocation 1) Traumatic versus atraumatic • Traumatic: direct or forceful quad contraction while foot is planted • Atraumatic: not associated with trauma; frequently have a history of traumatic dislocation 2) Contributing factors: • Shallow intercondylar femoral groove • Tight lateral structures: e.g. iliotibial band • Biomechanical factors: proximal, distal, local (see below) 3) Recurrent dislocation usually an indication for surgery (D.Scotti lectures) • moving apprehension test • contact of patella with femur(intercondylar groove) – superior pole 135°; inferior pole 20° inferior pole has reduced fit subluxation 2. Chronic idiopathic PFP a. Most often described as anterior knee pain b. Prevalence: 1) Physically active populations: affects 1 in 4 people 2) Between 71% & 91% of individuals report chronic pain up 20 years following initial diagnosis (Ramskov, 2015) 3) More prevalent in females (Boling, 2009) 4) Associated with development of patellofemoral osteoarthritis c. Mechanism: 1) Patella acts as a dynamic lever for the quadriceps & experiences some of the highest loads of any structure in the human body (0.5 times body weight for walking to over 7X body weight for squatting). 2) Pain is thought to be caused by overloading of the subchondral bone secondary to patella malalignment (e.g., patella alta) and/or patella maltracking (e.g., medial femoral rotation); decreased PF contact area increased PFJ stress.
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