tibiofemoral rotation

what are the two movement system diagnoses for tibialfemoral rotaion?

tibiofemoral rotation with valgus

tibiofemoral rotation with varus

what is tibiofemoral rotation syndrome?

• knee pain associated with impaired rotation of the tibiofemoral joint in transverse or frontal plane

• MR/ADD of femur in relation to tibia

  • or

• LR/ABD of tibia in relation to femur

what could the source of symptoms be?

• ligaments

  • cruciates, collaterals

  • retinaculum

• patellofemoral joint structures

• tibiofemoral joint structures

  • meniscus

• IT band (especially distal insertion)

• surrounding musculature

what are the history and symptoms for a patient with tibiofemoral rotation syndrome?

• pain: joint line or peripatellar

• pain associated with tibiofemoral rotation (WB or NWB)

• history of early stages of DJD or OA

• equestrians

• ballet dances

• runners/cyclist (ITB friction syndrome)

what does tibiofemoral rotation syndrome look like in a ballet dancer with femoral anteversion?

• excessive flexibility

• at knee and ankle (compensating for lack of hip LR)

• imagine her assuming 1st position in ballet

what does tibial rotation syndrome with valgus look like?

• pronated foot or abnormal pronation during gait

• weak hip abductors, external rotators

• poor dynamic knee joint stability / medial collapse

• at risk for ACL injuries

what are key tests and signs for tibiofemoral rotation with valgus?

• standing alignment

• small knee bend

• sit to stand

• single lef stance

• step up

• heel tap

• SL squat

what musles could contribute to the LR of the tibia on the left during right stance?

biceps femoris

what are muscle tissue contributions for tibiofemoral rotation with valgus?

• weal posterior glute med, deep LR and glute max

• Short TFL - ITB

  • may observe LR of tibia during supine hip flexor length test or prone knee flexion

  • keep in mind that the SITE OF COMPENSATORY/EXCESSIVE MOTION is often the painful site

what should you also monitor during two joint hip flexor test?

if the tibia is LR

what is treatment for tibiofemoral rotation with valgus?

• education

• alignment: must account/accommodate for structural impairments

• functional activities

  • sit to stand, stairs

• gait

  • improve alignment during loading (glute squeeze)

  • improve push off (decrease hyperextension, lift heel earlier)

• fitness activities

what does an HEP look like for tibiofemoral rotation with valgus?

• improve muscle performance of gluteals and deep LRs

• improve extensibility of TFL-ITB

  • prone knee flexion (unilat/bilat)

  • prone hip LR

• key: must stabilize tibiofemoral joint along with pelvis

  • goot pointing forward slightly inward

    • with bilateral knee flexion, toes touching and heels in line with tibias

• functional activity modification

what are examples of exercises for posterior gluteus medius?

• AROM abd in LR

• marching

• band around thighs not ankles

• hold isometric clam shell

what is tibiofemoral rotation syndrome with varus?

• typically supinated foot

• often with hyperextension

• may demonstrate a varus trust

• may have increased risk for OA

what compartment is compressed during tibiofemoral rotation with varus?

medial compartment

what goes along with having an increased risk of acquiring OA with TFR syndrome with varus?

• higher BMI

• previous injury

• deep knee flexion activities

• external knee adduction moment

what lowers the knee adduction varus moment?

• toe out/external rotation of the foot lowers the adduction moment

• it moves the ground reaction vector closer to the knee joint

what should you focus on for treatment of TFR syndrome with varus?

glute strengthening

what is the risk of progression in patients with OA?

• 5 degree mal alignment results in a significant increase in progression

  • varus: odds are increased 4-10 fold

  • valgus: odds are increased 2-5 fold

• DO NOT FOCUS ON QUADS STRENGTHENING IN MAL ALIGNED OR LAX KNEES, ESPECIALLY IN OPEN CHAIN

what is the impact of varus thrust?

• in varus aligned knees a thrust increases odds of progression of OA x 3 - potent risk factor

• adductor moment frater in knees with a thrust compared to those without

• related to static varus alignment

• risk factors: male gender and greater knee extensor strength

what is treatment for TFR with valgus?

• improve gait

  • improve hip control

  • neuromuscular training

  • walk with hips abducted

• orthotics for the foot

what is treatment for TFR with varus?

• improve gait

  • toe pointing outward?

  • reduce hyperextension

  • improve hip control

  • walk with hips adducted

• improve shock absorption

  • bracing