Ch 7- The patellofemoral articulation
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| What are joint reaction forces? | Forces that are transmitted through a joint's articular surfaces.
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| What are the 4 names of the outlying areas of the anterior patella? | Superior pole, lateral border, inferior pole, and medial border.
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| Name the 3 articular surfaces of the patella. | Superior, middle, and inferior.
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| What are the 3 facets of the patella? | Lateral facet, medial facet, and "odd" facet.
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| Where does the patella lie in 0 degrees of flexion? | Patella resting on the suprapatellar fat pad on the distal femoral shaft.
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| Where does the patella lie in 20 degrees of flexion? | Inferior portion of facets.
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| Where does the patella lie in 45 degrees of flexion? | Medial and lateral facets.
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| Where does the patella lie in 90 degrees of flexion? | Largest contact area across the medial and lateral facets.
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| Where does the patella lie in 135 degrees of flexion? | odd facet.
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| What maintains the patella's position through out the arc of motion? | patellar retinaculum (medial and lateral).
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| Where does the lateral retinaculum lie? | Originates off the vastus lateralis and the IT band and inserts on the lateral border of the patella.
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| Where does the medial retinaculum lie? | Originates from the distal portion of the vastus medialis and adductor magnus and inserts on the medial border of the patella.
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| What does the superior portion of the knee's thick fibrous capsule that inserts on the patella's superior border form? | The medial and lateral patellofemoral ligaments.
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| What is the primary muscle that pulls the patella laterally? | Vastus lateralis.
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| What is the primary muscle that pulls the patella medially? | The oblique fibers of the vastus medialis (VMO).
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| Where does the suprapatellar bursa lie? | Deep at the distal end of the quadriceps femoris muscle group.
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| What does the suprapatella bursa allow? | Free movement over the distal femur.
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| Where does the prepatellar bursa lie? | Over the anterior portion of the patella.
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| What does the prepatellar bursa allow? | The patella to move freely beneath the skin.
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| What protects the distal portion of the patellar tendon from friction and blows? | Subcutaneous infrapatellar bursa (overlying the tibial tuberosity) and the deep infrapatellar bursa (between the tendon and the tibia).
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| What does the infrapatellar fat pad do? | Separates the patellar tendon and the deep patellar bursa from the joint capsule.
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| What are 8 things you should look for during inspection of the knee? | Patellar alignment, patellar malalignment, posture of the knee, Q angle, tubercle sulcus angle, leg length difference, foot posture, and areas of scars.
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| What are three possible postures of the knee? | Genu varum, genu valgum, and genu recurvatum.
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| What are four possible patellar positions (and causes)? | Patella alta (abnormally long patellar tendon), patella baja (abnormally short patellar tendon or athrofibrosis after surgery or injury), squinting patella (hip anteverson, internal femoral rotation, internal tibial rotation, or arthrofibrosis after surge
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| Define anteversion. | A forward bending or angulation of a bone or organ.
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| What constitutes a positive Q angle test with the knee extended? | A Q angle greater than 13 degrees for men or 18 degrees for women.
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| What constitutes a positive Q angle test with the knee flexed? | A Q angle greater than 8 degrees.
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| What are the 12 important structures to palpate for a patellar dysfunction evaluation? | Tibial tuberosity, patellar tendon and bursae, fat pads, patella and bursae, patellar articulating surface, femoral trochlea, suprapatellar bursa, retinacular and capsular structures, synovial plica, the pes anserine muscle group, nerve on medial aspect o
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| What constitutes a positive clarke's sign? | The patient experiences patellofemoral pain and the inability to hold the contraction.
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| What does a positive clarke's sign indicate? | Possibly chondromalacia patella. Note: The clarke's sign is an unreliable test, producing false-positive results in otherwise asymptomatic knees.
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| What are the possible consequences of patella alta? | Increased patella glide, decreased quad strength, increased patellofemoral compressive forces when the knee is flexed.
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| What are the possible consequences of patella baja? | Decreased patellar glide, decreased tibiofemoral range of motion, decreased quad strength, increased patellofemoral compressive forces when the knee is flexed.
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| What are the possible consequences of squinting patella? | Increased Q angle, tight medial retinaculum, maltracking of the patella, altered patellofemoral compressive forces.
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| What are the possible consequences of "frog eyed" patella? | Increased lateral patellar glide, tight lateral retinaculum, patellar maltracking decreased quad strength, increased patellofemoral compressive forces where the knee is flexed.
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| What constitutes a positive medial glide test? | The patella should glide one to two quadrants (approximately half its width) medially. Movement of less than one quadrant is hypomobile medial glide. Movement more than two quadrants is hypermobile medial glide.
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| What does a positive medial glide test indicate? | Hypomobile glide is the result of tightness of the lateral retinaculum or IT band. Hypermobile medial glide indicates laxity of the lateral restraints.
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| What constitutes a positive lateral glide test? | Normal lateral motion is 0.5 to 2.0 quadrants of glide. Less than that is hypomobile lateral glide; greater than two quadrants is hypermobile lateral glide.
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| What does a positive lateral glide test indicate? | Hypomobile lateral glide is caused by tightness of the medial restraints. Laxity of the medial restraints results in hypermobile lateral glide, a predisposition to patellar dislocation.
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| What constitutes a positive patellar tilt test? | A normal result is the lateral border raising between 0 and 15 degrees. More than 15 degrees is hypermobile lateral tilt; less than 0 degrees is a hypomobile lateral tilt.
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| What does a positive patellar tilt test indicate? | A tilt of less than 0 degrees indicates tightness of the lateral restraints and often occurs in the presence of a hypomobile medial glide. A tilt of more than 15 degrees may predispose the individual to anterior knee pain.
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| Define morphologic. | Changes in form and structure with regard to function.
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| What are the pain characteristics of a dislocating or subluxating patella? | Medial joint capsule, indicating trauma to the medial patellar restraints as well as pain reported beneath the patella.
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| What is the MOI of a dislocating or subluxating patella? | During extension of the knee or an eccentric contraction of the quadriceps group within the last 30 degrees of the rang of motion; a valgus force may also be associated with the onset of injury.
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| What would you find on inspection of a dislocating or subluxating patella? | Unreduced patellar dislocations exhibit obvious deformity. Effusion of the knee occurs within 24 hours after the onset of the injury.
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| What constitutes a positive aprehension test? | Forcible contraction of the quadriceps by the patient to guard against dislocation of the patella. The patient may also demonstrate apprehension verbally or through facial expression.
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| What does a positive aprehension test indicate? | Laxity of the medial patellar retinaculum, predisposing the patient to patellar subluxations or dislocations.
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| What are the pain characteristics of patellar tendinitis? | Inferior patellar poles, midsubstance of the tendon, or the tendon's point of insertion on the tibial tuberosity.
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| What is the MOI of patellar tendinitis? | Repeated activity involving resisted knee extension (e.g. jumping) or secondary to contusive forces on the patella.
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| What would you find on inspection of patellar tendinitis? | The patellar tendon and inferior patella pole may appear inflamed. Swelling may be localized around the patellar tendon.
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| What are the pain characteristics of a patellar tendon rupture? | Patellar tendon, patella, and quadriceps muscle group.
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| What is the MOI of a patellar tendon rupture? | Dynamic overload of the extensor mechanism secondary to extending the knee aginst resistance or a forceful eccentric contraction of the quad muscle.
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| What would you find on inspection of a patellar tendon rupture? | Gross deformity caused by the patella riding high on the femur, exposing both femoral condyles and a defect in the patellar tendon.
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| What are the pain characteristics of prepatellar bursitis? | Localized to a specific bursa and possibly the infrapatellar fat pads.
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| What is the MOI of prepatellar bursitis? | Direct trauma to the bursa or overuse.
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| What would you find on inspection of prepatellar bursitis? | Localized swelling possible if a superficial bursa involved.
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| What are the pain characteristics of synovial plica syndromes? | Pain is located in the anterior portion of the knee; the patient may describe clicking, popping, psuedolocking of the knee, or the knee's "giving way." Symptoms are often described as being worse in the morning, with a gradual decrease as the day progres
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| What is the MOI of synovial plica syndromes? | Friction caused by the plica's rubbing across a femoral condyle.
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| What would you find on inspection of synovial plica syndrome? | No visual findings.
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| What constitutes a positive medial synovial plica test? | Reproduction of the symptoms is described by the patient. The clinician may feel the plica as it crosses teh medial femoral condyle, especially in the range of 60 to 45 degrees of flexion.
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| What does a positive medial synovial plica test indicate? | Symptomatic medial synovial plica.
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| What constitutes a postive stutter test? | Irregular motion or stuttering between 40 and 60 degrees as the plica passes over the medial condyle.
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| What does a positive stutter test indicate? | Medial synovial plica.
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| What are the pain characteristics of osgood-schlatter disease? | Radiating up the distal one third of the patellar tendon.
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| What is the MOI of osgood-schlatter disease? | Stress placed on the tibial tuberosity's growth plate by forceful contraction or passive tension of the extensor mechanism; onset often associated with a rapid growth spurt or overtraining
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| What would you find on inspection of osgood-schlatter disease? | Swelling or deformity of the tibial tuberosity.
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| What is palliative? | Serving to relieve or reduce symptoms without curing.
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| What are the pain characteristics of sinding-larsen-johansson disease? | Superior or inferior patellar pole point tenderness, beinning as activity related pain and progressing to pain at all times.
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| What is the MOI of sinding-larsen-johansson disease? | Repetitive stresses from running and jumping.
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| What would you find on inspection of sinding-larsen-johansson disease? | Antalgic gait; a deformity possibly present at the affected pole of the patella.
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