PDF(Pubmed)
Abstract：
There is little consensus on the conservative management of lateral patellar dislocations (LPD). Mechanical diagnosis and therapy (MDT) is an established classification system in the spinal and extremity population. This case report describes the use of MDT in the management and classification of a patient with LPD.
The patient was a 20-year-old female with a 3-month history of left knee pain precipitated by a lateral patellar dislocation. The patient described pain and a feeling of instability with standing and walking and limitations in work and recreational activities which involve lifting, squatting, and running. Based on the patient\'s response to repeated end range knee movements, the patient was found to have a directional preference (DP) for knee extension and instruction in performance of knee extension DP exercises was provided.
The patient\'s knee examination and subsequent intervention included her responses to repeated end range knee movements. Her knee pain was abolished, and strength, function, and motion were fully restored in five visits. A minimal clinically important difference (MCID) was achieved on the Lower Extremity Functional Scale (LEFS). At discharge, the patient was able to independently manage symptoms and perform all work and recreational activities at a pre-injury level and these improvements were maintained at a 9-month follow-up.
There are various management strategies for lateral patellar dislocation. This case demonstrated the use of classifying, subgrouping, and treating a patient with lateral patellar dislocation using the principle of DP.
The patient\'s outcomes suggest that MDT may be used in the nonoperative management of people with LPD who present with a DP.
The patient was a 20-year-old female with a 3-month history of left knee pain precipitated by a lateral patellar dislocation. The patient described pain and a feeling of instability with standing and walking and limitations in work and recreational activities which involve lifting, squatting, and running. Based on the patient\'s response to repeated end range knee movements, the patient was found to have a directional preference (DP) for knee extension and instruction in performance of knee extension DP exercises was provided.
The patient\'s knee examination and subsequent intervention included her responses to repeated end range knee movements. Her knee pain was abolished, and strength, function, and motion were fully restored in five visits. A minimal clinically important difference (MCID) was achieved on the Lower Extremity Functional Scale (LEFS). At discharge, the patient was able to independently manage symptoms and perform all work and recreational activities at a pre-injury level and these improvements were maintained at a 9-month follow-up.
There are various management strategies for lateral patellar dislocation. This case demonstrated the use of classifying, subgrouping, and treating a patient with lateral patellar dislocation using the principle of DP.
The patient\'s outcomes suggest that MDT may be used in the nonoperative management of people with LPD who present with a DP.
摘要：
■对于髌骨外侧脱位（LPD）的保守治疗几乎没有共识。机械诊断和治疗（MDT）是脊柱和四肢人群中已建立的分类系统。此病例报告描述了MDT在LPD患者的管理和分类中的应用。
■患者是一名20岁女性，有3个月的左膝疼痛病史，原因是髌骨外侧脱位。患者描述了站立和行走时的疼痛和不稳定感，以及工作和娱乐活动中涉及举重的局限性，蹲着,和跑步。根据患者对重复的末端范围膝盖运动的反应，发现患者对膝关节伸展具有定向偏好（DP），并提供了进行膝关节伸展DP练习的指导。
■患者的膝关节检查和随后的干预包括她对重复的末端范围膝关节运动的反应。她的膝盖疼痛被消除了，和力量，函数,动议在五次访问中完全恢复。在下肢功能量表（LEFS）上实现了最小的临床重要差异（MCID）。出院时,患者能够独立处理症状,并在伤前水平进行所有工作和娱乐活动,这些改善在9个月的随访中得以维持.
■髌骨外侧脱位有多种管理策略。这个案例展示了分类的使用，分组，应用DP原理治疗髌骨外侧脱位患者。
■患者的结果提示MDT可用于存在DP的LPD患者的非手术治疗。
■患者是一名20岁女性，有3个月的左膝疼痛病史，原因是髌骨外侧脱位。患者描述了站立和行走时的疼痛和不稳定感，以及工作和娱乐活动中涉及举重的局限性，蹲着,和跑步。根据患者对重复的末端范围膝盖运动的反应，发现患者对膝关节伸展具有定向偏好（DP），并提供了进行膝关节伸展DP练习的指导。
■患者的膝关节检查和随后的干预包括她对重复的末端范围膝关节运动的反应。她的膝盖疼痛被消除了，和力量，函数,动议在五次访问中完全恢复。在下肢功能量表（LEFS）上实现了最小的临床重要差异（MCID）。出院时,患者能够独立处理症状,并在伤前水平进行所有工作和娱乐活动,这些改善在9个月的随访中得以维持.
■髌骨外侧脱位有多种管理策略。这个案例展示了分类的使用，分组，应用DP原理治疗髌骨外侧脱位患者。
■患者的结果提示MDT可用于存在DP的LPD患者的非手术治疗。
