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Document Title: McConnell-EKLR-Ch15-2000
Article Title: Patellofemoral Joint Complications and Considerations
Author: Jenny McConnell, BApp Sd (Phty),
Director, McConnell Institute, Neural Bay, New South Wales, Australia.
Publication: Knee Ligament Rehabilitation, edited by Todd S. Ellenbecker.
Philadelphia, Pennsylvania: Churchill Livingstone (Harcourt), 2000. (This book
has 51 contributing authors and 465 pages.)
Pages: 202-224
Keywords: patellofemoral pain, patellar tracking, biomechanics, foot mechanics,
orthotics, patellar taping, knee pain, shock absorption, vastus medialis
oblique/obliquus.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables. Although this article has been published as a book chapter, it can be read independently of the other chapters in the book. Other chapters from this book can be found here.)
Comments: This superbly insightful article discusses in depth the complex biomechanics of the patella. The author notes how any loss of sensory nerve endings in knee tensile structures (such as the ligaments) and/or in other structures (including the highly pain-sensitive fat pads) can result in protracted problems. The author quotes research involving saline injections into knees (to simulate the blood released by ACL tearing), and notes how the vastus medialis becomes inhibited long before the vastus lateralis (and so it is not surprising that ACL-injury-history knees [including those which have undergone reconstruction] have patellar-tracking problems).
The author goes on to discusses the importance of good strength in the innermost portion of the quadriceps (specifically the VMO, or vastus medialis oblique), and provides suitable training exercises in this regard. The author notes that a mere 5 millimetres of lateral displacement of the patella causes a 50 percent decrease in VMO tension. The author discusses the benefits of closed-kinetic-chain exercises (herein defined as exercises in which the foot is on the ground) in the context of patellar-tracking issues. (Closed-kinetic-chain exercises are also ideal for ACL rehabilitation.) These exercises are preferable because they improve patellar congruence, and also because with these types of exercises, muscle training is specific to limb position.
Also noted is the importance of proper foot biomechanics. Too much or too little foot pronation will alter tibial rotation, which in turn affects patellofemoral joint mechanics. (Excessive foot pronation is often a result of a collapsed arch, and can result from various causes, including use of footwear containing inadequate arch support. The author additionally notes that although foot orthotics are often useful to correct such problems, the orthoses must not be too hard. Rigid orthoses can do more harm than good, because although they can support the arch, they can inhibit the natural movement of the foot which is essential to shock absorption.)
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