Hip and Knee Weakness and Ankle Dorsiflexion Restriction in Individuals Following Lateral Patellar Dislocation: A Case-Control Study

Abstract

Objective: To explore the relationship between ankle dorsiflexion range of motion (ROM) and hip and knee muscle strength between patients with a history of patellar dislocation (PD) to healthy controls. Design: Case-control study. Setting: Orthopaedical specialty outpatient clinic at a tertiary hospital. Participants: 88 individuals were recruited; 44 individuals aged 16 years or older, of both sexes, with a history of at least one episode of atraumatic unilateral or bilateral PD requiring emergency care (14 males; 30 females; mean age 20 years) and 44 healthy (control) individuals (11 males; 33 females; mean age 21 years) matched for age, weight and height to PD cases. Intervention: Assessment of hip and knee strength and ankle dorsiflexion ROM. Outcome measures: Ankle dorsiflexion ROM was assessed through the lunge test with a goniometer. Hip and knee muscle strength was evaluated through isometric hand-held dynamometry. Differences between healthy and control individuals were assessed using Student T-Tests and Mann-Whitney U Test. Results: PD individuals presented with a reduced ankle dorsiflexion ROM (mean difference (MD): 9°; effect size (ES): 1.39; p<0.001) and generalised hip and knee weakness (MD range: 4.74 kgf to 31.4 kgf; ES range: 0.52 to 2.35; p<0.05) compared to healthy subjects. Conclusion: Individuals with a history of PD have reduced ankle dorsiflexion ROM and hip and knee muscle strength compared to healthy controls.

Objectively quantified lower limb strength recovery in people treated surgically or non-surgically after patellar dislocation: A systematic review

“…Knee extension strength was assessed in all 24 studies; 11 of these also assessed knee flexion strength. 5,6,66,21,27,30,38,41,42,51,54 Hip abduction strength was assessed in three studies, 3,25,54 hip external rotation was assessed in two studies, 3,25 and hip flexion, extension, adduction and internal rotation strength were assessed in one study. 3…”

“…They found increased pain with slower angular velocities: 6°/second pain pre-surgery = 3.4, post-surgery = 1; 12°/second pain pre-surgery = 2.9, post-surgery = 1.2; and 60°/second pain presurgery = 1.7, post-surgery = 0.6. Four studies 3,21,25,51 did not report any adverse events and it was unclear if adverse events were reported in Liebau et al 23 as the full-text was not translated. In the remaining 17 studies, no reported adverse events related to lower limb strength assessments.…”

“…Short-term knee extension strength LSI was assessed by three studies, 3,4,6 and knee flexion strength LSI was assessed by one study. 6 After surgery mean knee extension strength was 59.8% (SD 39.5).…”

Is an Individually Tailored Programme of Intense Leg Resistance and Dynamic Exercise Acceptable to Adults with an Acute Lateral Patellar Dislocation? A Feasibility Study

“…The median follow-up timepoint was 15 (13)(14)(15)(16)(17)(18)(19) weeks. Two participants had treatment durations of 102 and 116 days, exceeding the three months permissible.…”

“…Intense leg strengthening and dynamic exercises, such as hopping and changing direction, are rarely used (9,11). As this is mainly a young active patient population that experiences most instability symptoms during multidirectional running and hopping activities (12), and that often fails to restore leg strength symmetry after injury (7,13,14), current rehabilitation programmes may be inadequate. A programme of leg resistance exercises prescribed in accordance with evidence-based guidelines (15), and dynamic exercises that prepare patients for the demands of the activities they wish to resume, could improve outcomes in terms of regaining function and reducing the risk of recurrence.…”