Patellofemoral Instability or Dysfunction

It includes subluxation or dislocation of a single or recurrent episode. There may be an abnormal Q-angle, a shallow groove or flat lateral side of the femur, a patella that is pushed up, and inadequate medial stabilizers (VMO). The instability is usually in the lateral direction.

Causes: If dislocated, it may derive from direct trauma to the patella or from a forceful contraction of the quadriceps where the femur is externally rotated while the knee is flexed. If dislocation is recurrent, surgery may be needed to redirect the forces through the patella.

Patellofemoral Pain without Misalignment

Causes: Includes many subcategories of lesions that cause anterior knee pain.

• Types of soft tissue lesions:

• Plica Syndrome – This describes a condition that is relating to irritation of remnants of embryological synovial tissue around the patella. With chronic irritation, the tissue can become an inelastic, fibrotic band that is tender when palpated.
• Fat pad syndrome – Involves irritation of the infrapatellar fat pad from trauma or overuse.
• Tendinitis – Often occurs because of repetitive jumping; that is when the patella or quadriceps tendon becomes overused.
• Iliotibial (IT) band friction syndrome – this is the irritation of the IT band as it passes over the lateral side of the femur. Factors that contribute to this syndrome include tight tensor fasciae latae or tight gluteus maximus.
• Prepatellar bursitis (housemaid’s knee) – this usually results from prolonged kneeling or recurrent minor trauma to the anterior knee. Because of this, there may be restricted motion at the knee due to swelling and inflammation.
• Patellofemoral osteoarthritis – may be due to unknown causes or post trauma and is diagnosed by radiographic changes consistent with degeneration.
• Tight medial and lateral retinacula or patella pressure syndrome – increased contact pressure of the patella in the trochlea groove.
• Trauma- this usually occurs when squatting, stair climbing and resisted knee extensions and includes tendon rupture, fracture, contusions (bruising), and articular cartilage damage which results in inflammation, swelling limited motion, and pain with dysfunction whenever contracting the quadriceps.

Symptoms/Common Impairments and Functional Limitations:

• Overstretched medial sheath that bind tendons
• Restricted lateral sheath that binds tendons, IT band or fascial structures around the patella
• Decreased movement of the patella
• Tight rectus femoris or hamstring, and calf muscles
• Pronated foot (weight on the inside of the foot)
• Pain in the retro patella region (due to biomechanical changes of patella)
• Irritated patella tendon

Limitations

Pain with walking, jumping, or running which interferes with ADL or IADL, work and sport or recreational activities

Pain or poor knee control when ascending or descending the stairs.

Pain and stiffness with prolonged flexed knee postures such as squatting or sitting

Management of Patellofemoral Symptoms at Curezone Physiotherapy Clinic

Our Registered physiotherapist makes sure to do a detailed assessment and provide treatment based on it.

Protection phase:

• Treat acute symptoms as acute joint problem—this includes modalities, rest, gentle motion, and muscle setting exercises in pain-free positions.
• Splinting the patella with a brace or tape may unload the joint and relieve the irritation stress.

            Controlled motion and return to function phase:

            Our physiotherapist usually plans return to functional phase gradually based on your symptoms.  

• Educate/advice the patient – end range stress and prolonged postures tend to exacerbate symptoms; for example, it is important to avoid positions and activities that provoke the symptoms. It is also important to minimize and avoid stair climbing and descending until the knee and hip muscles are strengthened to a level at which knee function can be controlled without symptoms.
• Home exercise program- such as self-stretching techniques; this will help to increase the flexibility of restricting tissues.
• Patella mobilization – medial glide
• Medial tipping of the patella
• Patella taping
• Self-stretching – insertion of IT band

Call us now to get yourself checked and book an appointment today.