The Best Treatment for Patellofemoral Pain Syndrome
Preoperative anterior knee pain may indicate use of the hamstring graft. Avoiding any trauma to the patellofemoral joint is advisable in patients with patellofemoral syndrome. Daniel stated that the principal cause of anterior knee pain is the lack of extension. He felt that the flexion contracture led to increased patellofemoral contact force and to the development of chondromala-cia patella. The aggressive rehabilitation program that emphasizes early knee extension may prevent the development of the flexion contracture.
Is preexisting patellofemoral pain a contraindication to harvesting the patellar tendon The conventional wisdom is yes it would not be a wise procedure in this situation. Rather, it is like hitting a sore thumb with a hammer In the past, when chondromalacia was seen at the time of arthroscopy, the graft choice would be changed to hamstrings.
The most important advance in ACL reconstruction in the past decade has been the concept of accelerated rehabilitation as proposed by Shelbourne. This has reduced the problems of limited range of motion and patellofemoral pain and has increased the return to sports participation. It has also reduced the time of return to sports from 12 months to 4 months.
The disadvantages are the harvest site morbidity of patellar tendonitis, anterior knee pain, patellofemoral joint tightness with late chondromalacia, late patella fracture, late patellar tendon rupture, loss of range of motion, and injury to the infrapatellar branch of the saphe-nous nerve. Most of the complications are the result of the harvest of the patellar tendon. This is still the main drawback to the use of the graft.
The conventional wisdom is that the young pivoting contact sport athlete should have a patellar tendon reconstruction. Patients with preexisting patellofemoral symptoms or who are only involved in recreational activities should undergo a semitendinosus reconstruction. The metaanalysis of the five studies in the literature that compare the hamstrings and the patellar tendon grafts concluded that the outcome is vir
The video on the CD shows how the diagnostic arthroscopy must be performed in a similar fashion each time, so that the knee will be completely examined and no region forgotten. This must be done before any surgical procedures are started. The video shows the inside view of the W arthroscopy. The W procedure enables the physician to view the patellofemoral joint, the medial gutter, the medial compartment with the medial meniscus, and then to go over the top of the
The loss of flexion is due to suprapatellar pouch adhesions, or the tight patellofemoral joint. The loss of extension is the result of anterior notch scarring. The solution to loss of flexion is to manually mobilize patella longitudinally. If this fails, then arthroscopic medial lateral retinacular release should be done. The patella is mobilized by the therapist to regain the mobility of the patellofemoral joint (Fig. 8.6).
The main disadvantage of the patellar tendon graft is the harvest site morbidity. The problems produced by the harvest are patellar ten-donitis, quadriceps weakness, persistent tendon defect, patellar fracture, patellar tendon rupture, patellofemoral pain syndrome, patellar entrap The quads weakness may be the result of pain and the inability to participate in a strength program. If significant patellofemoral symptoms develop, the athlete may be unable to exercise the quads. If the defect is closed too tight, the patella may be entrapped, and patellar infera may result. This will certainly result in patellofemoral pain, because of an increase in patellofemoral joint compression. Patellofemoral Pain This topic is controversial in the literature. The older literature reported a high incidence of patellofemoral pain associated with ACL reconstruction. However, most of the disability could be blamed on rehabilitation programs that consisted of immobilization. There is no doubt that some...
The knee joint, or tibiofemoral joint, is the largest and most complex diarthrosis of the body (figs. 9.23 and 9.24). It is primarily a hinge joint, but when the knee is flexed it is also capable of slight rotation and lateral gliding. The patella and patellar ligament also form a gliding patellofemoral joint with the femur.
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