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Patellorfemoral

Pathologic conditions

QuestionAnswer
When we talk about patellofemoral what structures are involved? -Quads -Quads Tendon -Patella -Patella Tendon -Patellofemoral articulation
What is a Q angle? Tracking the petllar deviations
What position is the knee in for a normal Q angle? Slight valgus due to the inward angle of the femur which allows the femoral condyles to be parallel with the ground
Why are the ridges of the femoral condyles important to the q angle? The ridge of the lateral femoral condyle is higher the medial condyle which then give it an angle
When drawing a line of the Q angle what does that consist of ? A line from ASIS to asis of the patella and distally tot he insertionof the patellar tendon on the tibial tubercal
How is the Q angle increased? the proximal tibial is ER, distal tibial varus, and knee genu valgum
Why is it considered that females have a higher Q angle? Wider hips for child bearing
What happens if a person has a greater than normal Q angle? IT affects the tracking mechanisms of the patella during flex and ex
What is VMO? Pulls on the patella medially to keep in on track(65 degrees)
What are the 3 positions of the patella to the femur? 1.Patella alta - higher 2.Normal 3.Patella baja-lower
If someone has a camel sign what does this mean? Patella Alta w/ exposed intrapatellar fat-pad 2 bumps like a camels humps
What are the characteristic of miserable malalignment syndrome? 1.Femoral anterversion 2.squinting patella's 3.proximal external tibial torsion(bayonet sign) 4.foot pronation
What are the causes of Recurrent Lateral Patellar Dislocation/patellar tracking disorder? 1.< Q angle 2.Patella Alta 3.Weakness in VMO 4.Hamsting Tightness 5.Trama 6.Miserable malalignment sysndrom
What are some management for non operative Recurrent Lateral Patellar Dislocation/ patellar tracking disorder non op? Control anterior knee pain and swelling / RICE NSAIDS, elevation
What ex can be performed for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? Initiate add and quadriceps strengthening ex emph. the VMO with quad sets, SAQ. mini squats w/ hip in ER
What are some classic systoms for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? -Inflammation -Crepitus (audible, palpable grity sandpaper and creaking under patella 3. Ant. knee pain and pain behind patella 4. A lateral tracking patella
What is important for the therapy team to work on in rehab for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? Select appropriate quad strengthening ex that counter the effects of tight lateral structures
What ex are done to improve the quad strength for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? Initially do isometrics quad sets to accommodate for pain VMO is the focus of attention when addressing quads strength they emphasized for their ablility to stabilize the patella superiorly and more important medially
What ex are done to improve the quad strength for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? The superior medial pull of the VMO complex directly counteracts lat tracking syndroms. Therefore progressive quad sets serve as the doundationof the intial rehab program
What ex are done to improve the quad strength for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? Adductors can also contribute to the medial pull on the patella Ex- isometric Ball & hold progressing to isotonic add ex progress to CKC step ups, leg presses and squats
What mm need to be Stretched for Recurrent Lateral Patellar Dislocation/patellar tracking disorder? Hamstrings, IT band, Patella mobs pushing lat to medial
What are some supportive devices used for Recurrent Lateral Patellar Dislocation/ patellar tracking disorder? Neoprene sleve, brace w. lat buttress support, tapping techniques Support device to dynamically stabilize patella and prevent dislocation
What are the operative management for patella disfunction? 1.Proximal realignment 2.Distal realignment 3.Cartilage shaving 4.Perforation of abrasion chronoplast
What happens with Proximal realignment procedures? Lateral retinacular release surgical procedure is disigned to free up or release tight lateral structures and allow the patella better anatomic alignment
What is involved in rehab for Proximal realignment? Tx, RICE lat. patella compression buttress pad, elevation WBAT w/immobilizaiton then follow nonoperative strenthening and stretching
What is involved with Distal realignment procedures? Surgically ermove the patellar tendon insertion at the tibial tubercle and reattach it to a more mechhanically advantageous site
What is the rehab with Distal realignment procedures? Immob. in cast or hinged brace 4-6 wks NWB to PWB to FWB with crutches Limit AROM to 100 degrees of flex 1st 2 wks progress to 120 degrees by 6 wks stat quad strength when site is healed
What happens in Cartilage shaving procedures? Arthroscopic shaving of the under surface of the patella and femoral condyles
What disease process might call for a Cartilage shaving procedures? Chrondromalacia refers to degeneration or softening fo the cartilage
What is involved in the rehab of Cartilage shaving procedures? Patella mob, ice, compression & limited ROM & strengthing until healed WBAT
What is done in a Perfornation or abrasion chronoplast? Tech to smooth out rough articular surface. Stimulates a communication between damaged articular surface and vascular supply of subconydal bone
What is the rehab for Cartilage shaving procedures? Pain and swelling must be controlled NWB to PWB 4-6 wk ROM isometrics, quad strengthening
What patellar position is associated with a higher incidence of patellar instability? Patella alta
A line drawn from the ASIS through the ctr of axis of the patella and distally to the insertion of the patellar tendon on the tibial tubercle is called what? Quadriceps angle - Q angle
What describes the miserable malalignment syndrome? Squinting patella, external tibial torsion, and Bayonet sign
What is the connerstone in the rehab of a painful laterally tracking patella? Hamsting stretching,stetch lat. retinaculum, strengthening quad, and control pain and swelling
What are the recongnizable signs and symtoms of anterior knee pain? Crepitus, Lat tracking patella, pain, and VMO weakness
In addition to strengthening the quads with anterior knee pain what other mm group contribute to improving the apporpriate line of pull on the patella Hip Adductors
What procedure is used to dritectly address retopatellar and femoral condyle articular cartilage degeneration? Perforation chondroplasty, Abrasion arthroplasty, and articular shaving
What is the purpose of a TKA? Improve function and eliminate or reduce pain
What is the most common age of persons with rheumatoid arthritis who undergo TKA Less than 60 years old
What are some goals of recovery from TKA? Relief of pain Restoration of mechanical axis of the knee Restoration of anatomic axis of the knee Provision of adequate stability
Created by: demiller243