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Patellofemoral Joint Assessment

Patellofemoral Joint Assessment. Chapter 7, p. 244. Clinical Anatomy p. 244-245. Sesamoid Bone Patellar Facets: medial, lateral, odd (Table 7-1, p. 245) Joint Reaction Forces Retinacula Patellofemoral ligaments Bursa. Patellar Movement.

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Patellofemoral Joint Assessment

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  1. Patellofemoral Joint Assessment Chapter 7, p. 244

  2. Clinical Anatomyp. 244-245 • Sesamoid Bone • Patellar Facets: • medial, lateral, odd (Table 7-1, p. 245) • Joint Reaction Forces • Retinacula • Patellofemoral ligaments • Bursa

  3. Patellar Movement • 135 – 45 degrees extension: firmly seated within condyles of femur • 45 – 18 degrees: medially • 18 – 0 degrees: laterally • Greatest amount of facet contact with condyles occurs between 60 – 90 degrees of flexion

  4. Joint Reaction Forces • As the flexes, so does the PFJRF • Quadriceps Torque during • Level walking – 0.5 X BW • Stair climbing = 3-4 X BW • Squat position = 7-8 X BW Pressure = Force (body weight)/Area

  5. Muscular Anatomyp. 245 • Quadriceps • VM:VL relationship • Quad:HS relationship • Triceps surae involvement •  PF pronation   tibial rotation  improper tracking • Edema & Muscle Recruitment • 20-30 cc's cause inhibition of VM (50-60 cc's to impair extensor mechanism)

  6. History—p. 246 • Mechanism/Onset • Acute: fractures or contusions • Chronic: overuse syndromes, Chondromalacia (Box 7-1, p. 247) • Theater Sign • ”Locking” vs Clicking/Grinding • “Giving Way” • Referred pain patterns • Changes in activity level • PMH/Surgeries

  7. Inspection—p. 247 • Full extension: • Centered on femur • Inferior pole @joint line • Malalignments: • (Box 7-2, p. 248) • Patella length/size • Knee posture: valgum, varum, recurvatum • Leg Length Difference? • Foot deformities

  8. Patella Abnormalities • Patella Alta: when the patellar tendon is 20% longer than the patella. Common in females. Usually seen with a tight rectus femoris • Patella Baja: when the tendon is 20% shorter than the patella. Sometimes a result of a PTG ACL reconstruction

  9. Inspection: Q Anglep. 249, 250 • Box 7-3, p. 250 • Measured in full ext. • Measure angle from ASIS to patella to tibial tuberosity • NL: • Males: < 13° • Females: < 18° • In knee flexion, Q should be < 8°

  10. Palpation—p. 249 • Tibial Tuberosity • Patellar Tendon • Patella Borders • Synovial Plica • Crepitus with AROM • Patellar Mobility

  11. Clarke’s SignBox 7-5, p. 253 • Stabilize patella during quad set • (+) test=grinding + pain with QS • Many false (+)

  12. Synovial Plica—p. 253 • Histology • Med. Plica easier to palpate • Biomechanics

  13. Patellar Mobility—p. 254 • NML AROM: patella moves superiorly & laterally with flex-ext • Glide/Tilt (Box 7-6 & 7-7,p. 255-256) • NL Lateral glide=25%-50% • Hypomobile vs hypermobile • Indicates tightness of IT Band, pat. ret., capsule, VL

  14. Patellofemoral Pathologies

  15. Patellofemoral Pain Syndrome( PFPS) • Usually insidious onset • Pain greatest with ECC movements • AROM & RROM painful • Mild swelling possible • Usually accompanies maltracking patella &/or tight stabilizing structures • Orthotics may be helpful • McConnell Taping

  16. Meniscal vs Patellofemoral Findings—p. 257 • Meniscus Signs • Acute/twisting mechanism • Pain @joint line • Pain in full squat • No pain in sitting • Slow generalized edema • Locking possible • Patellofemoral Signs • Insidious/Overuse onset • Pain localized to patella tendon/patella • Stiffness, but no true locking • Pain with ECC motions • Pain with sitting • Localized inflammation

  17. Patellar Subluxation/ Dislocation—p. 259, Box 7-4, p. 260 • Acute or recurrent onset • Dislocates laterally • Predisposing factors: •  Q Angle • Lateral tracking • Hypermobile patella • Obvious deformity • (+) Apprehension test • May accompany MCL sprain

  18. Usually gradual onset with overuse activities Tenderness @ proximal or distal tendon Pain with AROM ext or PROM flexion Pain inc. with ECC loading Localized inflammation Check PMH and tracking Patellar Tendinitis—p. 259

  19. Osgood-Schlatter Disease—p. 265 (Table 7-9, p. 267) • Chronic inflammation of the tibial tuberosity growth plate • Osteochondritis • Symptoms similar to patellar tendinitis • Conservative treatment • Common in young athletes

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