This case report describes the use of patellar taping to treat an individual with PA. Because of the progress demonstrated to this point, the patient was instructed to begin the conditioning exercises as described previously and the frequency of physical therapy was reduced to one visit every two weeks. Sudden trauma can damage parts of your knee joint. [23] evidence level: 5Patellofemoral Instability: acute dislocation of the patellaNonoperative treatment:It is a treatment that consists of immobilization followed by a period of structured rehabilitation. Self-taping allowed the patient to provide a more consistent, inferior force to the patella to help relieve her symptoms. The knees are bent at 90 degrees, and the thigh is horizontally positioned. The patella lies in an indentation of the femur known as the intercondylar groove. Visual observation of the tape applied by the patient revealed that she had positioned the tape correctly. Patella Alta - Symptoms ,Causes ,Diagnosis And Treatment Influence of patellar position on the knee extensor mechanism The second length is vertical and is the superior patella articular surface. Prior to the most recent visit to her physician, and subsequent follow-up with physical therapy, the patient reported a significant increase in pain that she was trying to manage with over-the-counter pain medication. Diagrammatic representation of the direction of force applied through taping to the patellofemoral joint. Thus, the patient had to ascend and descend the stairs several times per day. What is Patella Alta? The final component of the intervention provided to the patient was education regarding the initiation and progression of a conditioning program for general health and fitness. Different measurement methods are used to define patella alta. The patient sits on the edge of the examination table with the feet on the ground. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Muscle control will also increase with physical therapy. Treatment for patella fracture varies depending on how severe the break is, as well as your age, health and other factors. The result, as with studies examining patellar taping with a medial stabilization force (Bockrath, et al, 1993; Pfeiffer, et al, 2004), was decreased pain and increased function. Inclusion in an NLM database does not imply endorsement of, or agreement with, By contrast, ascending and descending the stairs did increase her pain. Having patella alta also increases the risk of developing knee arthritis and inflammation in the infrapatellar bursa or fat pad. In 1988, three-year-old Eric Rogstad of Minneapolis, Minnesota was discovered to have the condition in both knees after several attempts by his parents and family physician to discover the cause of his difficulties with walking and running. Jacobsen K, Bertheussen K. The vertical location of the patella. This dip is known as the patellofemoral groove, aka patella groove, trochlear groove or intercondylar groove. Relative to the controls, subjects with patella alta demonstrated significantly smaller amounts of patellofemoral contact area at the point of maximal stress for both the normal and fast walking conditions. Patellar Fractures (Broken Kneecap) - OrthoInfo - AAOS No corrections were provided at the time of the examination because her gait was not painful. The patient in this case demonstrated a reduction in pain and a significant improvement in her functional status with such conservative measures. Rest the knee as much as possible. American Journal of Orthopedics. Of these three conservative interventions, taping the patella with an inferiorly directed force seemed to most significantly benefit the patient. With this surgery they move the attachment of the patellar ligament downwards to the tibia. FOIA In another study by Ward, et al (2007), patellar height was found to be negatively correlated with the magnitude of the contact area at each knee flexion angle measured, confirming that patellofemoral contact area is reduced in subjects with patella alta. Knee injury Patella alta may arise due to an injury occurring in the knee. The effect of bracing on patella alignment and patellofemoral joint contact area. Shift trunk anteriorly to improve the ability to effectively recruit the quadriceps and the hip extensors. The patient continued self-taping for both knees for the duration of therapy, and was instructed to tape herself as needed following discharge. During this visit, the patient subjectively noted that pain was no longer limiting function. Following the initial evaluation, four exercises were prescribed to address issues with regards to muscle length and motor recruitment (table 3). Patella Alta. Patellofemoral Syndrome Symptoms, Exercises, and Treatment - Healthline Based on the results of this re-evaluation, it was clear that the patient had improved relative to her baseline level and that she was able to effectively manage her symptoms with tape and exercise. Knee pain that improves during physical activity but returns after activity suggests tendinitis. Try not to do things that increase the pain, such as climbing stairs, kneeling or squatting. Future research could certainly help to explain the biomechanical mechanisms underlying the taping method used, but the current case study provides some preliminary evidence for taping that can be practically applied in a clinical setting, in addition to the correction of the underlying movement impairments, to control pain and to improve function in patients with patella alta. The joint is particularly vulnerable to instability during this period. Brandon, Colin R. Smith, Tom F. Novacheck, Causes Diagnosis Treatment An acute injury to the patella (kneecap) can happen from a blow to the knee or a fall. Kneecap Problems and Treatments - WebMD A normal value of the patella is a ratio between 0,8 1,2. 2001. According to the patient, the injections relieved most of her pain and improved her function, but she was still taking multiple doses of Advil per day to manage her symptoms. In addition, the patient stood with her knees slightly flexed. Of the five knees that did not show improvement in this study, four of them had patella alta. A kneecap in an "alta" position sits above the "trochlear groove" and therefore is less stable. Ward SR, Powers CM. Powers CM, Ward SR, Chen Y, Chan L, Terk MR. Effect of bracing on patellofemoral joint stress while ascending and descending stairs. IRB Approval: The Human Research Protection Office does not require IRB approval for a Case Report. If the indicator of progress had improved relative to baseline a score of 1 was assigned. Various techniques, including those by Blackburne and Peel, Caton et al., and de Carvalho et al., have since been developed in the attempt to classify patella position. Because the brace used in this study only provided stabilization for medial and lateral patellar glide, it might not have been the most optimal brace design for individuals with patella alta. A lateral view from the side should be used, with the knee in 30 degrees of flexion. With radiographic measurements, patella alta is defined as a Caton-Deschamps index (CDI) of > 1.2 to > 1.3, an Insall-Salvati index (ISI) of > 1.2, a Blackburne-Peel index (PBI) of > 1.0[4][5][6][7]and a patellotrochlear index (PTI) of < 0.125 to 0.28.6,26.[8][9]. Emergency treatment may include draining blood and fluid from the joint to reduce swelling and pain and to make it easier to diagnose the problem. The procedures used to apply the tape in this fashion were as follows. Van Duijvenbode D, Stavenuiter M, Burger B, van Dijke C, Spermon J, Hoozemans M. The reliability of four widely used patellar height ratios. Use compensatory pattern of motion, as needed, by descending one step at a time. To modify her symptoms the patient was first cued to transition from sitting to standing at the edge of her chair. [20][21] evidence level: 3, A study suggest that Patellar tendon tenodesis and tibial tubercle distalization result in normalization of patellar tendon length, a stable patellofemoral joint, and good long-term knee function in patients with patella alta. Finally, open chain activities such as knee extension in sitting were also painful, which supports the diagnosis of Patella Tracking Syndrome with Superior Glide because knee extension from 90 degrees of knee flexion to 25 degrees can increase patellofemoral joint reaction force (Grelsamer and Klein, 1998). Indeed, the patient reported decreased pain with sit to stand and noted that she was able to walk approximately one mile on the track with minimal difficulty. [citation needed]. The prevalence of patella alta in individuals with patellar osteoarthritis was 6 times that of individuals with normal patellar articular cartilage (Ahlback and Mattsson, 1978). Line graph demonstrating patient status according to the assigned scores from selected indicators of progress. The patient was a 56 year-old female with bilateral knee pain associated with PA. The patient was instructed to perform three sustained inferior patellar glides on both knees for 30 seconds each. Other symptoms include knee pain, swelling, and bruising. Ahlback S, Mattsson S. Patella alta and gonarthrosis. The patient could not attribute her increase in symptoms to any specific activity or event. Knee Symptoms Front Knee Pain Lateral Knee Pain Medial Knee Pain Pain Behind Knee Kneecap Pain Calf Pain Burning Knee Hyperextended Knee Knee Locking Leg Cramps Knee Pain Bending Pain Kneeling Pain At Night Pain On Stairs Pain With Squats Popping Knee Running Knee Pain Sharp Knee Pain Swollen Knee Stiff Knee Severe Knee Pain Twisted Knee Conditions 1173185, Ward SR, Powers CM; The influence of patella alta on patellofemoral joint stress during normal and fast walking; Clin Biomech (Bristol, Avon). When a pillow was placed between her lower extremities, the patient did, in fact, report increased comfort, but, again, no specific changes in knee pain were noted. in normal and crouched walking. Attenuated patella alta is an extremely rare condition affecting mobility and leg strength. The groove is nice and deep, forming a good barrier at the sides to keep the patella very stable by limiting the sideways movement of the kneecap. As the treatment progressed and the tape was deemed successful at reducing her symptoms, the patient was instructed how to tape her knees independently. The focus of treatment was to decrease pain during functional activities by using tape to correct patella alignment. Based on the existing evidence demonstrating a decrease in patellofemoral contact area with patella alta (Ward and Powers, 2004; Ward, Terk, and Powers, 2005), it is possible that the reduction in anterior knee pain demonstrated by the patient in this case in response to conservative measures was related to an increase in the patellofemoral contact area, which could potentially decrease joint stress. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations. Several methods are used to determine the presence of patella alta. A perfect postoperative stability was found in 76.8% of patients[12], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. As the patient progressed in therapy, she was instructed on the performance of a walking program to improve her cardiovascular health while minimizing her symptoms. At the time of the initial physical therapy evaluation, the patient reported 2/10 achy pain in the anterior aspect of both knees that worsened with sit to stand and stair climbing. Patella alta has been shown to be associated with chondromalacia on the articular surface of the patella and pain. It causes a tracking issue of the patellofemoral joint as the patella is not ideally located over the femoral trochlea as it should be. However, the patient subjectively reported that her knee was functioning at only 30% of normal. However, it was observed, that the tape on the patients knee had been applied incorrectly. Inspection of her patellar alignment suggested that her patella was superiorly displaced (figure 1). Activities that. Journal of Biomechanics. 82A:1639-1650, 2000, https://en.wikipedia.org/w/index.php?title=Attenuated_patella_alta&oldid=1087879586, This page was last edited on 15 May 2022, at 01:13. Knee extension range of motion was not reassessed. Top Tips On Getting Up & Down Stairs With Knee Pain. Thank you!" According to Healthh, there are two basic causes of patella alta. This is more remarkable In a unilateral Patella alta. Because a significant reduction in pain was noted in this case, it is possible that taping the superior margin of the patella to provide an inferiorly directed force produced some subtle changes in the resting alignment of the patella (inferior displacement) that contributed to a change in the contact area magnitude of the patellofemoral joint. At discharge, the patient scored a 56 on the ADL-KOS and rated her function at 70% of normal. Patellofemoral pain syndrome - Symptoms and causes - Mayo Clinic
