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PFPS and Anatomical Deviations of the knee

THE

CREATIVE

ZONE

Abby Labar, Danielle Laughlin, Justine Levchak, Shannon Neumeyer

PFPS

Patellar Femoral Pain Syndrome

What it is: generic term for pain on the anterior portion of the knee

PFPS

Etiology

- Patella dysplasia

- Femoral condyle dysplasia

- Hip anteversion & tibial torsion

- Foot over pronation

- Coxa vara & increased genu valgum

- Increased Q-angle

- Patella squinting

- IT band tightness

- Lateral retinaculum tight

- Medial retinaculum tight

Muscular dysfunctions Associated with it

- Weak VMO vs. VL

- Lateral pull of Biceps femoris, tensor fascia lata & gluteus maximus

- Hip abductor weakness as well as hip external rotator weakness

- Patello-femoral ligament laxity

Signs and Symptoms

- Dull, aching pain localized to medial/lateral side

- Anterior knee and/or lateral knee pain

- Localized edema possible

- Pain increased with prolonged sitting, squatting, stair climbing

- Weight bearing activities

Management

Conservative treatment:

- Strengthening/retraining

- Closed kinetic chain w/ biofeedback

- Strengthening focused on:

- Quads, glute medius, abductors, and external rotators

- Flexibility

- Iliotibial band, hamstrings, quadriceps femoris

-Foot orthotics

- McConnel Taping

-Bracing

-Patellar “sparing” activties

Surgical Intervention:

-Lateral retinaculum release

-Proximal alignment procedure

-Distal realignment procedure

-

Palpation

All borders of patella should be palpated

Palpation

Special Tests

- Patellar apprehension test

- Ober’s, Ely’s, Thomas test

- Compression of patella

- Retinacula Test

- Lateral step-down test

Special Tests

Knee Biomechanical Deviations

-Genu valgum

-Genu varum

-Genu recurvatum

Genu Valgum

  • Etiology
  • Coxa Vara
  • Compensations

Forefoot varus

Excessive subtalar supination

Toeing in

Ipsilateral pelvic lateral rotation

  • Special Tests
  • Valgus testing of knee

Genu Valgum

Genu Varum

  • Etiology
  • Coxa Valga
  • Pes planus
  • Excessive subtalar pronation
  • Lateral tibial torsion
  • Lateral patellar subluxation
  • Excessive hip adduction
  • Lumbar spine contralateral rotation
  • Compensations
  • Forefooot valgus
  • Excessive subtalar pronation
  • Ipsilateral pelvic medial rotation
  • Special tests
  • Varus testing of knee

Genu Recurvatum

Etiology

Excessive anterior pelvic tilt, Ankle plantar flexion, Excessive lateral angulation of the tibia, Medial tibial torsion, Excessive hip abduction

Etiology

Management

Proprioception training, Awareness of knee terminal extension, Biomechanical corrections, Muscular control, Balance of firing between hamstrings and gastrocnemius in conjunction with quads, Weight bearing exercises, Eccentric and concentric control, Gait training, Functional activities

Compensations

Posterior pelvic tilt, Flexed trunk posture, Excessive thoracic kyphosis

Compensations

Special Tests

Goniometry measurement of knee extension, Gait analysis, Postural assessment

Special Tests

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