Successful treatment for knee and patellar increase range of motion and degrees of freedom.

Case History at 3/30/2023

16 months since fall injury caused ruptured kneecap in multiple pieces ➡️ surgery reconstruction ➡️ physical therapy ➡️ some screws came out of place➡️a second surgery ➡️ more physical therapy intervention ➡️ lack of range of motion improvements leading to nerve damage/impingement ➡️ specific injection treatment and 5 out of 6 doctors seen advising for patellar replacement surgery ➡️ an unfortunately car accident for my client and significant backup with the improvements ➡️ more physical therapy ➡️ months of constant pain and difficulty to achieve basic daily physical tasks, walking with a crane, not being able to move anyhow the knee because of the excruciating pain discomfort, toe walk and ankle locked in a high heel plantar-flexion.

FRA (Functional Range Assessment) and palpation tissue evaluation

Initial findings 3/30/2023

▪️Difficulty assessing in prone position causing pain discomfort when gravitational extension of the knee and knee skin touching the table surface (high sensitivity of the encapsulated 4 type mechanoreceptors of the knee joint with result of a high muscle threshold when lengthening and alterated length-tension relationship),

▪️Knee flexion 140* Passive ROM

▪️Knee extension -40* Passive ROM

▪️Ankle dorsi flexion-difficult to assess (when walking, heel always positioned above the ground circa 6-8cm, like an imaginary high heel shoe 👠 )

▪️Absence of any patellar gliding, no degrees of freedom (completely restricted into one position),

▪️Abnormal fibrotic tissue deposition, visibly and palpable increase in volume of the infrapatellar fat pad under, medial and lateral to the patellar tendon,

▪️Restricted movement of the scar, tissue missing extensibility (notice: second surgery cut along same scar tissue)

▪️Medial part of the patellar tendon presence of a significant “ropiness”sensation of the connective tissue, (seems related with the surgery cut, a deep collagenous scar and haphazardly deposition of fibroblast cells)

▪️Additional important anatomical structures restricted over time, tissue retraction, loss of extensibility and atrophy for lack of use of the knee over 1,5 years (quadriceps group, rectus femoris insertion site, patellar tendon and all the rest of the tendons involving the patella, ACL, PCL, LCL, MCL and other knee joint ligaments, Achilles tendon and calf muscles, distal tendons of the semi-group and biceps femoris of the hamstrings including muscle bellies, etc.)

▪️Left leg bone density loss over 20%

▪️Adipose/Fatty infiltrations surrounding quadriceps tendon, above the kneecap, popliteal fossa, Achilles tendo-calcaneus medial and lateral area.

We’ve followed a treatment and training plan entirely based on Functional Range Systems rules and principles, since April for a total of 12 hands-on sessions, 45 min each, using @FunctionalRangeRelease manual therapy inputs combined with @FunctionalRangeConditioning homework, multiple daily training inputs.

My client’s successful achievements allowed her doctor to schedule an arthroscopic knee surgery where investigating if bone spurs are formed under the kneecap as also to extract and clean up all the adhesive formations still accumulated.