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Patellofemoral Disorders
It is an inflammation of a tendon in the knee which results
in pain and/or discomfort. This condition is caused by a
weakening of the cartilage. The softened cartilage places
additional stress on the patella (around the knee), which
results in the knee are no longer gliding smoothly when
moved. The result of this is pain in the anterior knee that
is worse with climbing stairs or prolonged sitting. In many
cases, the patella appears to "pop" or shift suddenly when
the leg is extended.
Causes of Patellofemoral Disorders:
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Stress due to improper exercise.
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Weakness of the vastus medialis.
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Poor bio mechanics or existing bio mechanical problems.
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Overuse, especially in situations where high stress or
weight is placed on the knee.
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Sitting for excessively long periods of time.
The symptoms of Patellofemoral Syndrome can be varied and
somewhat vague, but usually the athlete will have pain in
the front of the knee, surrounding the kneecap patella) and
extending, to varying degrees, away from the kneecap, more
often to the inner side of the knee. The pain may worsen
when descending (or climbing) stairs or hills, upon standing
after sitting for a time, and shortly after, or even during,
the causative activity or sport. The pain can be either
sharp, well-localized pain or a dull, nagging type of
discomfort.
The diagnosis is made almost exclusively based on your
symptoms and the exam of your knee. Although there are
specialized tests and x-rays that can identify problems in
the kneecap and knee joint, few are reliable at pinpointing
the exact cause of your symptoms.
Arthroscopic Lateral Release: this day-case
arthrosopic surgical procedure may be used to divide the
lateral retinaculum (the soft tissue which pulls the patella
towards the outside of your knee). It is performed in order
to reduce this pull and therefore to centralise the patella,
in people with patellofemoral pain combined with patella
tilt. This simple procedure is not effective for most
patellofemoral problems and in some cases it may make things
worse, in terms of discomfort, pain and swelling. Most
surgeons would recommend that a lateral release be used only
when there is residual patella tilt, which is a physical
examination sign of a tight lateral retinaculum. As it is
very important that you fully understand the goals and
potential complications of this simple procedure, please
discuss this operation in detail with your surgeon.
Sometimes, if the pain or bleeding can not be controlled
well enough before you are discharged home on the day of
your surgery, we prefer to keep you in the hospital
overnight.
Patella Stabilisation: historically, surgical
procedures to stabilize the patella involved an advancement
of the vastus medialis obliquus (VMO) portion of the
quadriceps muscle in an effort to dynamically prevent the
kneecap from dislocating laterally. This could be done in
isolation as a muscle transfer, or with imbrication of the
medial retinaculum, which forms the distal extent of the
deep fascia of the VMO muscle. The clinical significance of
the medial patellofemoral ligament (MPFL) has been
demonstrated in a variety of recent scientific publications.
These studies yield strong evidence that the MPFL provides a
critical soft-tissue restraint against lateral patella
translocation. A more modern approach to surgical
stabilization of the patella is to reestablish a medial
soft-tissue restraint by repairing or reconstructing the
MPFL, which is quite difficult in chronic cases. Only this
surgical procedure restores normal passive limits of the
patella against lateral translation. It is believed that the
MPFL is the essential ligament to be restored to a suitable
tension or length after acute lateral patella dislocation,
but there continues to be debate on how to accomplish this
goal.
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