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An angle greater than 25 degrees between the patellar tendon and quadriceps muscle can predispose a person to patellar dislocation. [11] In patella alta, the patella sits higher on the knee than normal. [11] Normal function of the VMO muscle (VMO) stabilizes the patella. Decreased VMO function results in instability of the patella.
The Q-angle, lateral hypermobility, and J-sign are commonly used to determine patellar maltracking. [18] The patellofemoral glide, tilt, and grind tests ( Clarke's sign ), when performed, can provide strong evidence for PFPS.
Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [2] Other signs from the Thomas test: opposite/ contralateral hip flexes without knee extension- tight iliopsoas
The normal knee flexion is between 130 and 150 degrees. Any pain, abnormal movement, or crepitus of the patella should be noted. If there is pain or crepitus during active extension of the knee, while the patella is being compressed against the patellofemoral groove, patellofemoral pain syndrome or chondromalacia patellae should be suspected ...
For instance, the target orientation can be reached as follows (note the reversed order of Euler angle application): The XYZ system rotates about the z axis by γ. The X axis is now at angle γ with respect to the x axis. The XYZ system rotates again, but this time about the x axis by β. The Z axis is now at angle β with respect to the z axis.
On a normal radiograph, the line intersects the inferior pole of the patella, and so can be useful in diagnosing a broken femur as well as a patellar tendon rupture. It also helps to define "Schottle point" intra-operatively for reconstruction of MPFL(Medial patello-femoral ligament.) [3] It may also be used to describe the course of an ACL graft.
A patella alta is a high-riding (superiorly aligned) patella. An attenuated patella alta is an unusually small patella that develops out of and above the joint. A patella baja is a low-riding patella. A long-standing patella baja may result in extensor dysfunction. [5] Insall-Salvati ratio (A divided by B). [6]
Assess any pelvic tilt by keeping an index finger on each ASIS. Normal (Trendelenburg negative): In the one-legged stance, the unsupported side of the pelvis remains at the same level as the side the patient is standing or even rise a little, because of powerful contraction of hip abductors on the stance leg.