Patellar Tendinopathy: Some Aspects of Basic Science and Clinical Management
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The Influence of Altered Lower-Extremity Kinematics on Patellofemoral Joint Dysfunction: a Theoretical Perspective
The Influence of Altered Lower-Extremity Kinematics on Patellofemoral Joint Dysfunction: A Theoretical Perspective Christopher M. Powers, PT, PhD 1 Although patellofemoral pain (PFP) is recognized as being one of the most common disorders of It has been recognized by sev- the lower extremity, treatment guidelines and underlying rationales remain vague and controver- eral authors that the patel- sial. The premise behind most treatment approaches is that PFP is the result of abnormal patellar lofemoral joint may be influenced CLINICAL COMMENTARY tracking and/or patellar malalignment. Given as such, interventions typically focus on the joint by the segmental interactions of itself and have traditionally included strengthening the vastus medialis oblique, taping, bracing, the lower extremity.6,7,21,27,34,45 Ab- soft tissue mobilization, and patellar mobilization. More recently, it has been recognized that the normal motion(s) of the tibia and patellofemoral joint and, therefore, PFP may be influenced by the interaction of the segments and femur in the transverse and frontal joints of the lower extremity. In particular, abnormal motion of the tibia and femur in the transverse and frontal planes may have an effect on patellofemoral joint mechanics. With this in planes are believed to have an mind, interventions aimed at controlling hip and pelvic motion (proximal stability) and ankle/foot effect on patellofemoral joint me- motion (distal stability) may be warranted and should be considered when treating persons with chanics and therefore PFP. An un- patellofemoral joint dysfunction. The purpose of this paper is to provide a biomechanical derstanding of how lower- overview of how altered lower-extremity mechanics may influence the patellofemoral joint. -
Knee Pain Prevention
DOCTORS CARE OSTEOARTHRITIS PROGRAM FOR Knee Pain Prevention Our program offers a non-surgical option that is safe and effective What Is Osteoarthritis of the Knee? In most cases osteoarthritis is caused by a slow degenerative process whereby, as we age and become less active, we tend to get tighter joints and weaker muscles. This in turn causes our joints to become dysfunctional and then become inflamed. The inflammation causes decreased blood flow to the joint tissues and thus decreased production of joint fluid. This, in turn, causes wear and tear on the joint which causes more inflammation and even less nutrients to the joint tissues. As a result, range of motion and strength are further decreased causing greater dysfunction Aand Healthy greater Joint inflammation. Left untreated, this will lead to a Medialdownward collateral ligamentspiral of degeneration. Joint capsule Muscles Tendons A Healthy Joint Medial collateral ligament Joint capsule Muscles TendonsBone Cartilage Synovial uid In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a Bonesynovial membrane thatCartilage produces synovial uid. e capsule and uid protect the cartilage, muscles, and connective tissues.Synovial uid InA aJoint healthy With joint, theSevere ends of Osteoarthritis bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovialMedial uid. collateral e capsule ligament and uid protect the cartilage, muscles, and connectiveBone spurs tissues. Muscles A Joint With Severe Osteoarthritis Tendons Medial collateral ligament Bone spurs Muscles TendonsBone Worn-away Cartilage cartilage Synovial uid fragments in uid With osteoarthritis, the cartilage becomes worn away. -
Knee Osteoarthritis
BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Standard of Care: _Osteoarthritis of the Knee Case Type / Diagnosis: Knee Osteoarthritis. ICD-9: 715.16, 719.46 Osteoarthritis/Osteoarthrosis (OA) is the most common joint disease causing disability, affecting more than 7 million people in the United States 1. OA is a disease process of axial and peripheral joints. It is characterized by progressive deterioration and loss of articular cartilage and by reactive bone changes at the margins of the joints and in the subchondral bone. Clinical manifestations are characterized by slowly developing joint pain, stiffness, and joint enlargement with limitations of motion. Knee osteoarthritis (OA) results from mechanical and idiopathic factors that alter the balance between degradation and synthesis of articular cartilage and subchondral bone. The etiology of knee OA is not entirely clear, yet its incidence increases with age and in women. 1 The etiology may have genetic factors affecting collagen, or traumatic factors, such as fracture or previous meniscal damage. Obesity is a risk factor for the development and progression of OA. Early degenerative changes predict progression of the disease. Underlying biomechanical factors, such as varum or valgum of the tibial femoral joint may predispose people to OA. However Hunter et al 2reported knee alignment did not predict OA, but rather was a marker of the disease severity. Loss of quadriceps muscle strength is associated with knee pain and disability in OA. Clinical criteria for the diagnosis of OA of the knee has been established by Altman3 Subjects with examination finding consistent with any of the three categories were considered to have Knee OA. -
A Simultaneous Bilateral Quadriceps and Patellar Tendons Rupture In
Tao et al. BMC Musculoskeletal Disorders (2020) 21:179 https://doi.org/10.1186/s12891-020-03204-6 CASE REPORT Open Access A simultaneous bilateral quadriceps and patellar tendons rupture in patients with chronic kidney disease undergoing long- term hemodialysis: a case report Zhengbo Tao†, Wenbo Liu†, Weifeng Ma, Peng Luo, Shengpeng Zhi and Renyi Zhou* Abstract Background: The incidence of rupture of the quadriceps or patellar tendon s is low, especially that of bilateral quadriceps tendon rupture, and it is generally considered a complication secondary to chronic systemic disorders. We report two rare cases of simultaneous bilateral tendon rupture affecting the extensor function of the knee in patients with chronic kidney disease who have been treated with long-term haemodialysis. Case presentation: Two young males with a history of chronic kidney disease who were being treated with long- term haemodialysis presented to our hospital with clinical signs of disruption of the extensor mechanism of the knee. One patient was diagnosed with bilateral quadriceps tendon rupture, and the other patient had bilateral patellar tendon rupture. They underwent surgical repair of the tendons, and their knees were actively mobilized during physiotherapy. Conclusion: Bilateral quadriceps or patellar tendons rupture is a rare occurrence in patients with chronic kidney disease who are being treated with long-term haemodialysis. Timely surgical treatment and scientific physiotherapy can lead to good recovery of knee joint function. Keywords: Quadriceps tendon, Patellar tendon, Rupture, Haemodialysis, Chronic kidney disease Background undergoing long-term haemodialysis. There were only The disruption of the extensor mechanism of the knee is two cases of simultaneous bilateral quadriceps or patel- commonly caused by fractures of the patella; the inci- lar tendons rupture, and both of them had undergone dence of rupture of the quadriceps or patellar tendons is long-term haemodialysis. -
Closure of Patellar Tendon Defect in ACL Reconstruction
Systematic Review Closure of Patellar Tendon Defect in Anterior Cruciate Ligament Reconstruction With BoneePatellar TendoneBone Autograft: Systematic Review of Randomized Controlled Trials Rachel M. Frank, M.D., Randy Mascarenhas, M.D., Marc Haro, M.D., Nikhil N. Verma, M.D., Brian J. Cole, M.D., M.B.A., Charles A. Bush-Joseph, M.D., and Bernard R. Bach Jr., M.D. Purpose: This study aimed to systematically review the highest level of evidence on anterior cruciate ligament (ACL) reconstruction with boneepatellar tendonebone (BPTB) autografts with patellar tendon defect closure versus no closure after surgery. Methods: We performed a systematic review of multiple medical databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Level I and Level II randomized controlled trials comparing patellar tendon defect closure to no closure during ACL reconstruction with BPTB autografts were included. Two inde- pendent reviewers analyzed all studies. Descriptive statistics were calculated. Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS) and Jadad scale. Results: Four studies with a combined 221 patients (154 male patients and 67 female patients) with an average age of 26.6 Æ 2.4 years (range, 17 to 54 years) were included. All studies randomized patients before surgery into ACLR with BPTB autografts either with patellar tendon defect closure or without closure. There were no differences in clinical outcomes (Lysholm score, Tegner scale, International Knee Documentation Committee [IKDC] classification, modified Larsen score, and Lauridsen rating) between groups. There were no significant differences in knee pain between groups. All studies reported imaging findings of the patellar tendon defect, with 2 studies showing no difference in appearance between groups, one study showing excessive scar formation with defect repair, and one study showing improved restoration of normal tendon appearance with defect repair. -
Physical Examination of the Knee: Meniscus, Cartilage, and Patellofemoral Conditions
Review Article Physical Examination of the Knee: Meniscus, Cartilage, and Patellofemoral Conditions Abstract Robert D. Bronstein, MD The knee is one of the most commonly injured joints in the body. Its Joseph C. Schaffer, MD superficial anatomy enables diagnosis of the injury through a thorough history and physical examination. Examination techniques for the knee described decades ago are still useful, as are more recently developed tests. Proper use of these techniques requires understanding of the anatomy and biomechanical principles of the knee as well as the pathophysiology of the injuries, including tears to the menisci and extensor mechanism, patellofemoral conditions, and osteochondritis dissecans. Nevertheless, the clinical validity and accuracy of the diagnostic tests vary. Advanced imaging studies may be useful adjuncts. ecause of its location and func- We have previously described the Btion, the knee is one of the most ligamentous examination.1 frequently injured joints in the body. Diagnosis of an injury General Examination requires a thorough knowledge of the anatomy and biomechanics of When a patient reports a knee injury, the joint. Many of the tests cur- the clinician should first obtain a rently used to help diagnose the good history. The location of the pain injured structures of the knee and any mechanical symptoms were developed before the avail- should be elicited, along with the ability of advanced imaging. How- mechanism of injury. From these From the Division of Sports Medicine, ever, several of these examinations descriptions, the structures that may Department of Orthopaedics, are as accurate or, in some cases, University of Rochester School of have been stressed or compressed can Medicine and Dentistry, Rochester, more accurate than state-of-the-art be determined and a differential NY. -
Posterior Cruciate Ligament (PCL): Reconstruction and Rehabilitation
Patient information – PCL reconstruction Posterior cruciate ligament (PCL): reconstruction and rehabilitation Introduction Posterior cruciate ligament reconstruction is an operation to replace your torn posterior cruciate ligament (PCL) and restore stability to your knee joint. This leaflet outlines what happens during and after surgery, outlines the risks and benefits, and gives advice and exercises to help you recover if you decide to go ahead with the operation. Posterior (back) view Anterior (front) view The PCL is the largest ligament in the knee and stops the shin bone from moving too far backwards, relative to your thigh bone. It is commonly injured by a significant blow to the front of the knee/upper shin. Most athletic PCL injuries occur during a fall onto the flexed (bent) knee. Hyperextension (‘over straightening’) and hyperflexion (‘bending too far’) of the knee can also cause a PCL injury and the PCL is often involved when there is injury to multiple ligaments in a knee dislocation. Not everyone who has a PCL injury will require surgery as most isolated tears (no other ligaments involved) can heal just with the early application of an appropriate splint/brace. If the ligament does not heal or there are other ligaments involved, some people can notice a ‘looseness’ and an occasional feeling of giving way. This requires a reconstruction (replacement) operation. Posterior cruciate ligament (PCL) reconstruction, August 2020 1 Posterior cruciate ligament (PCL) reconstruction Reasons for not operating To undertake this major reconstruction, you must have appropriate symptoms of instability. This is not an operation for pain. An operation is not recommended if there is any active infection in or around the knee or when there is a lot of other disease, such as arthritis, within the joint. -
ANTERIOR KNEE PAIN Home Exercises
ANTERIOR KNEE PAIN Home Exercises Anterior knee pain is pain that occurs at the front and center of the knee. It can be caused by many different problems, including: • Weak or overused muscles • Chondromalacia of the patella (softening and breakdown of the cartilage on the underside of the kneecap) • Inflammations and tendon injury (bursitis, tendonitis) • Loose ligaments with instability of the kneecap • Articular cartilage damage (chondromalacia patella) • Swelling due to fluid buildup in the knee joint • An overload of the extensor mechanism of the knee with or without malalignment of the patella You may feel pain after exercising or when you sit too long. The pain may be a nagging ache or an occasional sharp twinge. Because the pain is around the front of your knee, treatment has traditionally focused on the knee itself and may include taping or bracing the kneecap, or patel- la, and/ or strengthening the thigh muscle—the quadriceps—that helps control your kneecap to improve the contact area between the kneecap and the thigh bone, or femur, beneath it. Howev- er, recent evidence suggests that strengthening your hip and core muscles can also help. The control of your knee from side to side comes from the glutes and core control; that is why those areas are so important in management of anterior knee pain. The exercises below will work on a combination of flexibility and strength of your knee, hip, and core. Although some soreness with exercise is expected, we do not want any sharp pain–pain that gets worse with each rep of an exercise or any increased soreness for more than 24 hours. -
Patellar Ligament Rupture During Total Knee Arthroplasty in an Ochronotic Patient
CASE REPORT Acta Orthop Traumatol Turc 2014;48(3):367-370 doi: 10.3944/AOTT.2014.3245 Patellar ligament rupture during total knee arthroplasty in an ochronotic patient Madan Mohan SAHOO, Sudhir Kumar MAHAPATRA, Gopal Chandra SETHI, Sunil Kumar DASH SCB Medical College, Cuttack, India Ochronotic arthropathy mainly involves the spine and large joints. Along with blackening of the joint, degeneration rapidly progresses mostly in the knee, resulting in symptoms by the 4th or 5th decade. As the role of medical treatment and joint conservation surgeries are limited in the early stages, joint replacement is the only effective option in one third of patients. We present a case of the unique com- plication of patellar ligament rupture during total knee replacement (TKR) of an ochronotic joint. A 51-year-old male presented with bilateral severe tricompartmental osteoarthritis with varus deformi- ties and restriction of motion. Bilateral TKR was performed. At the 28-month follow-up, the patient was walking pain free with acceptable position of implants in radiographs. To our knowledge this is the first report of rupture of the patellar ligament during TKR of an ochronotic joint. We propose ap- propriate preoperative preparation and greater care in the handling of the tendon during TKR of an ochronotic joint in order to avoid complication. Key words: Ligament rupture; ochronosis; total knee replacement. Blackening of the joint may be due to endogenous ochro- Considering that the knee is the most commonly re- nosis (deficiency of homogentisic acid oxidase) or, rarely, placed symptomatic joint, any complication occurring exogenous ochronosis (due to accumulation of hydro- during total knee replacement (TKR) is of great impor- quinone, resorcinol, phenol, mercury or picric acid). -
Patellar Tendon Tear - Orthoinfo - AAOS 6/14/19, 11:18 AM
Patellar Tendon Tear - OrthoInfo - AAOS 6/14/19, 11:18 AM DISEASES & CONDITIONS Patellar Tendon Tear Tendons are strong cords of fibrous tissue that attach muscles to bones. The patellar tendon works with the muscles in the front of your thigh to straighten your leg. Small tears of the tendon can make it difficult to walk and participate in other daily activities. A large tear of the patellar tendon is a disabling injury. It usually requires surgery and physical therapy to regain full knee function. Anatomy The tendons of the knee. Muscles are connected to bones by tendons. The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia). It is actually a ligament that connects to two different bones, the patella and the tibia. The patella is attached to the quadriceps muscles by the quadriceps tendon. Working together, the quadriceps muscles, quadriceps tendon and patellar tendon straighten the knee. https://orthoinfo.aaos.org/en/diseases--conditions/patellar-tendon-tear/ Page 1 of 9 Patellar Tendon Tear - OrthoInfo - AAOS 6/14/19, 11:18 AM Description Patellar tendon tears can be either partial or complete. Partial tears. Many tears do not completely disrupt the soft tissue. This is similar to a rope stretched so far that some of the fibers are frayed, but the rope is still in one piece. Complete tears. A complete tear will disrupt the soft tissue into two pieces. When the patellar tendon is completely torn, the tendon is separated from the kneecap. Without this attachment, you cannot straighten your knee. -
Focal Knee Swelling Clinical Presentation
Focal Knee Swelling Clinical Presentation Click for referral info for MSK Triage Click for History and Examination more info Click for Medial or Lateral Focal Click for Baker's Cyst more Swelling Bursitis more info info Consider meniscal Cysts Refer for Weight Bearing Refer for diagnostic Assessment and Management X-ray AP and Lateral ultrasound scan • depends on its aetiology • have a low threshold for performing, or referring for, aspiration to rule out septic arthritis Ganglion or Meniscal Cyst · likely to be a degenerative tear Osteoarthritis Normal · majority can be treated conservatively confirmed Non-septic Bursitis Click for Click for more Septic Bursitis more info info Conservative Management Refer for diagnostic Manage as per (where appropriate) ultrasound scan Osteoarthritis pathway Self-management for 6 Immediate referral to weeks secondary care Click for Refer to MSK triage more Manage as per See pathway If no improvement with info pathology Knee Pain Management conservative management Physio for 6 weeks If no improvement with self-management Physio to refer to MSK triage Click for more If no improvement with physio info Back to History and examination pathway History Ask about: · History of trauma · Pain: nature, onset · Stiffness · Fever, systemic illness · Locking or clicking · Past medical history · Occupational and recreational activities that may have precipitated pathology Examination · Look: assess location of swelling (generalised/media/lateral/ popliteal fossa), overlying erythema, lesions to overlying skin · Feel: -
Patellar Tendon Debridement Surgery
175 Cambridge Street, 4th floor Boston, MA 02114 Tel: 617-726-7500 PATELLAR TENDON DEBRIDEMENT SURGERY PREOPERATIVE INSTRUCTIONS Here are guidelines that will help you prepare for surgery: WITHIN ONE MONTH BEFORE SURGERY: The doctor will see you in the office. The doctor or his associate will do a preoperative history and physical examination and complete the necessary paperwork. He will write preoperative hospital orders and order laboratory tests. These tests usually include a complete blood count (and also electrocardiogram for patients over 40 years old.) SEVERAL DAYS BEFORE SURGERY: Wash the knee several times a day to get it as clean as you can. This decreases the risk of infection. Be careful not to get any scratches, cuts, sunburn, poison ivy, etc. The skin has to be in very good shape to prevent problems. You do not need to shave the knee. THE DAY BEFORE SURGERY: Please contact the doctor’s office to get the exact time you should report to the hospital for surgery. You can have nothing to eat or drink after midnight on the evening before surgery. It is very important to have a completely empty stomach prior to surgery for anesthesia safety reasons. If you have to take medication, you can take the medication with a sip of water early in the morning prior to surgery (but later tell the anesthesiologist you have done so). THE DAY OF SURGERY: Surgery is performed in the Wang building at MGH and at the Orthopedic Ambulatory Surgery Center at Mass General West in Waltham. • nothing to eat or drink • For surgery at MGH main campus in Boston: Report directly to the 12th floor of the Lunder Building, Center for Preoperative Care at Massachusetts General Hospital, two hours prior to surgery.