Patellofemoral Disorders

Standing examination

• Varus/ valgus alignment

• Examination of gait

• Pelvic obliquity and leg length inequality

• Q-angle

• Femoral and tibial torsion

• Miserable malalignment syndrome:

  • internal torsion of the femur, external torsion of the tibia and pronated feet

  • Position of subtalar joint. Pes planus.

Supine examination

• Q angle (Normal M 10° F 15)   

• Quadriceps mass (VMO atrophy)

• Hamstring tightness (popliteal angle)

• Examination for medial plica

• Tibial torsion

• Tenderness on quadriceps or patellar tendon insertion, patellar facets, retinaculum tightness hamstrings, or heel cord

• Crepitation and patellar compression

• Apprehension test (20-30°flexion)                                           

• Clarke's Snatch test (pain on contraction of the quadriceps with the patella fixed)

• Patellar tilt (evaluates tension of the lateral restraint)

• Patellar glide test (knee flexed 20 to 30°)

  • Decreased: 1 quadrant or less medial glide is indicative of tight lateral restraint

  • increased: subluxable, or dislocatable patella

Prone examination

• Hip motion - femoral neck anteversion (abnormal if IR exceeds ER by more than 30°)

• Quadriceps tightness - Ely test (especially rectus femoris)

• Leg-heel alignment (Normal 2-3° of varus)

• Hindfoot-forefoot alignment: (Normal: long axis of heel 90° perpendicular to transverse axis of forefoot)