Immobilization For Patella Femoral Syndrome?

by Jim
(Salem, NH)

What are your thoughts of immobilizing the knee for 4-6 weeks with patella femoral syndrome or subluxing patella?

My daughter is an 11 year old gymnast who has had 8 weeks of PT, knee brace, orthotics and rest/ice principle but continues with constant achy pain. History of subluxing x2. MRI is negative. Should she stop gymnastics all together?

Sorry so many questions.

Comments for
Immobilization For Patella Femoral Syndrome?

Average Rating

Click here to add your own comments

May 15, 2008
Rating

Not a big fan...
by: Bart - SII

Is this the treatment plan that your physician or PT is recommending? Immobilization is not something that I usually would recommend for patella femoral syndrome. It can have some detrimental effects on the joint structures, muscles, and connective tissue. As a clinician, I try to avoid immobilization unless it is clinically necessary to protect healing tissue. Immobilized joints lose the ability to adequately get nutrition to the articular cartilage, it facilitates adhesions and contractures, and contributes to loss of muscle strength and function.

You said that the MRI was negative. I am assuming that this was for any intra-articular pathology such as an ACL tear or cartilage pathology. Was there any mention of an area of inflammation, or possibly an enlarged or inflammed plica? Does your daughter have a lot of popping or clicking in her knee when she bends or straightens it out? If so, is this painful when it happens?

I have had several patients recently who had complaints of severe patella femoral syndrome with episodes of "subluxation" who had a significant medial plica (an area of thickening within the connective tissue of the patella). This plica actually caused the patella to shift laterally, and it caused it to sit outside of the groove. With activity, it continued to be irritated, and it then scarred and became larger. Over time, it became so painful that just walking was hard. Some of the subluxation episodes were actually the plica moving over the patella and the femoral condyle.

I say this only because a plica inflammation is sometimes overlooked because it is not readily seen on an MRI or thought about by clinicians.

Rehab focusing on hip / core strength, orthotic intervention, rest, anti-inflammatories, etc should all help your daughter, and if she is not seeing results, I would talk to your surgeon and PT about other treatment options.

I would also recommend that she decrease her activities to allow for a little less pain with her daily activities.

These are just ideas I have based on what I have seen before clinically from patients who didn't respond to the normal patella femoral syndrome treatments.

Hope this helps - feel free to comment back with other questions.

X Close Editor

May 15, 2008
Rating

Submitted by: Bart - SII

Title

Comment
Is this the treatment plan that your physician or PT is recommending? Immobilization is not something that I usually would recommend for patella femoral syndrome. It can have some detrimental effects on the joint structures, muscles, and connective tissue. As a clinician, I try to avoid immobilization unless it is clinically necessary to protect healing tissue. Immobilized joints lose the ability to adequately get nutrition to the articular cartilage, it facilitates adhesions and contractures, and contributes to loss of muscle strength and function. You said that the MRI was negative. I am assuming that this was for any intra-articular pathology such as an ACL tear or cartilage pathology. Was there any mention of an area of inflammation, or possibly an enlarged or inflammed plica? Does your daughter have a lot of popping or clicking in her knee when she bends or straightens it out? If so, is this painful when it happens? I have had several patients recently who had complaints of severe patella femoral syndrome with episodes of "subluxation" who had a significant medial plica (an area of thickening within the connective tissue of the patella). This plica actually caused the patella to shift laterally, and it caused it to sit outside of the groove. With activity, it continued to be irritated, and it then scarred and became larger. Over time, it became so painful that just walking was hard. Some of the subluxation episodes were actually the plica moving over the patella and the femoral condyle. I say this only because a plica inflammation is sometimes overlooked because it is not readily seen on an MRI or thought about by clinicians. Rehab focusing on hip / core strength, orthotic intervention, rest, anti-inflammatories, etc should all help your daughter, and if she is not seeing results, I would talk to your surgeon and PT about other treatment options. I would also recommend that she decrease her activities to allow for a little less pain with her daily activities. These are just ideas I have based on what I have seen before clinically from patients who didn't respond to the normal patella femoral syndrome treatments. Hope this helps - feel free to comment back with other questions.

Cancel Delete Delete & Ban

throbber Updating Comments page...