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Conservative Treatment of Patellofemoral Joint Instability

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Sports Injuries

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Abstract

Conservative and postsurgical rehabilitation following medial patellofemoral ligament injury is poorly described in the literature, with most interventions focusing exclusively on the knee joint. During single lower extremity jump landings, the three-dimensional lower extremity loading response at impact often includes a contralateral pelvic drop and associated trunk movements, femoral and tibial internal rotation, knee valgus, and foot pronation. Therefore, local (knee), regional (entire lower extremity), and more global (entire lower extremity in addition to core, upper body) factors need to be considered when attempting to treat or to prevent patellofemoral joint instability. The rehabilitation clinician must carefully blend local treatments with regional, and global therapeutic exercise interventions to develop coordinated lower extremity neuromuscular movement synergies that integrate the core and upper extremities in a functionally relevant manner. The ultimate goal is pain-free, three-dimensional dynamic knee stability. Paramount to attaining effective dynamic knee stability is having sufficient eccentric muscle function to withstand activity-specific loads. Criterion based return to sport specific training guidelines, and self-reported surveys including items and item scoring weights that are more specific to athletic performance requirements are needed.

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References

  1. Alentorn-Geli, E., Myer, G.D., Silvers, H.J., et al.: Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee. Surg. Sports Traumatol. Arthros. 17(7), 705–729 (2009)

    Article  Google Scholar 

  2. Arendt, E.: Core strengthening. Inst. Course Lect. 56, 379–384 (2007)

    Google Scholar 

  3. Bicos, J., Fulkerson, J.P., Amis, A.: Current concepts review: the medial patellofemoral ligament. Am. J. Sports Med. 35(3), 484–492 (2007)

    Article  PubMed  Google Scholar 

  4. Brand, E., Nyland, J.: Patient outcomes following anterior cruciate ligament reconstruction: the influence of psychological factors. Orthopedics 32(5), 335–340 (2009)

    Article  PubMed  Google Scholar 

  5. Chaudhari, A.M., Hearn, B.K., Andriacchi, T.P.: Sport-dependent variations in arm position during single- limb landing influence knee loading: implications for anterior cruciate ligament injury. Am. J. Sports Med. 33(6), 824–839 (2005)

    Article  PubMed  Google Scholar 

  6. Davies, G.J.: Compendium of Isokinetics in Clinical Usage and Rehabilitation Techniques, 4th edn. S & S Publishers, Onalaska (1992)

    Google Scholar 

  7. Dejour, H., Walch, G., Nove-Josserand, L., et al.: Factors of patellar instability: an anatomic radiographic study. Knee. Surg. Sports Traumatol. Arthrosc. 2, 19–26 (1994)

    Article  PubMed  CAS  Google Scholar 

  8. Eckhoff, D.G., Brown, A.W., Kilcoyne, R.F., et al.: Knee version associated with anterior knee pain. Clin Orthop. Relat. Res. 339, 152–155 (1997)

    Article  PubMed  Google Scholar 

  9. Evjenth, O., Hamberg, J.: Muscle Stretching in Manual Therapy, vol. 1, 3rd edn. New Intherlitho Spa, Milan (1993)

    Google Scholar 

  10. Farahmand, F., Senavongse, W., Amis, A.A.: Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J. Orthop. Res. 16, 136–143 (1998)

    Article  PubMed  CAS  Google Scholar 

  11. Gerber, J.P., Marcus, R.L., Dibble, L.E., et al.: Effects of early progressive eccentric exercise on muscle size and function after anterior cruciate ligament reconstruction: a 1-year follow-up study of a randomized clinical trial. Phys. Ther. 89(1), 1–9 (2009)

    Article  Google Scholar 

  12. Heegaard, J., Leyvraz, P.F., Van Kampen, A.: Influence of soft tissue structures on patellar three-dimensional tracking. Clin. Orthop. Relat. Res. 299, 235–243 (1994)

    PubMed  Google Scholar 

  13. Irrgang, J., Snyder-Mackler, L., Wainner, R.S., et al.: Development of a patient-reported measure of function of the knee. J. Bone. Joint. Surg. Am. 80(8), 1132–1145 (1998)

    PubMed  CAS  Google Scholar 

  14. Jette, A.M., Haley, S.M., Tao, W., et al.: Prospective evaluation of the AM-PAC-CAT in outpatient rehabilitation settings. Phys. Ther. 87(4), 385–398 (2007)

    Article  PubMed  Google Scholar 

  15. Joseph, M., Tiberio, D., Baird, J.L., et al.: Knee valgus during drop jumps in National Collegiate Association Division I female athletes: the effect of a medial post. Am. J. Sports Med. 36(2), 285–289 (2008)

    Article  PubMed  Google Scholar 

  16. Kujala, U.M., Jaakkola, L.H., Koskinen, S.K., et al.: Scoring of patellofemoral disorders. Arthroscopy 9(2), 159–163 (1993)

    Article  PubMed  CAS  Google Scholar 

  17. LaStayo, P.C., Woolf, J.M., Lewek, M.D., et al.: Eccentric muscle contractions: their contributions to injury, prevention, rehabilitation, and sport. J. Orthop. Sports Phys. Ther. 33(10), 557–571 (2003)

    Article  PubMed  Google Scholar 

  18. Maenpaa, H., Huhtala, H., Lehto, M.U.: Recurrence after patellar dislocation. Redislocation in 37/75 patients followed for 6–24 years. Acta. Orthop. Scand. 68, 424–426 (1997)

    Article  PubMed  CAS  Google Scholar 

  19. Mann, G., Constantini, N., Hetsroni, I., et al.: Anterior knee pain syndrome. Adolesc. Med. 18, 192–220 (2007)

    Google Scholar 

  20. McConnell, J.: The management of chondromalacia patellae: a long term solution. Aust. J. Physiother. 32(4), 215–223 (1986)

    Article  PubMed  CAS  Google Scholar 

  21. Myer, G.D., Paterno, M.V., Ford, K.R., et al.: Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J. Orthop. Sports Phys. Ther. 36(6), 385–402 (2006)

    Article  PubMed  Google Scholar 

  22. Nikku, R., Nietosvaara, Y., Aalto, K., et al.: Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta. Orthop. 76(5), 699–704 (2005)

    Article  PubMed  Google Scholar 

  23. Nyland, J.: Rehabilitation complications following knee surgery. Clin. Sports Med. 18(4), 905–925 (1999)

    Article  PubMed  CAS  Google Scholar 

  24. Nyland, J., Kuzemchek, S., Parks, M., et al.: Femoral anteversion influences vastus medialis and gluteus medius EMG amplitude: composite hip abductor EMG amplitude ratios during isometric combined hip abduction-external rotation. J. Electromyogr. Kinesiol. 14(2), 255–261 (2004)

    Article  PubMed  CAS  Google Scholar 

  25. Nyland, J., Lachman, N., Kocabey, Y., et al.: Anatomy, function, and rehabilitation of the popliteus musculotendinous complex. J. Orthop. Sports Phys. Ther. 35(3), 165–179 (2005)

    Article  PubMed  Google Scholar 

  26. Nyland, J., Patton, C.M., Roberts, C.S.: Progressive movement-related valgus knee impairments: clinical examination, classification, and treatment. Phys. Ther. Rev. 12(4), 297–313 (2007)

    Article  Google Scholar 

  27. Pollard, C.D., Heiderscheit, B.C., van Emmerik, R.E.A., et al.: Gender differences in lower extremity coupling variability during an unanticipated cutting maneuver. J. Appl. Biomech. 21, 143–152 (2005)

    PubMed  Google Scholar 

  28. Powers, C.M., Ward, S.R., Fredericson, M., et al.: Patellofemoral kinematics during weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J. Orthop. Sports Phys. Ther. 33, 677–685 (2003)

    Article  PubMed  Google Scholar 

  29. Schepsis, A.: Instructional course lecture 204: patellofemoral instability. An algorithmic approach. Paper presented at the American Orthopaedic Society for Sports Medicine Meeting, Keystone, Colorado, 14–17 July 2005

    Google Scholar 

  30. Smith, C.E., Nyland, J., Caudill, P., et al.: Dynamic trunk stabilization: a conceptual back injury prevention program for volleyball athletes. J. Orthop. Sports Phys. Ther. 38(11), 703–720 (2008)

    Article  PubMed  Google Scholar 

  31. Sullivan, M.J.: Toward a biopsychomotor conceptualization of pain: implications for research and intervention. Clin. J. Pain 24(4), 281–290 (2008)

    Article  PubMed  Google Scholar 

  32. Tuxoe, J.I., Teir, M., Winge, S., et al.: The medial patellofemoral ligament: a dissection study. Knee. Surg. Sports Traumatol. Arthrosc. 10(3), 138–140 (2002)

    Article  PubMed  Google Scholar 

  33. van Praag, H.: Exercise and the brain: something to chew on. Trends Neurosci. 32(5), 283–290 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  34. van Praag, H., Kempermann, G., Gage, F.H.: Neural consequences of environmental enrichment. Nat. Rev. Neurosci. 1(3), 191–198 (2000)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Division of Sports Medicine, School of Medicine, University of Louisville, 210 East Gray Street, Suite 1003, 40202, Louisville, KY, USA

    John Nyland, Brent Fisher & Brian Curtin

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  1. John Nyland
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  2. Brent Fisher
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  3. Brian Curtin
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Correspondence to John Nyland .

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Editors and Affiliations

  1. Fac. Medicine, Dept. Orthopedics & Traumatology, Hacettepe University, Hasyrcylar Caddesi, Ankara, 94110, Turkey

    Mahmut Nedim Doral

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© 2012 Springer-Verlag Berlin Heidelberg

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Nyland, J., Fisher, B., Curtin, B. (2012). Conservative Treatment of Patellofemoral Joint Instability. In: Doral, M. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15630-4_79

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  • DOI: https://doi.org/10.1007/978-3-642-15630-4_79

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