Di Fabio Perissinotto
physiotherapist specializing in manual therapy osteopathic Mézières method and graduated from the Certag of Paris, Doctor of Sciences.
go to home Dance and physiotherapy
Normally the patella slides through the femoral condyles as a train between its tracks. When it comes deviates outward iperpressione patella syndrome, which consists precisely in a painful syndrome caused by a defective sliding of the patella in its groove.
After the injury to the meniscus is the disorder that most commonly affects the knee.
The pain is initially mild and subtle, only appears when you sit a lot or go down the stairs, but tends to worsen over time. It looks like a burning sensation or as a vice located before, under and around the kneecap. There may be noise pop and crackle as well as sudden failure. Often the failure is confused with a diagnosis of distortion of the medial collateral ligament.
The knee may swell and become painful enough to limit daily activities. The symptoms worsen after long walks, bike rides or special training of the lower limbs.
Another symptom is the locking of the knee, not to be confused with the meniscus. This fact locks the knee in extension, while the former does not allow full flexion of the leg.
In general, when the only pain is the most important symptom, the disease will be benign and easily will not need surgery could be treated by Physiokinesitherapy. However, when instability is an important sign, you should investigate the presence of anatomical changes that may be indications for surgery.
Depending on the degree of misalignment between the patella and trochlea is possible to identify four levels of increasing severity:
I) iperpressione External: the patella is centered in the trochlear groove, but excessive exercise pressure on the side wall;
II) subluxation: the patella, in the early degrees of flexion, is lateralized with respect to trochlear groove, only to re-enter in full flexion;
III) dislocation recurrent / habitual : the patella completely abandons its groove, displacing outward during the fall (occasionally or constantly). The first dislocation occurs only after a trivial fall. The kneecap back in place often alone with a painful snap followed by a payment of varying duration. There may be then:
▪ pain at the insertion of outer ligament;
▪ restlessness of the patient When you push the kneecap to the outside, the impression is that the patella moves (a sign of apprehension);
▪ patellar tendon angle outward from the anterior tibial tuberosity.
possible position to the outside of the kneecap.
IV) chronic dislocation: the patella is permanently dislocated outwards, leaving deserted the trochlea. It is generally a congenital malformation.
To differentiate the problem from the meniscal injury, we proceed with clinical trials followed by instrumental survey.
Some radiographs in axial limb flexed to different degrees (30 ° and 60 °), in addition to the standard projection, highlighting the relationship between abnormal patella and femur.
few millimeters are sufficient to profoundly alter the physiological mechanism, generating friction, inflammation, degeneration of cartilage and bone deformities. Early patellofemoral osteoarthritis develops only in severe cases of misalignment.
Drug therapy is palliative and should be used occasionally in times of acute pain, such as after a performance in sport. The category pharmacology key is represented by the Anti-inflammatory painkillers.
treatment, as mentioned, can be surgical or fisichinesiterapico depending on the presence or absence of anatomical changes that result in true patellar instability.
must firstly determine whether it is not in the presence of hypoplasia of the trochlea on the external side. This can be done by means of a lateral radiograph of the knee that will show a flat trochlea.
Secondly, it should exclude the presence of a high patella by radiography and clinical signs of apprehension or Smillie.
With a TAC will then assess the TA-GT, the distance between the anterior tibial apophysis and throat of the trochlea, as well as the Tilt-patella will be measured, ie the angle formed by the patella with the rear floor of the two femoral condyles, which reflects an imbalance due to a muscular dysplasia of the quadriceps.
In the cases described above a simple arthroscopic surgery, targeting the section of the external lateral ligament (lateral release) will not succeed as well as the operation will fail Physiokinesitherapy.
The procedure is rather a means of specific action to be performed under general anesthesia, depending on the anatomic abnormalities existing plastic trochlea dysplasia trocleari be discussed in more important; lowering of the patella in the case of high patella, medial transposition of the anterior tibial tuberosity, to correct the CT-GT, and finally plastic outer wing section of the vastus medialis, to correct patellar tilt.
while excluding the above-mentioned alterations Physiokinesitherapy a specific treatment may be decisive.
In this case, since there are certain predisposing factors that can be corrected. The knee valgus (knee X) is one of the top, next to the torsional defects of the femur or tibia that often accompany the valgus same. Another predisposing factor may be a weakness interno0 quadriceps muscle, the vastus medialis, or at least an imbalance of strength of four parts that make up the quadriceps femoris.
no coincidence colitis by this problem are mainly women in youth or young / older adults, and obese subjects both in the highest percentage in the presence of valgus knee (leg X), factor as we have seen that alters the proper sliding patella. It should then intervene before the situation escalates.
In physiotherapy / orthopedics is classically proposed reinforcement of the medial compartment of the quadriceps (vastus medialis) associated elongation of the vast alterale use of orthotics to correct the valgus.
Definitely a selective expansion may make sense as it should be noted that the articulation femoro-patellar bone stability is not inherent in the first 20-30 ° of flexion and stability becomes effective only after the 70-80 ° when the kneecap slips into the groove between the condyles. Initially, the stability is thus ensured by the muscles and ligaments and, most important in the flexed position, the V-shape of the patella femoral stuck in the throat. In addition, the insertion of the patellar tendon often external, it generates a strong tendency to move out of the patella when the quadriceps is contracted or when the knee is totally extended position.
Often these solutions by themselves give few results, or gain only a temporary success, because it does not take into account the global nature of the problem. In this case it is of great help treat postural Mézières acting on the set of muscle-fascial imbalances that are the cause of the misalignment-patellar trochlea.
cases refractory to treatment and physiotherapy are candidates for surgical therapy, as in arthroscopic surgery, but if the disorder is significant and / or the misalignment is severe enough to make provision arthritis early. It should be short, be careful before undergoing an operation that may not be decisive and lead to new hardships.
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