Case Report
Kevin Helgeson, A Russell Smith Jr
K Helgeson, PT, DHSc, is Assistant
Professor, Physical and Occupational Therapy Department, Idaho
State University, Campus Stop
8045, Pocatello, ID 83209-8045
(USA). Address all correspondence
to Dr Helgeson at: helgkevi@
isu.edu.
AR Smith Jr, PT, EdD, OCS,
FAAOMPT, is Chair, Athletic Training and Physical Therapy Department, Brooks College of Health,
University of North Florida, Jacksonville, Florida.
[Helgeson K, Smith AR Jr. Process
for applying the International Classification of Functioning, Disability
and Health model to a patient with
patellar dislocation. Phys Ther.
2008;88:956 –964.]
© 2008 American Physical Therapy
Association
Background and Purpose. The International Classification of Functioning,
Disability and Health (ICF) has been proposed as a possible framework for organizing physical therapist practice. The purpose of this case report is to describe an
evaluative and diagnostic process that is based on the ICF framework for a patient
with a patellar dislocation.
Case Description. The patient was a 23-year-old woman who sustained a right
knee and patellofemoral joint injury, resulting in a sprain of the medial collateral
ligament and a suspected sprain of the medial patellofemoral ligament. Evaluation at
4 weeks demonstrated a primary impairment of patellar instability associated with the
primary activity limitation of limited walking distances. A plan of care to address
impairments, activity limitations, and participation restrictions was developed, with
modifications made on the basis of the patient’s health condition and personal and
environmental factors.
Outcomes. The patient attained all of her goals for therapy and was able to return
to her normal activities and recreational pursuits without a recurrence of a patellar
dislocation. Lower-Extremity Function Scale scores increased from 30 out of 80 to 76
out of 80 during the course of treatment.
Discussion. The ICF model has been proposed as a framework for developing
diagnostic classifications for rehabilitation professionals. The ICF model also should
be assessed with regard to whether it provides a useful process for clinical decision
making. The ICF model directs practitioners to address patients’ problems at the level
of the whole person, with modifications made on the basis of health conditions and
personal and environmental factors.
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Process for Applying the International
Classification of Functioning, Disability
and Health Model to a Patient With
Patellar Dislocation
Applying the ICF After Patellar Dislocation
T
A patellar dislocation may result in
damage to the soft and bony tissues
of the patellofemoral joint.4 – 6 A significant sprain or rupture of the medial patellofemoral ligament (MPFL)
has been highly associated with a
lateral dislocation of the patella and
can be considered the essential lesion
responsible for ongoing patellar instability.4,5,7 Consideration of the healing
time needed for the MPFL is critical
in the design of rehabilitation programs for patients with patellar dislocations. Studies of rehabilitation programs used after patellar dislocations
have described interventions only in
broad terms, with impairment-level
goals for range of motion and strength
(force-generating capacity) and for a
return to activities.8 –10
developed on the basis of an evaluative process that considers patients’
examination findings, their goals for
returning to activities, and the prevention of further patellar subluxation and dislocation events. A plan of
care based on just a consideration of
patients’ impairments and associated
pathologies may not consider the
problems at the level of the whole
person.
Rehabilitation programs for patients
with patellar dislocations need to be
Case Description
Figure 1.
Components and definitions of the International Classification of Functioning, Disability
and Health (ICF) model.1 Health conditions⫽umbrella term for diseases, disorders,
injuries, or traumas; body function⫽physiological functions of body systems; body
structure⫽anatomic parts of the body; impairments⫽problems in body function or
structure, such as a significant deviation or loss; activities⫽execution of tasks or actions
by an individual; activities limitations⫽difficulties an individual may have in executing
activities; participation⫽involvement in a life situation; participation restrictions⫽
problems an individual may experience in involvement in life situations; environmental
factors⫽physical, social, and attitudinal environments in which people live and conduct
their lives; personal factors⫽particular background of an individual’s life and living,
comprising features of an individual that are not part of a health condition. Reprinted
with permission from: International Classification of Functioning, Disability and Health:
ICF. Geneva, Switzerland: World Health Organization; 2001.
August 2008
The purpose of this case report is to
describe an evaluative and diagnostic
process that is based on the ICF
model for a patient with a knee injury, that addresses the patient’s current impairments and limitations,
and that can be used to develop strategies to prevent recurrences.
The patient was a 23-year-old female
graduate school student who incurred a right-knee injury during a
recreational floor hockey game. She
reported feeling her right patella in a
dislocated position that she was able
to reduce by extending her knee.
She was subsequently seen in a local
emergency department; she was assessed as having a knee sprain and
was placed in a knee extension immobilizer. Because she was about to
leave school for Christmas break, she
was advised to follow up with an
orthopedic surgeon in her hometown. She was seen the following
week by an orthopedic surgeon,
who concluded that she had incurred a second-degree tear of the
medial collateral ligament (MCL) of
the right knee, with a lateral dislocation of the patella. She was referred
for magnetic resonance imaging
(MRI) of her right knee; the MRI was
performed the following week.
The MRI findings reported by the
radiologist were “sprain of the medial collateral ligament with overlying edema and bone bruises of the
posterior medial tibial plateau and of
the lateral femoral condyle with a
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he International Classification of Functioning, Disability and Health (ICF) has been
proposed by the World Health Organization as a unified framework for
describing the health status of people (Fig. 1).1 The ICF recently was
discussed in the physical therapy
community as a possible framework
for organizing and directing treatment for patients and clients.2,3
Jette3 described the language, framework, and concepts used within
the ICF. Discussions about the ICF
have centered on how this framework or model can be used to develop diagnostic classifications, with
little discussion of whether the model
provides a process that is useful for
clinical decision making. In this case
report, we describe a process of
applying the components of the ICF
model for a patient with a knee injury.
Applying the ICF After Patellar Dislocation
The patient’s first visit to a physical
therapist was at a university campus
physical therapy clinic 4 weeks after
her injury. She reported that this was
her fourth right patellar dislocation
event and that she had also had multiple left patellar dislocations. The
patient gave written informed consent for treatment, and Health Insurance Portability and Accountability
Act guidelines were followed.
The patient was very anxious to regain her mobility because she was in
her last semester of graduate school
in geology and would need to be
making field trips to geological sites
for sample collection. She also was
concerned that her repeated patellofemoral injuries would interfere
with her future work as a geologist,
which would require her to make
frequent hikes over uneven terrain.
During her initial visit, she reported
having mild medial patellofemoral
discomfort that increased with walking long distances. This was a significant problem at that time of year
because she usually walked 0.8 km
(0.5 mile) to and from campus in
snowy and icy conditions. She re958
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Figure 2.
Identification of patient information and classification into the International Classification of Functioning, Disability and Health model. Modified and reprinted with permission
from: International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001.
ported feelings of instability in her
right patella when descending stairs
and walking on uneven surfaces. Her
score on the Lower-Extremity Function Scale was 30 out of a possible
score of 80, indicating the inability to
squat, run, hop, or participate in her
normal recreational activities.12
A review of systems demonstrated
normal finding for the myotomes
and dermatomes in the lower extremities. Active movements of the
left lower extremity and trunk were
all within normal limits. The patient
was ⬃165 cm (65 in) tall and
weighed ⬃59 kg (132 lb), for a body
mass index of 22. She appeared be
very fit and healthy and was very
knowledgeable about her knee
condition.
Clinical Impression
The patient’s detailed knowledge of
the history of her condition allowed
for the identification of patient infor-
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mation and classification into the ICF
model (Fig. 2). The focus of the examination was to further identify and
measure her body function and
structure impairments and activity
limitations. The interrelationships of
the ICF framework components
would continue to be evaluated during the examination.
Examination
The patient’s gait pattern was characterized by her right knee being
held in an extended position
throughout the stance phase, limited
ankle plantar flexion at the end of
the stance phase, and limited knee
flexion during the swing phase. A
walking speed test demonstrated her
walking 35 m in 25 seconds, for a
speed of 83.3 m/min (2.7 miles/h).
Her standing posture showed normal
alignments of the lower extremities.
She was able to stand on the right leg
only without discomfort for 30
seconds.
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small knee joint effusion.” These MRI
findings are consistent with a “flexion with valgus and external rotation” mechanism for a knee injury
that also is associated with lateral
patellar dislocations.11 The radiologist’s report did not include an assessment of the patellofemoral joint.
At 3 weeks after the injury, the patient was again seen by the orthopedic surgeon, who concluded that the
ligamentous sprain was healing satisfactorily. The surgeon encouraged
her to start moving her knee as tolerated and to begin a rehabilitation
program as soon as she returned to
campus. She was given a neoprene
knee sleeve with a cutout and lateral
pad for the patella to wear and was
advised to take ibuprofen at 800
mg/d for knee pain.
Applying the ICF After Patellar Dislocation
tibial attachment of the MCL and
over the medial patellofemoral joint.
The medial patellofemoral joint discomfort was further localized toward the medial femoral condyle,
the attachment site for the MPFL.
Ligamentous testing of the knee joint
was deferred on the basis of the patient’s knowledgeable report of her
condition and her overall anxiety regarding passive movements of her
knee.
The patient expressed apprehension
with minimal amounts of medial and
lateral gliding of the right patella as
well as with lateral gliding of the left
patella. To further assess the stability
of her patellofemoral joint, her knee
was flexed to the point at which she
began to complain of medial patellofemoral discomfort (approximately
80° of flexion); a medially directed
force placed across the patella immediately relieved the medial patellofemoral discomfort. These findings
were interpreted to mean that increasing tension within the MPFL
and other medial knee joint tissues
with knee flexion decreased with a
medially directed force (Fig. 3).13
Application of the ICF Model
The ICF framework was used to organize the patient’s examination information, make judgments about
the examination findings, and guide
the decisions needed for the management of the patient’s condition.14
The first step was to classify all of the
examination findings into the following components: body function and
structure impairments, activity limitations, participation restrictions,
and environmental and personal factors (Fig. 4).1
The second step was to evaluate the
interrelationships among each of the
6 concepts of the ICF framework.
The following principles were used
in this step:
1. The ICF model does not describe
unidirectional causations of the
components but does describe associations or relationships among
the components.
2. The first consideration is the patient’s problems at the level of the
whole person; these are her activity limitations and participation
restrictions.
3. Consistent with the scope of
physical therapist practice,14 the
relationships between a patient’s
activity limitations and impaired
body functions and structures are
the emphasis of the evaluative
process for determining a diagnosis and plan of care.
Figure 3.
Relief of medial patellofemoral discomfort when the knee was placed at 80 degrees of
flexion and a medially directed force was applied to the patella (arrow).
August 2008
The third step was to prioritize or
rank the activity limitations. The activity limitation the patient considered to be her most significant current problem was identified. Most
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The patient’s right knee passive
range of motion showed full extension, but she tolerated only 85 degrees of knee flexion, with complaints of medial patellar pain and
what she described as a “catching
sensation.” Volitional contraction of
the right quadriceps femoris muscle
groups was assessed with the lower
extremities supported on a plinth
with the knees extended. Visual and
palpatory comparisons of the isometric quadriceps femoris muscle contractions demonstrated significantly
decreased contraction of the right
quadriceps femoris muscle versus
the left muscle. Circumferential measurements of the right and left thighs
at 10 and 20 cm above the knee joint
line showed decreases of 2 and 4 cm,
respectively, in the right thigh muscle circumference. Palpation of the
right knee demonstrated diffuse
swelling over the medial aspect of
the joint, with tenderness over the
Applying the ICF After Patellar Dislocation
Next, possible relationships between
the patient’s primary activity limitations and body function and structure
impairments were evaluated. Many relationships were considered for this
patient. For example, the diminished
function of her quadriceps muscle was
considered to be related to the limitations in ambulation, especially in walking long distances to and from school.
Medial patellofemoral joint discomfort
also was an important feature because
this discomfort was what she initially
described as limiting her walking abilities. The structural impairments of
the MCL sprain and the suspected
MPFL rupture, along with residual
swelling from the injury, were considered to be related to the limitations
in walking and might have been related to an inhibition of the quadriceps
muscle function and to pain. The impaired mobility of the knee was not
considered to be closely associated
with the limitations in walking long
distances because the knee flexion
range was more than that needed for
ambulation.15
The strongest relationship with the
patient’s primary activity limitation
was considered to be the finding of
impaired stability of the patellofemoral joint. This impaired stability
of joint function was closely associated with the impaired structure of
the MPFL from her injury.4,5,7 This
impaired stability was a recurrent
problem for this patient and might
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Figure 4.
Classification of all of the examination findings into the components of the International
Classification of Functioning, Disability and Health. Modified and reprinted with permission from: International Classification of Functioning, Disability and Health: ICF. Geneva,
Switzerland: World
Health
From
figOrganization;
4 to 5, the2001.
stability
becomes the main impairment
have been related to other structural
impairments or to a problem with
controlling lower-extremity movements. The impaired stability of the
patellofemoral joint was considered
to be the primary impairment, with
secondary impairments of pain in
the patellofemoral joint, diminished
quadriceps femoris muscle function,
and impaired knee joint mobility.
Following these clinical judgments
of the relationships and identification of the primary impairment, the
model was reorganized (Fig. 5).
In addition to the patient’s immediate needs, the prevention of recurring patellar dislocations would be a
long-term consideration for this patient. She considered regular exercise and recreational activities to be
important components of her physical and psychological health status.
The long-term instability of her patella had significant social and economic consequences because her
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ability to hike over rocky terrain for
long distances was necessary for the
collection of geological samples for
her graduate school work and future
employment as a geologist.
The application of the ICF model to
this patient began with identification
of the components of the model determining her problems at the level
of the whole person. The evaluative
process focused on the relationship
between activity limitations and impairments. As indicated by this process, the most appropriate diagnostic label for this patient is the
relationship between the primary activity limitation and the primary impairment, which was limited ambulation distance associated with
patellofemoral joint instability. This
diagnostic label will help to direct
the goals and plan of care for this
patient.
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significant to the patient was her
limitation in walking long distances,
which was clearly related to her
limited participation in recreational
activities and potentially limited her
participation in the data collection
needed to complete her degree in
geology. Limited walking distance, therefore, was ranked as her
primary activity limitation. Because
she also reported significant limitations with stair climbing, this was
considered to her secondary activity
limitation.
Applying the ICF After Patellar Dislocation
Reorganization of the International Classification of Functioning, Disability and Health
(ICF) model following clinical judgments of the relationships among the components of
the ICF and identification of the primary limitation and impairment. Modified and
reprinted with permission from: International Classification of Functioning, Disability and
Health: ICF. Geneva, Switzerland: World Health Organization; 2001.
The patient’s prognosis was based
on her current level of activities and
impairments and the normal healing
time for ligaments. Her prognosis
was a return to her usual walking
and hiking activities within 12
weeks. The prevention of future patellar injuries was considered the
most difficult challenge because of her
previous patellar dislocations.4,5,10
Intervention
Consistent with the ranking of the
patient’s activity limitations and participation restrictions, she agreed to
the following goals for her physical
therapy program:
1. Walking needed for transportation
from her home to school without
patellar instability in 4 weeks.
2. Ascending and descending stairs
without patellar instability in 4
weeks.
August 2008
3. Returning to hiking activities without patellar instability in 8 weeks.
The ICF model includes environmental and personal factors as important
modifying variables in the development of patients’ goals and interventions. Because of the environmental
factor of the patient needing to walk
for daily transportation in snowy and
icy conditions, she was encouraged
to wear the neoprene sleeve and use
proper footwear when walking outside.16 The patient’s personal factors
of being recreationally active and
knowledgeable about her condition
made these restrictions and precautions easy for her to agree upon.
Interventions directed at improving
the dynamic stability of the patellofemoral joint were considered appropriate to address both the primary and the secondary impairments
in the stability of the patellofemoral
Cryotherapy with cold packs and ice
massage was used to address the
pain-related impairments and to control swelling around the knee. Because impaired knee mobility was
not highly ranked and knee flexion
past 80 degrees seemed to be causing tensioning of the MPFL, knee
flexion was limited for the first 2
weeks of treatment in order to allow
these tissues to heal and regain their
normal extensibility.
* Autogenic Systems, 620 Wheat Ln, Wood
Dale, IL 60191.
†
The Hygenic Corp, 1245 Home Ave, Akron,
OH 44310-2575.
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Figure 5.
joint and the diminished function
of the quadriceps femoris muscles.
First, isometric contractions of the
quadriceps femoris muscle group
with the knee in extended positions
was facilitated with the use of auditory and visual biofeedback.* This
exercise progressed to exercise with
the patient sitting in a chair with the
knee flexed to 45 degrees and the
right foot resting on the floor. Isometric contractions of the quadriceps femoris muscles, along with cocontractions of the hamstring and
hip extensor muscles, were initiated
by having the patient press her heel
downward onto an inclined platform
(Fig. 6). Because the patient had a
history of patellofemoral instability,
which has been associated with motor control problems throughout the
lower extremities,17 this exercise
progressed to standing with the knee
at approximately 15 degrees of flexion to reproduce the position of the
right lower extremity during the initial contact period of the gait cycle.18
Balance activities were started with
the patient standing on the right leg
only and then progressed to singleleg standing activities with perturbations with a Thera-Band† (Fig. 7) and
with the patient maintaining good
alignment and stability at the hip,
knee, and ankle joints.19,20
Applying the ICF After Patellar Dislocation
Figure 6.
Sitting quadriceps femoris muscle sets. Contraction of the quadriceps femoris muscle
group was initiated by pressing the foot downward. Electromyographic activity of the
vastus medialis muscle was monitored with a biofeedback unit. The exercise progressed
to a standing position to replicate the lower-extremity position during the initial contact
period of the gait cycle.
Dynamic control of the lower extremities with stepping motions was
introduced with an ⬃20-cm (8-in)
step.21 This stepping activity progressed to ascending and descending
stairs with the patient keeping the
knee aligned with the foot and maintaining control of the hip and thigh
muscles. Passive knee flexion, with
stretches of up to 2 minutes in duration, was added during the third
week. The patient had minimal discomfort with knee flexion at that
time and reached full knee flexion
within the next 6 weeks.
The patient did not attend therapy
sessions during weeks 5 to 8 because
of graduate school work that included hiking into remote areas. She
returned to therapy during weeks 9,
11, and 12 to continue her exercise
program and monitor her symptoms.
Lower-extremity squatting, stepping,
and hopping activities progressed
during these visits, and the patient
continued with these activities during her home exercise program. The
patient was counseled to avoid knee
valgus and laterally (externally) rotated positions during activities to
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Figure 7.
Single-leg standing activities with perturbations. The patient was instructed to hold on
to the Thera-Band at the level of the umbilicus, and oscillating perturbations were
applied by the therapist pulling on the Thera-Band. Perturbations can be applied in
multiple directions and at various speeds and intensities.
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The emphasis during the third and
fourth weeks of treatment continued
to be dynamic control of the lower
extremities with decreasing levels of
protection of the healing tissues.20
The emphasis of the exercises was to
replicate the multijoint movements
that occurred during the patient’s activities of walking and squatting
while maintaining good dynamic
control of the patellofemoral joint as
well as the rest of the lower extremity. Walking forward and backward
was used to increasing the patient’s
walking speed through longer stride
length and arm swing. The patient
performed standing, squatting, and
lunging activities while keeping the
hip, knee, and ankle aligned and
maintaining control of the hip and
thigh muscles.
Applying the ICF After Patellar Dislocation
decrease the risk of recurrent patellar subluxation and dislocation.
Outcomes
The patient was contacted at 6
months after the injury and indicated
that she was able to tolerate the hiking activities required to complete
her graduate degree in geology and
was planning to work as a geologist
in the western United States.
Discussion
The ICF model is a secondgeneration biopsychosocial model
designed as a framework for developing diagnostic classifications for
rehabilitation professionals.1 Biopsychosocial or disablement models
have been advocated as the models
that typify physical therapist practice and are the models used for
organizing clinical practice.3,14 The
ICF model, as proposed by the
World Health Organization, does not
provide a “process” for evaluating
functioning and disability; rather,
the model provides users with
building blocks with which to conAugust 2008
An important aspect of this evaluative process is the ability to reevaluate the interrelationships within the
ICF framework and decisions made
throughout the course of treatment.
The choice of impaired patellofemoral joint stability as the primary impairment for the patient in this case
report was reevaluated through an
assessment of the level of improvement of the patient’s primary activity
limitation. If she had not been making progress toward resolving the activity limitation in the first weeks of
treatment, then reevaluation of the
primary and secondary impairments
would have been indicated. If the
primary impairment of limited patellofemoral joint stability was still considered to be appropriate, then
changes to the interventions would
have been considered.
One of the concerns for many clinicians regarding disablement models
has been how a patient’s pathology
will be considered and applied to the
plan of care. The ICF model provides
for the consideration of the patient’s
health condition and impaired body
structures. The health condition of
the patient in this case report included repeated patellofemoral joint
injuries and impaired structures, including the MCL and possibly the
MPFL. The primary lesion demonstrated in imaging studies and surgical examinations of patellofemoral
joints after patellar dislocation is a
sprain or rupture of the MPFL.4 – 6
The plan of care for this patient was
directed initially at protecting the
healing tissues and then at addressing the lack of patellofemoral joint
stability.
Interventions directed at resolving
primary or secondary impairments
need to be appropriate for and modified on the basis of a patient’s health
condition. For the patient in this case
report, the secondary impairment of
impaired mobility of the knee joint
was not addressed until the MPFL
had had adequate time to heal. People with patellar instability potentially have ongoing pain and instability and may choose to significantly
limit their activities to avoid these
problems.8,23,24 Limitations in recreational pursuits may have a significant impact on the overall quality of
life and health status for these
people.
Conclusion
This case report highlights an evaluative process in which the ICF framework is applied for a patient with a
patellar dislocation. The ICF framework allowed for an evaluation at the
level of the whole person, with selection of goals and interventions
appropriate for the patient. Consideration by physical therapists of the
ICF model as a classification system
as well as an evaluative process may
be beneficial in the care of patients
and the management of various
conditions.
Both authors provided concept/idea/project
design and writing. Dr Helgeson provided
data collection, project management, the
patient, and facilities/equipment. Dr Smith
provided consultation (including review of
manuscript before submission).
This article was submitted August 14, 2007,
and was accepted April 4, 2008.
DOI: 10.2522/ptj.20070233
References
1 International Classification of Functioning, Disability and Health: ICF. Geneva,
Switzerland: World Health Organization;
2001.
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The patient reached the first and second goals of walking to and from
school and ascending and descending stairs without patellar instability
by week 3 of treatment and then
attained the third goal of tolerating
hiking activities without patellar instability by completing her data collection during weeks 5 and 6 of her
rehabilitation program. At week 9 of
the program, the patient scored 76
out of 80 points on the LowerExtremity Function Scale, indicating
some difficulties with squatting and
running on uneven surfaces.12,22
Treatment goals were then reestablished to include a return to running
activities. By week 12 of treatment,
the patient was running for up to
approximately 3 km (2 miles) 3
times per week and was maintaining
an independent program of lowerextremity weight-lifting activities and
jumping activities.
sider the possible interactions
among the components of the ICF
and to explore possible processes
for describing or evaluating patient
problems.1(p18) The evaluative process described in this case report
has been useful for the evaluation of
patients with musculoskeletal conditions. Physical therapists treating
other types of conditions should explore whether this process is useful
for the evaluation of their patients.
Applying the ICF After Patellar Dislocation
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11 Hayes CW, Brigido MK, Jamadar DA,
Propeck T. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging.
Radiographics. 2000;20(special number):
S121–S134.
12 Binkley JM, Stratford PW, Lott SA, Riddle
DL. The Lower Extremity Functional Scale
(LEFS): scale development, measurement
properties, and clinical application. North
American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79:
371–383.
13 Tanner SM, Garth WP Jr, Soileau R, Lemons JE. A modified test for patellar instability: the biomechanical basis. Clin J
Sports Med. 2003;13:327–338.
14 Guide to Physical Therapist Practice. 2nd
ed. Phys Ther. 2001;81:9 –746.
15 Neumann DA. Kinesiology of the Musculoskeletal System. St Louis, Mo: Mosby;
2002:557.
16 Herrington L, Simmonds C, Hatcher J. The
effect of a neoprene sleeve on knee joint
position sense. Res Sports Med. 2005;13:
37– 46.
17 Powers CM. The influence of altered
lower extremity kinematics on patellofemoral joint dysfunction: a theoretical
perspective. J Orthop Sports Phys Ther.
2003;33:639 – 646.
18 Cowan SM, Bennell KL, Crossley KM, et al.
Physical therapy alters recruitment of the
vasti in patellofemoral pain syndrome. Med
Sci Sports Exerc. 2002;34:1879 –1885.
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19 Cowan SM, Bennell KL, Hodges PW, et al.
Simultaneous feedforward recruitment of
the vasti in untrained postural tasks can be
restored by physical therapy. J Orthop Res.
2003;21:553–558.
20 Voight M Cook G. Impaired neuromuscular
control: reactive neuromuscular training. In:
Prentice WE, Voight ML, eds. Techniques in
Musculoskeletal Rehabilitation. New York
NY: McGraw-Hill; 2001:93–124.
21 Boling MC, Bolgla LA, Mattacola CG, et al.
Outcomes of a weight-bearing rehabilitation program for patients diagnosed with
patellofemoral pain syndrome. Arch Phys
Med Rehabil. 2006;87:1428 –1435.
22 Watson CJ, Propps M, Ratner J, et al. Reliability and responsiveness of the Lower
Extremity Functional Scale and the Anterior Knee Pain Scale in patients with anterior knee pain. J Orthop Sports Phys Ther.
2005;35:136 –146.
23 Hawkins RJ, Bell RH, Anisette G. Acute
patellar dislocation: the natural history.
Am J Sports Med. 1986;14:117–120.
24 Arendt EA, Fithian DC, Cohen E. Current
concepts of lateral patella dislocation. Clin
Sports Med. 2002;21:499 –519.
August 2008
Downloaded from https://academic.oup.com/ptj/article-abstract/88/8/956/2683635 by guest on 26 June 2020
2 Coffin-Zadai CA. Disabling our diagnostic
dilemmas. Phys Ther. 2007;87:641– 653.
3 Jette AM. Toward a common language for
function, disability, and health. Phys Ther.
2006;86:726 –734.
4 Arendt EA, Fithian DC, Cohen E. Current
concepts of lateral patella dislocation. Clin
Sports Med. 2002;21:499 –519.
5 Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue
restraints and osteochondral injuries of
the inferomedial patella. Radiology. 2002;
225:736 –743.
6 Nomura E, Inoue M. Cartilage lesions of
the patella in recurrent patellar dislocation. Am J Sports Med. 2004;32:498 –502.
7 Steensen RN, Dopirak RM, McDonald WG
III. The anatomy and isometry of the medial patellofemoral ligament: implications
for reconstruction. Am J Sports Med.
2004;32:1509 –1513.
8 Nikku R, Nietosvarra Y, Aalto K, Kallio PE.
Operative treatment of primary patellar
dislocation does not improve mediumterm outcome: a 7-year follow-up report
and risk analysis of 127 randomized patients. Acta Orthop. 2005;76:699 –704.
9 Beasly LS, Vidal AF. Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr
Opin Pediatr. 2004;16:29 –36.
10 Atkin DM, Fithian DC, Marangi KS, et al.
Characteristics of patients with primary
acute lateral patellar dislocation and their
recovery within the first 6 months of injury. Am J Sports Med. 2000;28:472– 479.