alignment issues such as genu valgum, tibial torsions, femoral anteversion, bony abnormalities of the patella or trochlear groove, and foot pronation are also attributed to poor knee mechanics resulting in patellofemoral disorder (Heintjes et al., 2003). Anterior knee pain in the absence of instability includes patellar tendinosis, also referred to as “jumper’s knee.” Exam findings include tenderness at the inferior pole of the patella and the belly of the patellar tendon. It is primarily seen in running and jumping athletes who cyclically load the knee. Management for this impairment should include NSAIDs, modalities to minimize inflammation such as pulsed ultrasound or iontophoresis, and exercises to improve quadriceps flexibility. A review of the literature for general patellofemoral pain concludes that interventions supported by evidence include acupuncture, knee strengthening, resistive bracing, and hip strengthening exercise combined with patellar taping and biofeedback, and neuromuscular electric stimulation (Bizzini et al., 2003; Logan, 2017; Saltychev, 2018). Evidence for manual therapy is noted as well (Espi-Lopez, 2017). Patellofemoral instability involving patellar subluxation generally occurs secondary to a laterally biased patella position. The patient may report a history of catching or giving way of the knee, generally with pain. The need for external support via bracing or taping should be assessed and will be based on the degree of passive mobility of the patella. Quadriceps strength is largely associated with the outcome of this impairment. Treatment should focus on quadriceps muscle activation during Conclusion The functional connection between the hip and knee joints commonly warrants assessment and treatment of both when a patient presents with impairments of one. Due to shared musculature and the reliance of both for ambulation and Ackerman, I. N., Kemp, J. L., Crossley, K. M., Culvenor, A. G., & Hinman, R. S. (2017). Hip and Knee Osteoarthritis Affects Younger People, Too. The Journal of Orthopaedic and Sports Physical Therapy, 47(2), 67-79. https://doi.org/10.2519/jospt.2017.7286 Altman, R., Alarcón, G., Appelrouth, D., Bloch, D., Borenstein, D., Brandt, K., Brown, C., Cooke, T. D., Daniel, W., & Feldman, D. (1991). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis and Rheumatism, 34(5), 505-514. https://doi.org/10.1002/ art.1780340502 American College of Rheumatology (n.d.). Western Ontario and McMaster Universities Osteoarthritis Index. Retrieved on October 20, 2020 from http://www.rheumatology.org/Practice/Clinical/Clinicianresearchers/ Outcomes_Instrumentation/Western_Ontario_and_McMaster_Universitie Andrews, K., Lu, A., Mckean, L., & Ebraheim, N. (2017). Review: Medial collateral ligament injuries. Journal of Orthopaedics, 14(4), 550-554. https://doi.org/10.1016/j.jor.2017.07.017 Baker B. (2018, October 12). Meniscus injuries treatment and management. Medscape. http://emedicine. medscape.com/article/90661- treatment Barratt, P. A., Brookes, N., & Newson, A. (2017). Conservative treatments for greater trochanteric pain syndrome: a systematic review. British journal of sports medicine, 51(2), 97-104. https://doi.org/10.1136/bjsports-2015-095858 Bellamy, N., Wilson, C., Hendrikz, J., Whitehouse, S. L., Patel, B., Dennison, S., Davis, T., & EDC Study Group. (2011). Osteoarthritis Index delivered by mobile phone (m-WOMAC) is valid, reliable, and responsive. Journal of Clinical Epidemiology, 64(2), 182-190. https://doi.org/10.1016/j.jclinepi.2010.03.013 Binkley, J. M., Stratford, P. W., Lott, S. A., & Riddle, D. L. (1999). The Lower Extremity Functional Scale (LEFS): Scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Physical Therapy, 79(4), 371-383. Bizzini, M., Childs, J. D., Piva, S. R., & Delitto, A. (2003). Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. The Journal of Orthopaedic and Sports Physical Therapy, 33(1), 4-20. https://doi.org/10.2519/jospt.2003.33.1.4 Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017). Osteoarthritis: Toward a comprehensive understanding of pathological mechanism. Bone Research, 5, 16044. https://doi. org/10.1038/boneres.2016.44 Cibulka, M. T., Bloom, N. J., Enseki, K. R., MacDonald, C. W., Woehrle, J., & McDonough, C. M. (2017). Hip pain and mobility deficits—hip osteoarthritis: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 47(6), A1-A37. Cimino, F., Volk, B. S., & Setter, D. (2010). Anterior cruciate ligament injury: Diagnosis, management, and prevention. American Family Physician, 82(8), 917-922. Claes, S., Vereecke, E., Maes, M., Victor, J., Verdonk, P., & Bellemans, J. (2013). Anatomy of the anterolateral ligament of the knee. Journal of Anatomy, 223(4), 321-328. https://doi.org/10.1111/joa.12087 Cook, J. L., & Purdam, C. (2012). Is compressive load a factor in the development of tendinopathy?. British journal of sports medicine, 46(3), 163-168. https://doi.org/10.1136/bjsports-2011-090414 References Croutze, R., Jomha, N., Uludag, H., & Adesida, A. (2013). 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progressive ranges of knee motion, especially during functional tasks (Malanga, 2017). Ninety percent of patella dislocations occur laterally. This has the possibility to become a chronic condition in some patients with frequent reports of patella displacement. These patients are often surgical candidates. Acute management for patella dislocation includes splinting for approximately 3 weeks with use of ice, NSAIDs, and rest to manage pain. Gentle quadriceps strengthening should be performed as tolerated. Misalignment issues should be treated according to objective measures, including hip abductor weakness and foot positioning. At week 4, the patient may be prescribed a hinged knee brace with lateral patella support. Continued strengthening of the quadriceps muscles should be a priority, with increased loading of the joint under pain-free conditions. Surgical management for chronic subluxation and dislocation may involve either a lateral retinaculum release or patellar realignment procedure. The lateral retinaculum release involves arthroscopic resection of the lateral retinaculum with possible tightening of the medial retinaculum. Patellar realignment typically involves moving the tibial tubercle medially to attempt to normalize patellar alignment issues. Recovery from this procedure is very slow, and post-op rehabilitation will vary by surgeon, but will inevitably include range of motion, quadriceps strengthening, and functional activity training. A study conducted on adolescents who underwent this procedure shows less frequent repeat subluxation and a 93% improvement in knee function and pain scores (Luhmann et al., 2011). activities of daily living, patients require adequate strength, range of motion, and coordination. 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