KNEE 2

Question 1

synonyms for patellofemoral syndrome

Answer 1

RUNNERS KNEE
chondromalacia patella
retropatellar pain syndrome
anterior knee pain syndrome

Question 2

patellofemoral pain syndrome is due to

Answer 2

repetitive, overuse activities
causes increased force at patellofemoral joint, resulting in pain during FLEXION AND EXTENSION

Question 3

so many factors leading to abnormal patellofemoral joint compression… listed:

Answer 3

Decreased knee extensor or gluteal muscle strength
Pes planus or pes cavus
Excessive foot pronation
Wide Q angle
Increased tibial torsion or femoral anteversion
Decreased flexibility of quadriceps, hamstrings, or ITB
Genu recurvatum, genu valgus, or genu varus
Lateral retinaculum tightness
Patella alta or patella baja
Patellar instability

Question 4

too much joint loading secondary to abnormal patellofemoral joint mechanics in flexion/extension results in _______

Answer 4

pain and inflammation
*due to increased stress on undersurface of patella as it goes up and down the trochlear groove

Question 5

To minimize patellofemoral stress, greatest amount of patellar contact should be when compressive loads are at their ______

Answer 5

highest (increased compressive loads at patellofemoral joint as knee moves into flexion)

Question 6

What is the most common problem involving the knee? (25% of knee injuries)

Answer 6

patellofemoral pain syndrome

Question 7

patellofemoral pain syndrome most commonly occurs in young or older people?

Answer 7

young (adolescents, young adults, especially ACTIVE)
*also more commonly FEMALES

Question 8

patellofemoral pain syndrome is due to one specific mechanism of injury (true or false)

Answer 8

flase: combo of multiple factors! results in abnormal patellofemoral joint mechanics

Question 9

pathology or altered biomechanics in the ___ or _____ are major factors contributing to patellar femoral pain

Answer 9

hip or ankle

Question 10

so many other contributing factors of patellofemoral pain syndrome: listed
(basically hams/glutes, foot stuff, q angle, tightness, patellar stuff)

Answer 10

Decreased knee extensor or gluteal muscle strength
Pes planus or pes cavus
Excessive foot pronation
Wide Q angle
Increased tibial torsion or femoral anteversion
Decreased flexibility of quadriceps, hamstrings, or ITB
Genu recurvatum, genu valgus, or genu varus
Lateral retinaculum tightness
Patella alta or patella baja
Patellar instability

Question 11

true or false: there is a referral pattern for patellofemoral pain syndrome

Answer 11

false (just like meniscal tears)

Question 12

common symptoms of patellofemoral pain syndrome include:

Answer 12

pain (increases w repeated activity)
swelling
crepitus

Question 13

“theatre sign/movie-goers knee” or prolonged sitting is a sign/aggravating activity of

Answer 13

patellofemoral pain syndrome
*also any activities like running, walking, squatting, biking, stairs are aggravating activities

Question 14

what makes patellofemoral pain syndrome feel better?

Answer 14

avoiding knee flexion activities/long flexed postures

Question 15

The main goal of patellofemoral pain syndrome is to address ________

Answer 15

primary contributing factors (like foot alignment, dcreased flexibility of lateral hip/knee, weak hip abductors or external rotators)

Question 16

What should you avoid in rehab of patellofemoral pain syndrome?

Answer 16

deep squats
stairs/step ups
last 30 degrees of extension
open kinetic chain: 0-30 degrees of flexion
closed chain: limit knee flexion range up to 60-90 degrees

Question 17

what helps in rehab of patellofemoral pain syndrome?

Answer 17

medial patellar glides
stretching lateral hip muscles
taping
orthotics for foot malalignments
quad strengthening in stress min range
knee extension (avoid terminal knee ext)
seated/supine leg press (avoid flexion more than 60 degrees)

Question 18

what is another name for patellar tendinopathy?

Answer 18

jumpers knee

Question 19

patellar tendinitis is acute or chronic?

Answer 19

acute inflammation of patellar tendon

Question 20

patellar tendinosis is acute or chronic?

Answer 20

chronic, degeneration of patellar tendon

Question 21

patellar tendinopathy is from what? (trauma or overuse)

Answer 21

overuse activity (usually sports related)

Question 22

tendinosis is due to

Answer 22

chronic histopathological changes
repetitive strain of tendon, leading to microtrauma of tendon

Tendons have a low metabolic rate, thus the demand for collagen and matrix production exceeds its reparative capacity.

Question 23

In tendinosis, collagen fibers repair into a disorganized pattern, marked by ___ and _____

Answer 23

variable fibrosis and neovascularization

Question 24

what is mechanism of injury of patellar tendinopathy?

Answer 24

repetitive jumping, running, ECCENTRIC loading of tendon

Question 25

list of contributing factors to patellar tendinopathy (at hip, knee, muscles, patella, footwear)

Answer 25

Excessive training intensity or duration Increased Q angle Genu valgum/varum Decreased muscle flexibility Abnormal patellar alignment Improper footwear Muscle weakness

Question 26

There is no referral pattern for patellar tendinopathy, just like ___ and ____

Answer 26

patellofemoral pain syndrome, meniscus tears

Question 27

common signs and symptoms of patellar tendinopathy

Answer 27

localized pain, swelling (most often at prox insertion of inferior patellar pole) pain during and after activities insidious onset of symptoms

Question 28

true or false: patellar tendinopathy symptoms may improve during activity only to get worse after activity stops

Answer 28

TRUE

Question 29

true or false: eccentric training is recommended for rehab of chronic tendinopathy

Answer 29

true

Question 30

what else is rehab protocol for patellar tendinopathy?

Answer 30

correct risk factors, activity mod improve quads and ham flexibility correct biomechanical stuff like ps planus/excess pronation/wierd patellar tracking REST EMPHASIS and stopping activities that aggravate pain cryotherapy eccentric exercises

Question 31

synonyms for patellar dislocation/subluxation

Answer 31

patellar instability

Question 32

patellar dislocation is ______

Answer 32

no contact between patella and trochlear groove

Question 33

patellar subluxation is ______

Answer 33

temporary, partial dislocation of patella from trochlear groove

Question 34

first time dislocations with history of prior subluxation are most observed in what population?

Answer 34

girls 10-17 years

Question 35

subluxations/dislocations are most often observed in what population?

Answer 35

young, athletic people (younger children/preadolescents have higher rate of recurrence)

Question 36

Acute dislocations can occur with direct trauma like fall/blow to knee. However most occur from _______

Answer 36

noncontact (frequent exposure to primary MOI)

Question 37

most dislocations/subluxations occur medially or laterally?

Answer 37

laterally (patella slides over lateral part of trochlear groove)

Question 38

dislocation/subluxation most often results from

Answer 38

noncontact, lower extremity INTERNAL ROTATION + knee valgus stress on fixed distal extremity

Question 39

contributing factors for subluxation/dislocations: age gender increased or decreased Q angle? genu _____ patella _____ increased femoral _____ coxa _____

Answer 39

age: young, active gender: female icnreased q angle genu valgum patella alta increased femoral anteversion coxa valga

Question 40

other contributing factors to patellar sublux/disloc

Answer 40

Family history of dislocation Trochlear dysplasia Abnormal foot mechanics: Excessive foot pronation that leads to genu valgum Weak hip abductors and external rotators may lead to genu valgum. Gross ligamentous laxity Excessive foot pronation

Question 41

If a patient presents with vague anterior knee pain, swelling, giving way with jumping/running/quick changes in direction, the patient prob has ____

Answer 41

patellar sublux/dislocation *in recurrent instability, symptoms episodic and long term

Question 42

interventions for patellar sublux/dislocations are similar to patellar tendinopathy. What are they?

Answer 42

Quadriceps strengthening exercises in ranges that place the least amount of stress on the patellofemoral joint. Proper footwear and assess the need for orthotics if excessive pronation or pes planus is present, contributing to genu valgum posture. Hip abduction and external rotation strengthening exercises to minimize femoral adduction and internal rotation, which may contribute to increased genu valgum posture in squat positions. Patellar taping to assist in normal patellar tracking during exercise. Improve ITB flexibility to decrease lateral pull on patella. Medial patellar glides to stretch lateral patellar retinacular soft structures.

Question 43

Surgery is recommended for what kind of patients?

Answer 43

recurrent sublux/dislocations or for patients with anatomical abnormality