Knee assessment

Hi everyone. Doing the blog thing while I have some spare time. Just in case you were interested, a quick update on my patient from last week. Was able to complete the objective Ax and did a gentle GII transverse mob at the relevant level. No immediate change, but the gentlemen left an item at the clinic and returned the next day to get it. He reported that his back was still sore but "...the pain in my leg is gone. Strange. I wonder how that happened?". So it feels good that I had some effect on the referred pain that was one of his main complaints. Now I just have to talk him into the fact that it was the treatment that is responsible for the change.

Anyway, I'm posting about a patient to whom I might not be able to make any change. A young man has presented post patella subluxation x3 over the last 6 months. All incidents were in a sporting context, where (via sharp direction change or external force) the knee has given way in a valgus direction. No current pain on any activity. Is still playing some sport but is scared of recurrence. Given the mechanism of injury I expected to find laxity in at least one direction and started a thorough knee assessment, going through all the orthopedic tests. No pain, no laxity, no clicking. I wasn't gentle. The only finding I have is from observation. He has a patella that sits high and laterally.

So what can I do? Well firstly I can see him again to re-check a number of things that I wanted to be more sure of: Foot position, tibial rotation, VMO activation/sequence, ITB tightness... Thing is, there's nothing wrong with his VMO activation. His stability around the hip and lower trunk is excellent (used some PNF techniques to assess: static and dynamic stability...). There is no way that I could claim that my initial objective assessment was good enough to exclude every problem, which is why I'm seeing the patient again. It will be interesting to see if I find anything more, given that now my focus is on trying to find a reason his patella sits high. So we'll see what happens. Patella alta can be surgically corrected, but I want to be sure before I suggest surgery as an option.

I'm writing about this patient because so far it has been a really good learning experience. Not only did I get to do the full bunch of orthopedic tests (among other things) but having to reason my way through a number of different ideas has really prepared me for my next knee patient.