Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Schawnn Decker

Keywords

Young Adult; Patellar Dislocation -- rehabilitation; Patellar Ligament -- injuries; Case Reports

Abstract

Background and Purpose: Medial patellofemoral ligament (MPFL) reconstruction is a common surgical procedure for the correction of recurrent patellar instability. There is a shortage of case reports, systematic reviews, and meta analyses conducted on the rehabilitation process of MPFL reconstructions post-operatively. The purpose of this case report is to look at the role of physical therapy in the course of recovery for a patient who has undergone an MPFL autograft reconstruction.

Case Description: The patient was a 21 year-old, Caucasian, English-speaking female. She presented with the chief complaint of R knee pain. She also had decreased core, hip, and R knee strength, decreased R knee ROM, R knee swelling, and gait abnormalities status post R MPFL autograft reconstruction. The patient’s prognosis and potential for achieving her desired outcomes in terms of self-cares, home management, community, and leisure activities were excellent.

Interventions: Procedural interventions consisted of therapeutic exercise, gait training, manual therapy (including soft tissue mobilization), and modalities (consisting of a vasopneumatic device and electrical stimulation). Therapeutic interventions closely followed evidence-based concepts and guidelines described in Fithian et al’s Rehabilitation of the Knee After Medial Patellofemoral Ligament Reconstruction.

Outcomes: Over the course of the patient’s physical therapy, her functional abilities increased with regard to ADLs, IADLs, self-cares, activity level, and quality of life. The patient made significant increases in R active knee flexion and her level of pain (as measured by the 0-10 Numeric Pain Rating Scale) decreased from 5 out of 10 to 0 out of 10 over the course of her therapy.

Discussion: The patient had successful outcomes and benefitted from the services of physical therapy in her rehabilitation. This case finding is consistent with other MPFL literature, such as that of Deie et al and Cheatham et al. The patient had no instances of R patellar subluxation or dislocation post-operatively. One limitation of this case report was that the patient received further therapy services beyond the scope of this report, so final outcomes are not known. Additional special tests and functional assessments could have been conducted, both on the post-operative and non-operative knee, as a way to gain more insight into musculature weakness, tightness, or imbalance.

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