1. David Kempin, Zac Snow, adam mathers, jimmy wernel
KNEE PAIN
David Kempin, Zac Snow, adam mathers, jimmy wernel

2. Patellofemoral Pain Syndrome
Anterior knee pain due to biomechanical pathophysiology
Improper joint tracking secondary to imbalances of lines of pull from quadriceps musculature
Or, structural abnormalities on posterior patella or anterior femur
MOI is not well known, but most likely due to repetitive microtraumas resulting in inflammation and pain in the underlying cartilage and subchondral bone
At risk population are runners, jumping athletes (basketball, volleyball), and females with large Q angles

3. Need to have a balance of forces between vastus medialis and vastus lateralis/IT band
Or, improper tracking can lead to microtraumas causing pain and inflammation

4. Signs, Symptoms, and Contributing Factors
Insidious, poorly-defined ache localized to the anterior knee or “behind the knee cap”
Aggravated by squatting, running, prolonged sitting, stairs (worse with descending)
Patellar instability – sensation of possible subluxation with twisting and cutting
Abnormal static alignment
Femoral Anteversion, Genu Varum or Valgum, Tibial external rotation, Pronation or supination of subtalar joint, abnormal Q angle

5. Signs, Symptoms, and Contributing Factors
Abnormal Dynamic Alignment with single leg squat or 6” step down
Contralateral pelvic drop
Hip adduction and internal rotation
Knee abduction
Tibial external rotation?
Hyperpronation
J Sign – patella moves laterally

6. Pt complains of anterior knee pain
Structural Observation: Tibial valgus, Tibial/femoral torsion, Q angle, STJ/TCJ Pronation/Supination
Observational swelling and circumference measurement
Positive
Stability testing
Possible patellar bursitis
Negative
Meniscal testing
Possible PFPS

7. Patient c/o anterior knee pain
Stability tests (ACL, PCL, MCL, LCL)
Positive
Refer to Primary Care Physician for imaging
Negative
ACL: Lachman, Anterior Drawer, Varus/Valgus at 0 degrees
PCL: Posterior Drawer, Posterior sag
MCL: Valgus stress test at 20 degrees knee flexion
LCL: Varus strest test at 20 degrees knee flexion
Meniscal Tests
(Appley’s, McMurray, Thessely)
Positive
Refer to Primary Care Physician for imaging
Negative
Continue

8. Patient c/o anterior knee pain
Functional Step Down Test
Positive
Negative
Pain with Jump?
Functional Single Leg Squat
Positive
Negative
Positive
Negative
Patellar Tendonosis
Patellar Bursitis
Reassess
Continue
Quad MMT

9. Patient c/o anterior knee pain
Positive Functional Single Leg Squat Test
Critical Test
Positive
(Probable PFPS)
Negative
Modified Ober’s
Positive
(IT band pulling patella out of proper tracking = possible PFPS)
Negative
Quad MMT

10. Pt c/o anterior knee pain
Negative Modified Ober and Critical Tests: Glute MMT, Navicular Drop Test, Apprehension Test, Patellar Tilt

11. Take Home Messages
Knee pain is not always as straight forward as it may seem. Knowing the correct tests and a progression for those tests is important.
The use of this algorithm and the positive AND negative tests will help you narrow down the possible cause.
Remember, the treatment for the knee dysfunction you diagnose may not be directly related to the knee (for example: hip strengthening). Educating your patient on the reasoning will be important.