- Habusta S.F.
- Coffey R.
- Ponnarasu S.
- Griffin E.E.
2. Clinical assessment
2.1 Physical examination
2.2 Dynamic movement assessment:16
2.2.1 Seated examination
2.2.2 Standing examination
- •Step-down test: assess for the strength and endurance of the hip and leg, wherein the patient stands on a 20 cm box with the hands folded across the chest and squats down on one lower extremity 5–10 times slowly until the heel touches the floor.
- •Single – leg squat: Evaluates the dynamic hip and quadriceps strength. Subjects with PFA, may show, greater knee abduction, hip abduction, pelvic drop on the opposite side or same side trunk lean during this activity.
- •2-legged jump test – prepares the patient for concentric propulsive push off motion and eccentric deceleration landing phase.
- •Single-leg hop test – helps with eccentric land with deceleration in the involved side.
- •Lower Extremity Functional Test (LEFT) – Involves many lower extremity movement patterns which replicate activities of daily functional performance.
- •Patellar Tilt: the angle between a line drawn parallel to another line (dotted line parallel to line AB in Fig. 3) connecting the medial and lateral posterior condyles makes an angle with the lateral facet of patella. This angle has to be greater than 7° in extension and 12-14° in 15° knee flexion. Decrease in this angle indicates maltracking of patella.
- •Patellar height: Various indices have been described of which the Insall- Salvati is most commonly used and measured on a lateral radiograph as shown in Fig. 4. It is calculated as a ratio of patella tendon length(TL)- length of the tendon measured from lower pole of patella to its insertion on the tibial tuberosity and patella length(PL) from superior to inferior pole of patella. The normal ratio is 0.8–1.2. If the ratio is less than 0.8, the condition is called patella alta or high riding patella and if ratio is more than 1.2, it is known as patella baja or low riding patella.
4.1 Non-operative treatment
4.2 Operative treatment
4.2.1 Procedures aimed at reducing pressure on the articular surface
4.2.2 Correction of patellar instability
4.2.3 Cartilage regeneration
4.2.4 Surface replacement
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☆All authors contributed in conceptualizing and drafting the manuscript.