The Patella: A Team Approach

Beth Israel Medical Center, New York, NY. Text representing the collaborative efforts of an orthopedic surgeon, two physical therapists, and a podiatrist. Addresses topics not addressed in other books: classification of patellofemoral disorders, controversies, and more. Halftone photographs and images. DNLM: Patella--physiopathology.

Contributors

ix

(2)

Preface

xi

(2)

Acknowledgments

xiii

Chapter 1--What Causes Pain? and Other Fundamental Controversies

1

(10)

Nomenclature: The Tower of Babel

1

(3)

What Causes Patellar Pain?

4

(1)

Why Aren't All Malaligned Patellae Painful? Why Does Only One Knee Hurt?

5

(1)

How Are Pain and Instability Related?

6

(1)

What Will Replace the Term Chondromalacia?

6

(1)

Does Patella Malalignment Lead to Knee Arthritis?

7

(1)

Can There Be Pain in the Absence of Cartilage Lesions?

7

(1)

Are There Differences Between Adults and Adolescents with Knee Pain?

7

(4)

Chapter 2 Normal and Abnormal Anatomy of the Extensor Mechanism

11

(14)

Embryology

11

(1)

Normal Anatomy

11

(9)

Abnormal Anatomy

20

(4)

Appendix 2 A: Analysis of Vastus Medialis Longus and Vastus Medialis Obliquus Characteristics

24

(1)

Chapter 3 Applied Mechanics of the Patellofemoral Joint

25

(18)

The Patella-A Lever or a Pulley?

25

(2)

The Quadriceps (Q) Angle

27

(1)

Patellofemoral Contact Area

28

(2)

Contact Load (Joint Reaction Force) and Pressure

30

(2)

Patella Tracking

32

(3)

Material Properties of Patellofemoral Cartilage

35

(1)

Gait Analysis

35

(1)

In Vitro Techniques-Present and Future

35

(1)

Interactive Manipulation of Joint Surface Models

36

(1)

Future Directions

37

(4)

Appendix 3-A: Derivation of Effective Moment Arm

41

(2)

Chapter 4 The History and Physical Examination: The Orthopaedist's Perspective

43

(14)

The Medical History

43

(1)

The Physical Examination

44

(13)

Chapter 5 Patellofemoral Imaging

57

(22)

Plain Radiographs

57

(12)

Technetium Scanning

69

(1)

Computed Tomography and Magnetic Resonance Imaging

69

(5)

An Algorithm

74

(5)

Chapter 6 Patellar Instability

79

(8)

Atraumatic Instability

79

(1)

Traumatic Disruptions of the Extensor Mechanism

80

(7)

Chapter 7 Nontraumatic Conditions Related to Malalignment

87

(6)

Osgood-Schlatter's Condition

87

(1)

Bipartite Patella

88

(1)

The Dorsal Defect

89

(1)

Patellar Duplication

89

(1)

Patellar Tendinitis

90

(1)

Patellar Tendon Rupture

90

(3)

Chapter 8 Patellar Pain Not Related to Malalignment: Differential Diagnosis

93

(10)

Neuroma

93

(1)

Iliotibial Tendinitis

93

(1)

Plica Syndrome

94

(1)

Patellar Tendinitis (Jumper's Knee)

94

(2)

Fat Pad Syndrome

96

(1)

Sinding-Larsen-Johansson Syndrome

96

(1)

Anterior Cruciate Ligament Tear

96

(1)

Quadriceps Atrophy

96

(1)

Tumors

96

(1)

Rheumatological Conditions

97

(1)

Osteochondritis Dissecans

97

(2)

Lyme Disease

99

(1)

Reflex Sympathetic Dystrophy and RSD-Like Conditions

99

(1)

Infection

99

(1)

Referred Pain

99

(1)

Overuse

99

(1)

Stress Fracture

99

(1)

Other Causes of Patellar Pain

100

(3)

Chapter 9 Classification of Patellofemoral Disoders

103

(6)

Nomenclature and Classification of Chondral Lesions

103

(2)

Nomenclature and Classification of Patellofemoral Disorders

105

(1)

Histology

106

(1)

Proposed Classification of Patellofemoral Symptomatology

106

(3)

Chapter 10 Examination of the Patellofemoral Joint: The Physical Therapist's Perspective

109

(10)

The Patient's History

109

(1)

Symptoms

109

(1)

Clinical Examination

110

(9)

Chapter 11 Conservative Management of Patellofemoral Problems

119

(18)

Symptom Reduction

119

(4)

Unloading

123

(1)

Muscle Training

124

(2)

Specificity of Training

126

(1)

Environment

126

(1)

Training the Vastus Medialis Obliquus

127

(2)

Progression of Treatment

129

(2)

Foot Problems

131

(1)

Weaning from Tape

131

(4)

Conclusion

135

(2)

Chapter 12 Surface Electromyography and Patellofemoral Dysfunction

137

(40)

Glenn S. Kasman

Overview

137

(1)

SEMG Background

137

(3)

SEMG and the Patellofemoral Joint

140

(16)

Case Histories

156

(3)

Conclusion

159

(6)

Appendix 12-A: Surface Electromyographic Application Guide for Patellofemoral Pain Syndrome

165

(12)

Chapter 13 Biomechanical Management of Patellofemoral Pain and Dysfunction with Foot Orthotic Devices

177

(52)

John E. McNernoy

Introduction

177

(1)

Practical Biomechanics of the Lower Extremity

177

(7)

Factors That Alter Normal Biomechanics and Kinematics of Gait

184

(10)

The Knee in Gait, Normal Function, and Dysfunction

194

(2)

Research

196

(6)

Foot Orthotic Devices

202

(2)

Classification of Foot Orthotic Devices

204

(13)

The Design of Orthotic Devices

217

(3)

Successful Use of Orthotics in Patients with Knee Dysfunction

220

(3)

Conclusion

223

(6)

Chapter 14 Surgery

229

(28)

Indications

229

(1)

Informed Consent

230

(1)

General Principles

230

(1)

Specific Procedures

231

(20)

Anesthesia

251

(1)

Author's Opinion

252

(5)

Chapter 15 The Failed Patella

257

(8)

Overview

257

(1)

Mechanical Pain

257

(1)

Biological Pain-Reflex Sympathetic Dystrophy and RSD-Like Conditions

258

(3)

Emotional Pain

261

(4)

Index

265

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The Patella: A Team Approach

Summary

Table of Contents

Supplemental Materials