PFPS and Instability

PF joint has - cartilage in the body

Thickest

Primary ligamentous stabilizer is - - -. It primarily restrains - - - at 0-30 degrees of - -

Medial Patellofemoral Ligament, Lateral Patellar Displacement, Knee Flexion

Stabilizers of patellofemoral joint (muscles)

Quads, Glute Med + Max, TFL/ITB

Function of patella?

Increase moment arm of quads

PFP comes on when at - degrees or greater

90

Pain is - (under the kneecap), mechanism is - or - - in activity, aggravating factors are -/-/-

Diffuse, insidious or rapid increase, squatting/running/stairs

Risk factors (CPG)

Overuse/overload, muscle performance deficits (KE, HAB, HER), coordination (valgus), mobility impairments (hyper/hypo)

3 criteria for dx

• Other testing

Presence of retro/peripatellar pain, reproduction of pain with activity, exclusion of all other conditions

• Functional ass., Patellar tilt, eccentric step test, MMT, Flexibility

Interventions

• Grade A

• Grade B

• Grade C

• Grade D

• Hip and Knee strengthening, Manual therapy, foot orthoses, exercise/orthotics/patellar taping/flexibility combo

• No biofeedback/EMG, No bracing, patellar taping

• Gait training

• Modailties

Educate on - - / - -, understanding of -, address -

load management/gradual return, pain, fear

Early on, we want…

• _ - _ degrees of flexion for CKC

• OKC: start from - position, avoid last - degrees of - (_-_ range)

• 0-45

• flexed, 30, extension, (90-45)

Mcconnel Taping does not move the - any particular -, but it does - it down which can be helpful

patellar, way, hold/compress

COME BACK TO SLIDE 24

Patellar subluxation is sliding out of - - and back in, dislocation remains out of it and always goes -

Trochlear groove, laterally

Anatomic RF for patellar instability

• Other factors

Trochlear dysplasia, patella alta, increased tibial tubercle-trochlear groove (TT-TG) distance

• CT disorders (Ehlers Danlos), family hx, previous dislocation

Typical dislocation

• Subjective

• Testing

• Pop, rapid swelling, non-contact (twist from flexed), apprehension

• Observe swelling, MPFL palpation, Fairbank’s apprehension test, patellar quadrants

Imaging?

X-ray and MRI

First line for instability is - -, recurrent can mean -

• Rehab timeline

• Surgery is either - or -

Conservative management, surgery

• 8 weeks (3 phases): pain/swelling/quad/ROM →C/OKC → advanced training

• Allograft, hamstring

What does recurrence rate look like?

Risk of arthritis?

High

High