J-sign with active knee extension/flexionįixed lateral tracking, when patella fails to center with increasing flexion (may be difficult to confirm on physical examination alone) ![]() Patellar glide in extension and various degrees of flexion evaluating amount of displacement (laxity) and endpointĪpprehension test for lateral instability: does displacement produce an apprehension reaction and at what degree of flexion? Single-leg stance, squat, or step-down as tolerated (screening evaluation of hip strength and core control) Standing alignment, gait (watching especially for valgus and rotational abnormalities) Patients With Suspected Recurrent Instability: Nonacute Visit Examination If patient is experiencing too much acute pain and swelling for meaningful examination, a repeat evaluation should be planned within several weeks Include general examination for range of motion of the ligament, meniscal pathology, referred pain, and neurologic compromise Hypermobility (Beighton score), emphasizing the presence of knee hyperextensionĭo not forget anterior cruciate ligament and medial collateral ligament examination Rotational alignment, including femoral anteversion, tibial torsion, and hyperpronation Tenderness along medial patella and/or medial patellofemoral ligamentsĮffusion (large effusion may raise suspicion of osteochondral fracture) Patellar glide in extension and various degrees of early flexion (if tolerated) evaluating amount of displacement and endpoint (in response to force)Īpprehension test at 30° if tolerated: does displacement produce an apprehension reaction? (subjective response) Patients With Suspected Acute Patellar Instability: First Time or Recurrent Symptoms of patellofemoral instability can be episodic because even in the presence of patholaxity, neuromuscular control and articular congruity can maintain the physiologically adequate position of the patella and trochlear groove relative to each other. Symptomatic patellar instability happens only when there is patholaxity. Patellar instability is a symptom that requires patholaxity for the patella to escape partially or completely from its asymptomatic stable position. Patholaxity can be due to genetic predisposition (as with hyperlaxity conditions) or as a result of trauma. Further study is needed to define the line that distinguishes normal from abnormal laxity. Patholaxity is abnormal laxity (too tight or too loose). Laxity is a physical examination finding that describes passive displacement under load. Such displacing force could be generated by muscle tension, movement, and/or externally applied forces. We define patellofemoral stability as constraint by passive soft tissue tethers and chondral/bony geometry that, with muscular forces, guide the patella into the trochlear groove and keep it engaged within the trochlear groove as the knee flexes and extends.įurthermore, we define patellofemoral instability as symptomatic deficiency of the aforementioned passive constraint (patholaxity) such that the patella may escape partially or completely from its asymptomatic position with respect to the femoral trochlea under the influence of displacing force. This process was a modification of the recognized Delphi protocol to facilitate creation of consensus statements among experts. The document was crafted into a combination of bullet points and discussion to facilitate brevity and clarity. By the third cycle, there were few comments, which were easily reconciled. This draft was circulated to participants, and comments were collected and incorporated blindly for a total of 3 review cycles. At this point, all responses were blinded to the proctors, who reviewed all comments and refined the document. All comments were carefully reviewed and incorporated into a second draft, which was sent to participants for review. and D.C.F.) and sent to all the expert participants for their review and input (see list of participants in the Appendix). ![]() Then, a working document summarizing the day’s discussion was created by the meeting chairmen (W.R.P. During the 1-day workshop, all topics were discussed and discussions summarized. Trauma center second opinion force progressive scan series#Prior to the workshop, a series of questionnaires was sent to all participants, with the goal of establishing areas of existing consensus and differences to provide focus for the workshop, which occurred on September 23, 2016, in Chicago, Illinois.
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