showed that when using real-time ultrasonography, the mean lateral displacement of the patella was 5.067 ± 0.325 mm. Using the ultrasonography methodology, males were found to have a lateral displacement of 5.535 ± 3.635 mm and females 4.598 ± 1.178 mm. The data collected clinically can be seen in Table 1 and Figure 5.
CONCLUSION The aim of this article is not only to help to dispel the current myths and ideas of the “dark art” nature of the ultrasound modality but also to set out a viable field taping alternative diagnostic tool in patellofemoral abnormalities. This tape-measurement technique would suit therapists working in the semi-professional and recreational sporting sectors, where often only the bare essentials in equipment are available. The ideas for this were formulated by reviewing the previous available research; establishing a reliable “normal” patella position could be accomplished by utilising ultrasonography by Shih and colleagues (3,8). These measurements were corroborated using the alternative tape method of measurement, first described by McConnell (6), which has already been shown by Herrington to be reliable when the measurements are taken by trained manual therapists (5). The previous research by Watson and colleagues suggested that flaws and inconsistencies existed in the methods of measurement conducted using tape and by the palpation of anatomical landmarks or measurements obtained by untrained therapists (9). The clinical investigation of these techniques has agreed with the findings of Herrington (5). When conducted by trained professionals, the measurements collected using these techniques are both reliable and accurate.
The use of ultrasound as a
diagnostic tool in musculoskeletal lesions and the availability of equipment will inevitably lead to further research and verification of these suggested techniques. This will further reinforce
medial epicondyle
normal patella position centre of patella
lateral epicondyle
The author would like to thank Mr Lee Herrington for his assistance and supervision during the clinical data collection and Miss Nikki Mackay for her help during the study’s preparation.
4.986mm (+0.162mm) Figure 5: Illustrating the clinical normal patella displacement
TABLE 1: CLINICAL SUBJECT PATELLA DISPLACEMENT DATA Subject
Latera (mm)
1
2 3 4 5 6 7 8 9
10 11
12 13 14 15 16 17 18 19
20
83.50 87.90 74.10
88.30 75.80 82.30 73.90 85.80 84.80 79.60 75.30 77.50 83.60 67.70 76.20 78.00 84.10
91.30 85.20 82.90
Media (mm)
87.00 92.10 78.80 90.50 81.80 87.10
78.40 93.00 90.00 86.50 77.40 82.10 88.60 73.30 79.90 82.40 89.70 97.60 90.40 89.30
the reliability of the technology and its alternatives in both the clinical and the field settings. These two techniques, once the therapist is familiar with the protocols, allow for a quick and reliable method of screening for potential patellofemoral weaknesses. This is possible by establishing the patient’s “normal” patella position before the onset of pain. It can then be used to tailor consequent treatment interventions to the individual and to improve their effectiveness and reliability.
OF MEASURING PATELLA DISPLACEMENT
20
THE TAPE TECHNIQUE PROVIDES A RELIABLE PRACTICAL METHOD
A-B
(mm) 3.50 4.20 4.70 2.20 6.00 4.80 4.50 7.20 5.20 6.90 2.10
4.60 5.00 5.60 3.70 4.40 5.60 6.30 5.20 6.40
4.70 4.60 3.42 1.90
4.94 4.94 3.38 5.96 4.11
7.47 3.40 5.60 5.80 4.80 4.50 5.20 6.28 7.42 5.53 7.38
Ultrasound (mm)
References 1. Donald I, MacVicar J, Brown TG. Investigation of abdominal masses by pulsed ultrasound. Lancet 1958;1:1188–1195 2. Herrington L, McEwan I, Thom J. The reliability and validity of a clinical measure of medial/lateral position of the patella. Ultrasound in Biology and Medicine 2006;32:1833–1836 3. Shih YF, Bull AM, McGregor AH, Amis AA. Active patellar tracking measurement: a novel device using ultrasound. American Journal of Sports Medicine 2004;32:1209–1217 4. McConnell J. Commentary. Physical Therapy 1995;75:93–94 5. Herrington L. The inter-tester reliability of a clinical measurement used to determine the medial/lateral orientation of the patella. Manual Therapy 2002;7:163–167 6. McConnell J. The management of chondromalacia patellae: a long-term solution. Australian Journal of Physiotherapy 1986;32:215–222 7. Hefzy MS, Jackson WT, Saddemi SR, Hsieh YF. Effects of tibial rotations on patella tracking and patello-femoral contact areas. Journal of Biomedical Engineering 1992;14:329–343 8. Shih YF, Bull AM, McGregor AH, Humphries K, Amis AA. A technique for the measurement of patellar tracking during weight-bearing activities using ultrasound. Journal of Engineering in Medicine 2003;217:449–457 9. Watson C, Propps M, Galt W, Redding A, Dobbs D. Reliability of McConnell’s classification of patella orientation in symptomatic and asymptomatic subjects. Journal of Orthopaedic and Sports Physical Therapy 1999;29:378–385
THE AUTHOR
Richard Moss is a graduate sports rehabilitator, gaining his BSc in Sports Rehabilitation from the University of Salford.
He also gained his accreditation as a certified strength and conditioning specialist from the NSCA in 2006, before moving onto to complete his PGCE from the University of Northampton in 2009. He is a member of BASRaT, UKSCA, NSCA and IFL.
He currently lectures at Moulton College at both
BTEC and undergraduate levels and is strength and conditioning module leader on the BSc Sports Performance and Coaching programme. He also practices extensively with the Midlands and East Midlands Rugby Football Unions and acts as a sports injuries consultant for numerous other sporting organisations within the East Midlands region. He can be contacted at
sportsrehab@hotmail.co.uk
sportEX dynamics 2009;22(Oct):18-20
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