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Definition/Description
The knee comprises of 4 major bones: the femur, tibia, fibula and
the patella. The patella articulates with the femur at the trochlear
groove. Articular cartilage on the underside of the patella allows
the patella to glide over the femoral groove, necessary for efficient
motion at the knee joint. Excess and persistent turning forces on
the lateral side of the knee can have a negative effect on the
nutrition of the articular cartilage and more specifically in the
medial and central area of the patella, where degenerative change
will occur more readily.
The quadriceps insert into the patella via the quadriceps tendon
and are divided into four separate muscles: rectus femoris (RF),
vastus lateralis (VL), vastus intermedius (VI) and vastus
medialis (VM). The VM has oblique fibres which are referred to the
vastus medialis obliques (VMO)
Not only do the quadriceps influence patella position, but also the
passive structures of the knee. These passive structures are more
extensive and stronger on the lateral side than they are on the
medial side, with most of the lateral retinaculum arising from the
iliotibial band (ITB). If the ITB is under excessive tension, excessive
lateral tracking and/or lateral patellar tilt can occur. This is can
be as a result of the tensor fasciae lata being tight, as the ITB itself
is a non contractile structure.
Epidemiology /Etiology
injury,
Characteristics/Clinical Presentation
Differential Diagnosis
Patellar subluxation
Osteoarthritis
Rheumatoid arthritis
Anterior knee pain
Patellofemoral pain syndrome
Diagnostic Procedures
Outcome Measures
Diagnosis
Tests
There are specific tests for anterior knee pain syndrome: [33]
Patellar grind test or Clarke’s sign: This test detects the presence of
patellofemoral joint disorder. A positive sign on this test is pain in
the patellofemoral joint.
Compression test
Extension-resistance test: This test is used to perform a maximal
provocation on the muscle-tendon mechanism of the extensor
muscles and is positive when the affected knee demonstrates less
power to when trying to maintain the pressure.
The critical test: This is done with the patient in high sitting and
performing isometric quadriceps contractions at 5 different angles
(0°, 30°, 60°, 90° and 120°) while the femur is externally rotated,
sustaining the contractions for 10 seconds. If pain is produced then
the leg is positioned in full extension. In this position the patella
and femur have no more contact. The lower leg of the patient is
supported by the therapist so the quadriceps can be fully relaxed.
When the quadriceps is relaxed, the therapist is able to glide the
patella medially. This glide is maintained while the isometric
contractions are again performed. If this reduces the pain and the
pain is patellofemoral in origin, there is a high chance of a
favourable outcome. [42]
Ice medication
Ice may be useful for reducing pain in an acute flare up, but not
as a long term treatment protocol. [47] NSAIDS may also be of
benefit in the short term to relieve pain so that knee function and
mobility is normalised and an exercise programme can begin.
Foot Orthoses
Foot orthoses are another option for pain relief, but only in cases
where a lower limb mechanics is deemed to be contributing to the
knee pain, which may be due to: poor pronation control, excessive
lower limb internal rotation during weight bearing and an
increased Q-angle. (Level of Evidence 2B) [31] [24]
Foam roller