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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues.
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PMID:CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES. 2790 92

Our purpose is to provide simple guidelines for the diagnosis and early care of patellofemoral disorders. Any clinician who treats knee problems, including family practitioners, rheumatologists, orthopedic surgeons, or physical therapists, must know how to make the correct diagnosis, or at least a presumptive diagnosis, at the initial visit. This can avoid unneeded and costly tests, ineffective treatment, and even damaging exercises and unnecessary surgery. The diagnosis of patellofemoral disorders is confusing because they can have many causes. That is, the etiology of patellofemoral disorders is multifactorial. To dispel this confusion and simplify the process, we use a clinical classification based on etiology. Within that framework are 7 key abnormalities or factors that can cause both patellofemoral pain and instability: vastus medialis obliquus deficiency, medial patellofemoral ligament laxity, lateral retinaculum tightness, increased quadriceps angle, hip abductor weakness, patella alta, and trochlear dysplasia. At the initial evaluation, the clinician can assess for these abnormalities through history-taking, physical examination, and standard radiography. Any abnormalities identified, along with their severity, can be used to arrive at a diagnosis, or a presumptive diagnosis, and begin early nonoperative treatment. The clinician does not need magnetic resonance imaging at this point, unless a presumptive diagnosis cannot be made or a more complex problem is suggested.
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PMID:The Diagnosis and Initial Treatment of Patellofemoral Disorders. 2843 90

Patellofemoral disorders including pain and instability are common orthopedic problems, particularly in the adolescent population. Patellofemoral pain is usually anterior, poorly localized, and diffuse. Because of its multifactorial etiology, patellofemoral pain can be clinically challenging to diagnose and manage. With regards to instability, predisposing factors include trochlear dysplasia, patella alta, patellar tilt, and an elevated tibial tuberosity and trochlea groove distance. Initially, nonoperative management is recommended to treat patellofemoral maladies such as overload, maltracking, and acute first-time dislocations. However, tibial tubercle transfer (TTT) is commonly used to address cases of symptomatic malalignment and overload and recurrent patellar instability. The tubercle can be translated in multiplanar directions to correct patellar height, maltracking associated with instability, and to offload chondral defects. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is essential for optimizing results after TTT. Individualizing the direction and degree of tubercle transfer on the basis of patient parameters is critical to producing successful long-term results after surgery. This article will review the indications for performing a TTT and highlight the various techniques.
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PMID:Why and Where to Move the Tibial Tubercle: Indications and Techniques for Tibial Tubercle Osteotomy. 3168 34


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