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).
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 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 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 activities of daily living, patients require adequate strength, range of motion, and coordination. Treatment of each may depend on their surgical status and comorbidities to create a unique yet evidence-informed plan of care.
WORKS CITED https://qr2.mobi/PT-hip-knee-rehab
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