Cheatography
https://cheatography.com
Presentation , management etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Risk Factors
- Micro-tearing/degeneration of the proximal attachment of the patella tendon (inferior pole on proximal, posteriomedial fibres of the tendon) |
- Jumpers knee - excessive loading of knee extensor mechanism |
- However, landing causes more forces on the tendon |
- Rapid acceleration and deceleration |
- Athletes that jump, basketball, volleyball |
- Excessive foot inversion/allow deeper angles of knee flexion/foot supination |
- Unilateral but can be bilateral |
Presentation
- Chronic without identifiable onset |
- Can relapse and remit |
- Painful during arising from seated position, squatting, jumping, stair climbing, running (downhill/downstairs) |
- May have pain over tibial tuberosity (consider osgood sclatters if swelling/pain over TT on skeletally immature pt) |
- Pain over inferior pole of patella |
- Pain/discomfort on PROM knee flex & RROM ext |
- Squat test |
- Pain decreases on knee flexion (passive knee extension flexion sign + standing active quads sign) |
- Assess for quadriceps and hamstring hypertonicity and weak quads |
- Allows excessive knee flexion due to inadequate deceleration |
Imaging
- Not usually required unless: Hx of trauma, surgery, joint swelling, OA |
DDx
- F# |
- Infection |
- Neoplasm |
- Articular cartilage injury |
- Chondromalacia Patella |
- Osgood Schlatter Disease |
- Osteochondritis Dissecans |
- OA |
- PFPS |
- Plica |
- Bursitits |
- Quad tendonitis |
- Sinding-Larsen Johansson syndrome |
- Bipartite Patella |
- Referred pain from Lx/Hip |
Management
- Transverse friction massage |
- Eccentric Exercise |
- US |
- Ice/Ice massage |
- Shockwave therapy |
- Avoid complete rest |
- Stretching and myofascial release of hamstring, quads, gastrosoleus, ITB, piriformis, anterior hip capsule, psoas |
- EMT of ankle, knee, hip, LS |
- Strengthening of Quads ( five 45 second isometric quad contractions at 75% strength) |
- Eccentric training + static stretching (unilateral squats on 25 degree decline board - return to standing using unaffected leg and should not squat >60 degrees , can progress to weights 10 reps twice a day for 12 weeks |
- Moderate effort with low reps - change in night pain |
- Address weakness in gluts, quads, hamstring |
- Arch supports |
- Treadmill walking/running (less stress on quads) |
- Surgical consult if : >50% tear, reoccurring |
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