management of patellofemoral pain syndrome joão barroso ... · • osgood-schlatter syndrome •...

38World Medical & Health Games& INTERNATIONAL SPORT MEDECINE SYMPOSIUM

CORPORATE SPORT ORGANISATION15/29, rue Guilleminot, 75014 PARIS - FRANCEPhone: +33 (0)1 77 70 65 15 - Fax: +33 (0)1 77 70 65 14Email: [email protected] - Website: www.medigames.com

Management of Patellofemoral Pain Syndrome

João Barroso Orthopaedic department – ULS Matosinhos

Portugal



2

Introduction

Anterior Knee Pain affects 1 in 4 athletes – very common ! (Knowles et al)

Patellofemoral pain syndrome (PFPS) is one of the most common problems (DeHaven & Lintner), mostly between the ages of 15 and 30.

Females athletes are 2.23 times more likely to develop PFPS compared with males



3

Anathomy and Biomechanic

•  DynamicStabilizers: - Quadriceps tendon, Patellar tendon,

Vastus medialis obliquus (VMO), Vastuslateralis,andIlio=bialband.

•  Sta1cStabilizers:-Ar=cularcapsule,themedialandlateralpatella re=naculum, special configura=onbetween the femoral trochlea and =bialplates.



Definition, Anatomy and Biomechanics

Strengths over patellofemoral complex: - 1/3 body weight during walking -  3x body weight when climbing stairs / inclined plane -  7x body weight when doing squatting / "Squatting“

One of the most highly loaded joint in the human body !

4



Risk Factors

Alterations in patellar tracking Increase of load and

tension on patellofemoral

apparatus

6



Risk Factors Muscular • Weakness , < muscular flexibility;

Anatomical • Femoral trochlea dysplasia, Patella position (patella

alta/baja or subluxation) General ligamentous laxity

Malalingment of the lower extremity

Overuse, Trauma

•  Subtalar Pronation, Valgus knee, external tibial torsion, Angle Q> 15º; Femoral anteversion



Risk Factors

7



In the majority of cases are enough to do diagnoses of PFPS

Clinical history Physical exam

Diagnosis



Diagnosis

•  Pain - Insidious onset; - Anterior knee pain “behind” or around patella; - Exacerbated after long periods in sitting position with flexed leg and/or with activities that increase load on patella.

8



Diagnosis

SWELLING

•  Not characteristic.

LOCKING

•  Not characteristic; •  Loose body or

meniscal lesion.

INSTABILITY

• Not characteristic; • When exists it’s reflex

of the painful arch that inhibits quadricipital contraction – “false instability”.

8



Diagnosis

8

•  Alignment, Lateral patellar tracking - J Sign?, compare with contralateral quadriceps;

INSPECTION

•  Pain on the patellar retinaculum; •  Patella is unusual! +++ OA, trauma or bipartite patella,

tendinopathies;

PALPATION

•  Complete passive and active knee mobilization, symptomatic or not.

MOBILITY



Diagnosis

8

Patellar Glide

>3 lateral quadrants – medial weakness <1lateral quadrant– lateral thickening

Patellar Tilt Test

Pressure medial facet Elevation <15º - lateral thickening

Patellar Grind Test

Pain – + test.



Diagnosis

RX mandatory if: - History of trauma; - > 50 years; - Knee swollen.

9



Differential Diagnosis •  Meniscal and cartilage lesion •  Bone tumor •  Patellar instability •  Hoffa Syndrome •  Patellar and quadricipital tendinopathy •  Osgood-Schlatter Syndrome •  Iliotibial Treatment Syndrome •  OA Patelofemoral •  Pre-patellar bursitis •  Symptomatic bipartite patella.

9



TREATMENT 1ST LINE

Relative Rest and activity

modification

Identification and

correction of precipitating

events

Rehabilitation program

Cryotherapy

9



TREATMENT 1ST LINE

Relative Rest and activity modification

Identification and


events


Cryotherapy

9



Treatment •  Relative rest and activity modification

–  Resistance training exercises have been identified as playing a role in causing the injury, so cessation of specific exercises such as full squats and lunges is indicated;

–  Runners should reduce mileage to a level that does not provoke pain;

–  Alternative activities: bicycling, swimming, or the use of an elliptical trainer

9



TREATMENT 1ST LINE


modification

Identification and correction of precipitating

events


Cryotherapy

9



Treatment •  Identification and correction of precipitating events

–  A careful history will identify a precipitating event

9



TREATMENT 1ST LINE


modification

Identification and


events


Cryotherapy

9



Treatment •  Criotherapy for pain and edema reduction

–  Reduce the pain in a short time but without pain improvement 4 months later

9



TREATMENT 1ST LINE


modification

Identification and


events


Cryotherapy

9



Treatment •  Rehabilitation Program

–  Focus on correcting maltracking of the patella;

–  Some patients may require significant strengthening of the quadriceps;

–  Others may have excessively tight lateral structures or poor quadriceps flexibility. Soft tissue techniques and flexibility exercises can be helpful for these patients.

9



OTHER TREATMENTS

NSAIDs

Patellartapingandbracin Footortho1cs

9



Other Treatments

•  NSAIDs

–  When a l te r nat i ve approaches have been unsuccessful, or when pain management is essential for participation in rehabilitation.

9



OTHER TREATMENTS

NSAIDs

Patellartapingandbracing Footortho1cs

9



Other Treatments

•  Patellar taping and bracing – controversial

–  Some evidence in short-term treatment to enable patients to perform pain-free exercise.

9



OTHER TREATMENTS

NSAIDs

Patellartapingandbracin

Foot orthotics

9



Other Treatments

•  Foot orthotics

–  No evidence

9



Treatment - Surgical

•  For those whose symptoms persist despite their completing at least 6 to 12 months of rehabilitation program, and in whom other causes of anterior knee pain have been excluded.

9



Treatment - Surgical •  Release of thickened lateral

retinaculum;

•  Proximal realignment, and distal realignment;

•  Antero-medialization of the tibial tuberosity;

•  Tibial valgization osteotomy.

9



THE END

management of patellofemoral pain syndrome joão barroso ... · • osgood-schlatter syndrome •...

Documents