Medial patellofemoral ligament physical therapy

Patellar instability is a complex topic that must be treated at the individual level. The majority of first-time patellar dislocations occur in sport, and there is a high rate of recurrence and ongoing symptoms. Physical examination and imaging studies can aid in treatment decisions. Patient symptoms, degree of trauma, compliance with therapy, anatomical factors, and desired activity levels influence management strategies (both operative and nonoperative). There is recent emphasis on the medial patellofemoral ligament and its involvement in patellar stability, and various surgical techniques have been studied; however there is no clear consensus...

The standard approach to reconstruct the medial patellofemoral ligament (MPFL) is by mini-open incision at its patellar insertion and femoral origin. At the medial patella rim, the MPFL insertion may be visualized in most cases by dissection during surgery. On the femur, it is more difficult to localize the MPFL remnants by a mini-open incision due to soft tissue covering the anatomical origin. Therefore, the femoral MPFL origin is usually identified by intraoperative lateral fluoroscopy. However, the insertion and origin of the MPFL at the patella and femur might be directly visualized using an arthroscopic extraarticular approach from the knee joint through a window of the synovial layer...

BACKGROUND: Over the long term, acute patellar dislocations can result in patellar instability, with high recurrence rates after nonoperative treatment. PURPOSE: To compare the results of operative (reconstruction of the medial patellofemoral ligament [MPFL]) versus nonoperative treatment of primary patellar dislocation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Thirty-nine patients (41 knees) (mean age, 24...

AIM: The diagnosis and treatment of patellar dislocation is very complex. The aim of this study is to give an overview of the biomechanics of the patellofemoral joint and to point out the latest developments in diagnosis and treatment of patellar dislocation. METHOD: The authors electronically searched Medline, Cochrane and Embase for studies on the biomechanics of the patellofemoral joint and for conservative and surgical treatments after patellar dislocation. We extracted baseline demographics, biomechanical, conservation and surgical details...

PURPOSE: Quadriceps strength and activation may play an important role in the recovery from ACL revision surgery. The purpose of this study was to describe quadriceps strength and central activation ratio (CAR) and correlate with radiographic findings in patients with ACL revision surgery. METHODS: Twenty-one patients who were on average 47.5 ± 21.1 months [range: 14-85 months] post-revision ACL reconstruction. We performed knee joint physical examination and radiographic evaluation...

INTRODUCTION: Medial patellar subluxation is usually seen after lateral retinacular release. Spontaneous medial subluxation of the patella is a very rare condition. There are few reports in the literature on the pathophysiology of iatrogenic medial patellar subluxation. To our knowledge, there are no reports of the pathophysiology of non-iatrogenic medial patellar subluxation in the English literature. In this study we present a case of spontaneous medial patellar instability that is more prominent in extension during weight bearing...

STUDY DESIGN: Resident's case problem. BACKGROUND: Kaposi's sarcoma (KS) is the most common form of cancer in patients with human immunodeficiency virus (HIV) infection. Although KS is often initially asymptomatic, this neoplasm may progress to affect multiple organ systems, including structures of the musculoskeletal system, which can produce symptoms similar to those associated with common orthopaedic conditions. This resident's case problem describes the evaluation and differential diagnosis of a 45-year-old male with HIV and KS, referred to physical therapy with an initial diagnosis of radiographic osteoarthritis (OA) and patellofemoral pain syndrome (PFPS) of the left knee...

PURPOSE: The objective of this study was to analyze and compare the results obtained after 2 types of treatment, surgical and conservative, for acute patellar dislocations. METHODS: We divided 33 patients with acute patellar dislocations into 2 groups. One group with 16 patients underwent conservative treatment (immobilization and subsequent physiotherapy), and the other group with 17 patients underwent surgical treatment. A radiographic examination was performed in the evaluation of the patients to verify predisposing factors for patellofemoral instability, and the Kujala questionnaire was applied with the intention of analyzing the improvement of pain and quality of life...

Recurrent patellar instability can result from osseous abnormalities, such as patella alta, a distance of >20 mm between the tibial tubercle and the trochlear groove, and trochlear dysplasia, or it can result from soft-tissue abnormalities, such as a torn medial patellofemoral ligament or a weakened vastus medialis obliquus. Nonoperative treatment includes physical therapy, focusing on strengthening of the gluteal muscles and the vastus medialis obliquus, and patellar taping or bracing. Acute medial-sided repair may be indicated when there is an osteochondral fracture fragment or a retinacular injury...

BACKGROUND AND PURPOSE: The International Classification of Functioning, Disability and Health (ICF) has been proposed as a possible framework for organizing physical therapist practice. The purpose of this case report is to describe an evaluative and diagnostic process that is based on the ICF framework for a patient with a patellar dislocation. CASE DESCRIPTION: The patient was a 23-year-old woman who sustained a right knee and patellofemoral joint injury, resulting in a sprain of the medial collateral ligament and a suspected sprain of the medial patellofemoral ligament...

PURPOSE: The purpose of this study was to evaluate the mid-term results of the Elmslie-Trillat procedure for the treatment of patella instability. Patella instability can be addressed by proximal, distal, and combined approaches. The Elmslie-Trillat procedure is a combined bony distal realignment with medial soft tissue technique offering a more rapid recovery than more extensive distal realignments. METHODS: A consecutive series of patients with recurrent patellar instability treated with a modified Elmslie-Trillat procedure were assessed subjectively by visual analog scale, Tegner scale, and both pre-and postoperatively by physical examination, International Knee Documentation Committee activity, Lysholm, and Fulkerson knee scores...

We describe the case of a 14-year-old boy with patellar instability on both sides resulting from ligamentous hyperlaxity and dysplasia of the lateral femoral condyle who had previously undergone an arthroscopic lateral release as well as plication of the medial capsule. The patient presented to our clinic 2 years after surgery with a locked lateral patella dislocation on the left side. The surgical correction involved a substantial open lateral release including an excision of the scar tissue and stabilization of the patella in the patellofemoral groove by tibial tubercle medialization and plication of the medial capsule...

Osteoarthritis of knee joint is the disease that can be easily found at the ordinary examination. The aging and the continuous long-term stress are the most important ones among the many kind of causing factors. Most of osteoarthritis is appeared in medial femorotibial joint. The second largest number of osteoarthritis is appeared in patellofemoral joint. The first appearance of the disease is over forty and the number of the patients increases as patients grow older. Patients are almost female. Complication of osteoarthritis is obesity and varix of the lower limbs...

A significant incidence of knee pain and disability arises from patellofemoral disorders. An accurate diagnosis relies both on a comprehensive history and a careful physical examination; radiologic modalities also play an important part in the diagnosis and follow-up. Most patellofemoral disorders can be examined in three groups: pain due to soft tissue abnormalities, patellar instability, and patellofemoral osteoarthritis. Conservative therapy can be successful in many patellofemoral disorders. Surgical treatment consists of lateral release, medial plication and reconstruction of the medial patellofemoral ligament, proximal and distal realignments, patellar osteotomies, and patellectomy...

There is a relative lack of research and literature investigating injuries to the posterior cruciate ligament (PCL), despite the fact that it is an important knee stabilizer. The PCL is injured less frequently than other knee ligaments, and the mechanism is usually a direct blow to the anterior aspect of a flexed knee. Clinical examination of a PCL-deficient knee may reveal a positive posterior drawer, quadriceps active test, or Godfrey test. Chronic PCL insufficiency may result in patellofemoral and medial compartment degenerative arthritis...

Patellofemoral disorders are a common cause of knee pain and disability. A thorough history and a careful physical examination are essential to accurate diagnosis, and imaging modalities play an important role. Magnetic resonance imaging can provide information on malalignment and soft-tissue injuries. Although there is a continuum of diagnoses, most patellofemoral disorders can be divided into three distinct categories: soft-tissue abnormalities, patellar instability due to subluxation and dislocation, and patellofemoral arthritis...

Muscle activity, joints, angles, and heart rate during uphill walking were compared for application in knee rehabilitation. The objectives of this study were to quantify muscle activation levels at different treadmill grades and to determine the grade(s) at which knee range of motion would not further compromise the joint. Average and peak electromyographic activity of the quadriceps (vastus medialis oblique and vastus lateralis) and hamstrings (biceps femoris and medial hamstrings (semimembranosus/semitendinosus)] was recorded during walking at 0, 12, and 24% grade...

We did a retrospective review and follow-up examination to investigate the incidence, risk factors, and outcome of patients who developed loss of motion after arthroscopic anterior cruciate ligament reconstruction. Two hundred forty-four patients with a minimum followup of 1 year were reviewed. Loss of motion (defined as a loss of extension of more than 10 degrees or flexion of less than 125 degrees) was identified in 27 patients for an overall incidence of 11.1%. Factors associated with loss of motion included acute reconstruction (less than 1 month from initial injury), male sex, and concomitant medial collateral ligament repair or posterior oblique ligament reefing or both...