Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of recurrent left patellar instability. Reports multiple episodes of the patella shifting out of the trochlear groove, often associated with a popping sensation, sharp pain, and subsequent swelling. Episodes are frequently triggered by pivoting or twisting maneuvers. Patient reports apprehension regarding knee stability and occasional mechanical symptoms. No history of direct trauma in the most recent episode.
Clinical Examination Findings
Left knee examination reveals a positive patellar apprehension sign. Mild to moderate effusion noted. Patellar tracking is abnormal with lateral hypermobility. Q-angle is [Value] degrees. Tenderness noted along the medial patellofemoral ligament (MPFL) insertion. No ligamentous laxity of ACL, PCL, MCL, or LCL. Range of motion is [Value] degrees, limited by pain/apprehension. Neurovascular status is intact distally.
Treatment Protocol
Initiate physical therapy focusing on VMO strengthening, hip abductor strengthening, and proprioceptive training. Prescribe a patellar stabilizing brace for activity. Activity modification to avoid high-impact pivoting sports. Consider referral for MRI to evaluate for osteochondral lesions or MPFL injury. Discuss potential surgical intervention (MPFL reconstruction or tibial tubercle osteotomy) if conservative management fails.