Index 377. G GAGS (glycosaminoglycans), 315 Gastrocnemius tightness, 99, 102 Genupath, 104 Glycosaminoglycans. See GAGS Ground surface, 56 57

Transcription

1 Index A Achilles tendonitis/tendinopathy, 257, 259 ACL (anterior cruciate ligament) AKP relating to, 61, 94 injuries, 3, 121, reconstruction, 3 4 with bone-patellar tendon-bone autografts, 4 ACL reconstruction, AKP treatment after, anterior interval release as, ACL reconstruction, using autografts arthroscopies relating to, 305 biochemical investigations of, 315 donor-site morbidity after, discomfort relating to, , 315 problems with, 306 hamstring tendon relating to, , 309 harvesting relating to, histological examinations relating to, iliotibial band relating to, 306 infrapatellar nerve relating to, 305, knee region, dissection studies in, 307 patellar tendon relating to, 306 postoperative restriction ROM and loss of strength, , 315 quadriceps tendon relating to, 306 radiographic assessments of, sensory nerve complications and, ultrastructural examinations relating to, AKP (anterior knee pain) ACL surgery as cause of, 61 biomechanical bases for, 55 76, 102, 106 case studies for, , as chondromalacia patellae, 4 7, 16, 122, 148, 185, 245 Envelope of Function relating to, extrinsic factors of, hyperinnervation into lateral retinaculum relating to, hypoxia relating to, as internal derangement of the knee, 5 6 as most common knee complaint, 3, 4, 21 neuroanatomical bases for, patellar tendonitis as cause of, 3 pathogenesis of, 21 32, 186 pathophysiology of, PFM relating to, 3 17, 33, psychological problems relating to, 14 symptoms of, 147 treating patient for, AKP, athletes with, conservative treatment of, balance and coordination training, 155 bracing and taping, clinical evaluation used in alignment of lower extremity in, differential diagnosis in, 148 factors in, 148 flexibility in, 151 functional knee scores in, hamstring/quadriceps ratio in, 150 history in, 148 patellar mobility in, 149 patellar position in, 149 quadriceps angle in, 149 quadriceps muscle strength in, vastus medialis v. vastus lateralis in, isokinetic training, 154 isometric training, 154 kinetic chain training, closed and open, knee-related functional training, 155 patellar pain v. patellar instability problems, 147 personality-psychological factors relating to, 148 quadriceps strengthening, 153 sport-specific exercises, 155 step-by-step treatment protocol for, stretching, 155, VMO, training of, AKP, conservative management of, clinical examination, checklist for, 174 dynamic, 170 prone, side lying, 172 supine lying, McConnell program, 167, 178, 181 pain-relieving techniques, 167 quadriceps strengthening, 167 treatment conservative, 173 of foot problems, lower limb mechanics, improvement of, 180 muscle stretching, 180 muscle training, patellar taping, unloading, 175 AKP, evaluation of patient with, arthroscopy used in, emotional and psychiatric examination used in, genupath relating to, 104 history used in, ACL,

2 376 Index AKP, evaluation of patient with (continued) overuse, PCL deficiency, 94 RSD, 94 severe pain, 94 imaging studies used in, CT, , MRI, 106, 109, 112, 132 pain, psychological, RSD v., 105 differential sympathetic block relating to, 105 physical examination used in, anomalies of knee alignment, 102 axial compression patellar test, 94, feet, 102, 106 Fulkerson s relocation test, gastrocnemius tightness, 99, 102 hamstrings flexibility, , 143 hips, , 107, J sign, 102, 105 knee ligaments, stability of, 103 leg-length measurement, 102 Ober s test, , 172 palpation, 96 97, 269 patellar apprehension test, 97 patellar glide test, 94, 97 98, 171 patellar tilt test, 94 95, quadriceps test, AKP, factors predisposing to altered foot biomechanics, 168, 169 biomechanical faults relating to nonstructural, 168 structural, 168 muscle imbalance, soft tissue tightness, 168 AKP, intrinsic factors of, external device s influence on, foot orthoses, 141, kneepads, 143 patellofemoral bracing, , 144 overload relating to, , 143 studies about, AKP, prevention of exercise program constructed for, model relating to, scientific program for, evaluation of, sequence of, 138 AKP, skeletal malalignment and, classification relating to, clinical experience relating to, diagnosis of frontal plane alignment relating to, rotational plane alignment relating to, sagittal plane alignment relating to, 190 patellofemoral joint pathology and, Q angle and, 186 rotational malalignment relating to contact pressures and, MPFL strain and, patellofemoral joint position in space and, treatment for, osteotomy, level of, , 198 AKP, treatment of, after ACL reconstruction anterior interval release, background of, complications of, 300 discussion about, materials and methods for, results of, surgical technique for, 298 AKP, uncommon causes of, infrequent lesions, PFM, posterior aspect of the knee, , 124 referred pain, tumors, , Alignment clinical case analysis of, 337 of extremity, lower, frontal plane, of knee, anomalies of, 102 patellofemoral, 8 sagittal plane, 190 Anatomical factors, for patellar instability, Anatomical features, of patellar dislocators, Anatomic basis, for selective denervation, Anatomy histopathology and, of patellar tendinopathy, 269 of MPP, 244 pathophysiology and, of articular cartilage, of supratella plica, Anomalies, of knee alignment, 102 Anterior cruciate ligament. See ACL Anterior interval release, after ACL reconstruction, background of, complications of, 300 discussion about, materials and methods for, results of, surgical technique for, 298 Anterior knee pain. See AKP Aprotinin, 278 Arthrofibrosis, patella infera and case discussion of avoiding arthrofibrosis in, 358 diagnosis in, 356 expected outcomes in, pathoanatomy in, surgical indications and technical pearls in, 357 case report of diagnosis in, history in, 353 imaging studies in, 353 initial management in, physical examination in, 353 post-op rehabilitation in, 356 surgical findings and technique in, 356 Arthroscopic technique, for MPP syndrome, Arthroscopies, 16, 89, , 305 Articular cartilage patella and trochlea defects relating to, patellar, 5, 6, 7, 14, 16, 33, Articular geometry, 78 Articular pressure, 73 Athletes. See AKP, athletes with, conservative treatment of Autografts. See also ACL reconstruction, using autografts bone-patellar tendon-bone, 4 transplantation, osteochondral, 217 Autologous chondrocyte implantation, Autologous periosteum transplantation, 6, evaluation of, postoperative treatment after, , preoperative evaluation for, 232 results of, 235 surgical technique for, 232, 235 Axial compression patellar test, 94, Axial radiograph, 7 B Balance and coordination training, 155 Biochemical investigations, of ACL reconstruction, 315 Biomaterials, for resurfacing techniques, 216 Biomechanical bases, for AKP, clinical relevance of, 70 impact of running and jumping chronic lesions caused by, footwear relating to, ground surface relating to, jumper s knee, 55 patellar tendinopathy caused by, shock absorption relating to, 56 mechanical theory, 55 PFJR, 55 56, PFJ relating to, 57 61

3 Index 377 Biomechanical bases, for AKP (continued) Q angle and valgus vector, pronation relating to, 62, 102, 106 Biomechanical bases, for patellar instability, anatomical factors, VMO, insufficiency of, mechanical theory, quadricep muscles, strengthening of, exercises for, Biomechanical faults nonstructural, 168 structural, 168 Biomechanics, foot, altered, 168, 169 Biopsy, excision, 3 Bipartite patella, Blazina s stage III, 14 Bone morphology, subchondral, 8, 70 Bone overload, subchondral, 55 Bone-patellar tendon-bone autografts, 4 Bones, long, osteotomy of, 341 Bone torsion, Bracing patellofemoral, , 144 and taping, for AKP, C Cartilage. See also Patella and trochlea, cartilage defects of; Patellar cartilage defects, fullthickness hyaline, 236 patellar articular, 5, 6, 7, 14, 16, 33, 72 74, Cartilage degeneration, 7 Cartilage repair stimulating factors, 216 Cartilaginous callus, 227 Case studies, for AKP, , C fibers, 37 Chemical synovitis, 70 Chondral injury, patellar, 5 Chondral (cartilage) lesion, 5, 6 Chondromalacia patellae, 4 7, 16, 122, 148, 185, 245 Chronic lesions, Chronic synovitis, 124 Cincinnati patient perception scale, 22, 24 Cincinnati symptom rating scale, 22, 23 Computed tomography. See CT Continuous passive motion. See CPM Coordination training, 155 Covert osseous pathology, 11 CPM (continuous passive motion), , , 237 CT (computed tomography), 8, 9, 10, 25 Cyclops syndrome, 117, 124 D Diagnosis AKP and skeletal malalignment, relating to, , , 190 arthrofibrosis and patella infera, relating to, differential, 148 Diagnostic criteria, for isolated symptomatic PFM, 22 Differential diagnosis, 148 Differential sympathetic block, 105 Dissection studies, 307 Donor-site morbidity, Doppler ultrasound, Dye, Scott F., 5, E Eccentric exercise protocols, Eccentric tendon strengthening, 264, 277 Ehlers-Danlos syndrome, 101, 104 Emotional and psychiatric examination, Envelope of Function, Examinations clinical, emotional, histological, physical, , , 143, , 269, 353 psychiatric, ultrastructural, Excision biopsy, 3 Exercise protocols, eccentric, Exercises, 71 72, , 155 Extensor mechanism, components of, Extensor mechanism pathology, morphotype and, MPFL, 15, 27 28, 64 spatial planes relating to, 62 frontal, 62 sagittal, transversal, Extensor mechanism surgery, 7 Extrinsic factors, of AKP, F Femoral interference screw, 126, 129, 130 Femoral trochlea, 10 Flexibility, 151 of hamstrings, , 143 Foot biomechanics, altered, 168, 169 Foot orthoses, 141, Foot problems, treatment of, Footwear, Fractures, stress, 117, 122 Free periosteal grafts, Frontal plane alignment, Frontal spatial plane, 62 Fulkerson s relocation test, Functional knee scores, G GAGS (glycosaminoglycans), 315 Gastrocnemius tightness, 99, 102 Genupath, 104 Glycosaminoglycans. See GAGS Ground surface, H Hamstring/quadriceps ratio, 150 Hamstrings flexibility of, , 143 grafts relating to, 4 Hamstring tendon, , 309 Harvesting, Hemangioma, intramuscular, Hips, , 107, Histological examinations, Hoffa s fat pad, 117, 121, 130, 131, 171 Homeostasis. See Tissue homeostasis, PFM v.; Tissue homeostasis theory Hyaline cartilage, 236 Hyperextension, 68, Hyperinnervation into lateral retinaculum AKP and nerve ingrowth relating to, C fibers, 37 myelinated nerve fibers, 36 37, 39, 40 SP-fibers, unmyelinated nerve fibers, 37 AKP and NGF relating to, Hyperpressure, 7 Hypopressure, 7 Hypoxia ischemia relating to, neural sprouting relating to, 44, 47, 48 vascular bending relating to, 44, 48 VEGF relating to, I IIatrogenous osteoarthrosis, 8 IKDC (International Knee Documentation Committee), 14 Iliotibial band. See ITB Imaging studies, , 132, , 272, 276, 353 Immunohistochemical analysis, for neural markers, Impingement mechanism, Infrapatellar nerve, 305, Inner cambium layer, of periosteum, 227, 237 Insall, John, 4, 7, 22, 28, 33, 67 Insall s proximal realignment. See IPR Internal derangement of the knee, 5 6 International Knee Documentation Committee. See IKDC International Patellofemoral Study Group. See IPSG Intra-articular ganglion, 117, 121

4 378 Index Intramuscular hemangioma, Intrinsic factors, of AKP, , IPR (Insall s proximal realignment), 8 11, 21 22, 25, 28 30, 116 IPSG (International Patellofemoral Study Group), 4, 5, 6, 67, 323 Ischemia, Isokinetic training, 154 Isolated symptomatic PFM as AKP, 33 Neural Model relating to, as patellar instability, 33 Isolated symptomatic PFM, clinical study for, patients and methods diagnostic criteria for, 22 follow-up evaluation, patient selection for IPR, 22 statistical data analysis of, 23 subjects, surgical technique, 22 results Cincinnati patient perception scale used in, 22, 24 Cincinnati symptom rating scale used in, 22, 23 clinical, discussion/conclusion, image analysis of, Lysholm score used in, 22, 24, 25 26, 198 SEMG analysis of, Tegner activity level used in, 22, 24, 198 Isometric training, 154 ITB (iliotibial band), , 117, 121, 306 J J sign, 102, 105, 288 Jumper s knee, 55, 62, 272, 315 Jumping, impact of, K Kinetic chain training, closed and open, Knee. See specific AKP headings; specific Patella headings; specific Patellar headings; specific Patellofemoral headings Knee arthroplasties, 7 Knee extensor mechanism, components of, Knee extensor mechanism surgery, 7 Knee ligaments, stability of, 103 Kneepads, 143 Knee-related functional training, 155 L Lateral patellar compression syndrome, 7 Lateral patellar motion, normal limits of, articular geometry relating to, 78 Lateral patellar plica, Lateral patellofemoral ligament reconstruction, Lateral retinacular release, 7, 15 16, 33 Lateral retinaculum, 33 hyperinnervation into, AKP and, morphologic neural changes into, nerve damage, Lateral subluxation of the patella, 69 Lesions chondral (cartilage), 5, 6 chronic, infrequent, meniscal, 4 Lower extremity, alignment of, Lower limb mechanics, 180 Lysholm scale, 22, 24, 25 26, 198 Lysis of pretibial patellar tendon adhesions. See Anterior interval release, after ACL reconstruction M Malalignment. See AKP, skeletal malalignment and; Miserable malalignment syndrome ; PFM (patellofemoral malalignment) Malalignment correction, 205 McConnell, Jenny, 167 McConnell program, for AKP, 167, 178, 181 Mechanical theory, 55, Medial and anterior knee structures, anatomy of, 78 Medial patellar dislocations, 8 Medial patellar plica. See MPP Medial patellar retinaculum. See MPR Medial patellofemoral ligament. See MPFL Medial retinacular laxity, 67, 87 Medial retinacular structures, 82 Medial retinaculum, Meniscal injury, 16 Meniscal lesion, 4 Meniscectomy, failure of, 4 Mesenchymal stem cells, 230, 236 Miserable malalignment syndrome, , 197 Morbidity, donor-site, Mosaicplasty, 6, MPFL (medial patellofemoral ligament), 15, 27 28, 64, 67 studies of, 78 82, VMO relating to, 81, MPFL reconstruction, 340, 341 MPFL strain, MPP (medial patellar plica) anatomy of, 244 syndrome of, arthroscopic technique for, management of, 249 symptoms, tests for, MPR (medial patellar retinaculum), 82 MRIs, 16, 87 89, 106, 109, 112, 132, 272, Muscle imbalance, Muscle strength, quadriceps, 70 74, 143, , 153, 167 Muscle stretching, 180 Muscle training, Myelinated nerve fibers, 36 37, 39, 40 N Nerve damage, Nerve fibers myelinated, 36 37, 39, 40 unmyelinated, 37 Nerves infrapatellar, 305, sensory, complications of, Neural and vascular models of pain, Neural growth factor. See NGF Neural markers, for immunohistochemical analysis, Neural Model, Neural sprouting, 44, 47, 48 Neuroanatomical bases, for AKP, Neuromatous knee pain, evaluation and management of anatomic basis for selective denervation, case examples of, discussion about, technique of selective denervation, NGF (neural growth factor), 42 44, 46, 48, 50 NSAIDS (nonsteroidal antiinflammatory) medication, 296 O Ober s test, , 172 Obesity, PFJ and, 60 OCD (osteochondritis dissecans), Orthoses, 141, Oscicles, in anterior tibial tubercle, 117, 123 Osteoarthritis, 122, , 185 Osteoarthrosis, 8, 13, 22, 55 Osteochondral allograft, , transplantation, , Osteochondral autograft transplantation, 217 Osteochondritis dissecans. See OCD Osteoid osteoma, 117, 120 Osteoporosis, 50

5 Index 379 Osteotomy for AKP, skeletal malalignment and, , 198 of long bones, 341 Outer fibrous layer, of periosteum, 227 Overload AKP relating to, , 143 bone, subchondral, 55 Overuse, pain caused by, 55 sports relating to, swimming relating to, 64 P Pain. See also Patellar pain, patellar instability problems v.; specific AKP headings neural and vascular models of, neuromatous knee, overuse relating to, 55, 64, patellar, 147 patellar dislocation as cause of, 77 patellofemoral, 7 8 psychological, 105 referred, sports relating to, swimming relating to, 64 Palpation, 96 97, 269 Paratendinitis, 3 Patella. See also Bipartite patella displacement of, 16, 77 78, 83 recurrent dislocation of, 7, 16, 77 rotation of, 172 Patella alta, 67 Patella and trochlea, cartilage defects of articular cartilage relating to, anatomy and pathophysiology of, repair of, abrasion arthroplasty, 210 debridement, 209 microfracture, 210 Pridie drilling, resurfacing techniques, therapeutical options for, congruence, improvement of, conservative treatment, 204 malalignment correction, 205 patellofemoral hyperpression, lessening of, 205 Patella infera. See Arthrofibrosis, patella infera and Patella plica syndrome infrapatellar plica, lateral patellar plica, MPP anatomy of, 244 syndrome of, supratella plica anatomy of, clinical significance of, Patellar. See Bone-patellar tendonbone autografts; Lateral patellar compression syndrome; Lateral patellar motion, normal limits of Patellar apprehension test, 97 Patellar articular cartilage, 5, 6, 7, 14, 16, 33, Patellar cartilage defects, fullthickness autologous periosteum transplantation for, 6, clinical studies of, free periosteal grafts relating to, treatment, indications for, 231 Patellar chondral injury, 5 Patellar dislocation medial, 8 pain caused by, 77 patho-anatomy of, primary, 13 recurrent instability caused by, 77 surgical treatment for, 77 Patellar dislocators, anatomical features of, patella alta, quadriceps dysplasia, 87 tibial tuberosity-trochlear groove distance, 87 trochlear dysplasia, Patellar glide test, 94, 97 98, 171 Patellar instability anatomical factors for, biomechanical bases for, isolated symptomatic PFM relating to, 33 pathogenesis of, Patellar mobility, 149 Patellar pain, patellar instability problems v., 147 Patellar pathology, 5, 16 Patellar position, 149 Patellar subluxation, recurrent, 7, 16 Patellar taping, Patellar tendinopathy, 14, anatomy and histopathology of, 269 biochemical models of pain in, biochemical irritants relating to, 264 eccentric tendon strengthening relating to, 264, 277 clinical presentation of, conservative management of, eccentric exercise protocols, electrotherapy and deep tissue massage, 277 pharmacotherapy, 278 tendon, decreasing load on, corticosteroid injections for, 259 imaging appearances of MRI, 272 US, 272, 276 mechanical models of pain in collagen fiber disruption as, 260 fat pad relating to, imaging appearances relating to, surgical findings relating to, tissue impingement relating to, 262 micrographs of, 271 neural and vascular models of pain in, overuse tendinosis relating to, surgical management of, Patellar tendon, 306 Patellar tendonitis, 3, 124, short-term inflammatory, tendinosis v., , Patellar test, axial compression, 94, Patellar tilt test, 94 95, Patellofemoral alignment, 8 Patellofemoral articulation, Patellofemoral bracing, , 144 Patellofemoral crepitation, Patellofemoral disease, 3, Patellofemoral hyperpression, 205 Patellofemoral joint. See PFJ Patellofemoral joint pathology, Patellofemoral joint position, in space, Patellofemoral joint reaction force. See PFJR Patellofemoral ligament reconstruction, lateral, Patellofemoral malalignment. See PFM Patellofemoral pain, 7 8, Patellofemoral pathology, 4 Patellofemoral surgery, failure of, clinical case analysis of alignment in, 337 cartilage in, 338 stability in, clinical cases relating to, revision surgery techniques lateral patellofemoral ligament reconstruction, MPFL reconstruction, 340, 341 osteochondral allograft, , osteotomy of long bones, 341 tibial tubercle transfer, Pathoanatomy, Pathogenesis, of AKP, 21 32, 186 Pathology. See also Extensor mechanism pathology, morphotype and covert osseous, 11 patellar, 5, 16 patellofemoral, 4 patellofemoral joint, Pathophysiology of AKP, of articular cartilage,

6 380 Index PCL deficiency, 94 Perichondrium transplantation, Periosteal flapping, Periosteal grafts, free, Periosteum, inner cambium layer of, 227, 237 outer fibrous layer of, 227 Periostic autologous transplants. See Autologous periosteum transplantation Personality-psychological factors, relating to AKP, 148 Perthes disease, 102 PFJ (patellofemoral joint) contact stress, 60 61, 67, 69 disorders of, 4, 6, 7 obesity s impact on, 60 parts of, 8 PFJR relating to, reaction force of, 73 PFJR (patellofemoral joint reaction) force, 55 56, 57 61, 64, 67, 73 74, 103 PFM (patellofemoral malalignment). See also Isolated symptomatic PFM; Isolated symptomatic PFM, clinical study for AKP relating to, 3 17, patellofemoral and tibiofemoral osteoarthrosis relating to, 13, 22, 55 tissue homeostasis v., 3 17 PFM theory, tissue homeostasis theory v., Posterior aspect of the knee, , 124 Postoperative restriction ROM and loss of strength, , 315 Postoperative treatment, after autologous periosteum transplantation, , Primary patellar dislocation, 13 Pronation, 62, 102, 106 Proximal malalignment syndrome, 7 Psychiatric examination, Psychological pain, RSD v., 105 Psychological-personality factors, relating to AKP, 148 Psychological problems, AKP relating to, 14 Q Q angle, 15, 55, 168, 186 valgus vector and, 61 62, 102, 106 Quadricep muscle exercises for, strengthening of, 70 74, 143, 153, 167 Quadriceps angle, 149 Quadriceps dysplasia, 87 Quadriceps muscle strength, Quadriceps tendon, 306 Quadriceps test, R Radiograph, axial, 7 Radiographic assessments, Range of motion. See ROM Realignment surgery, 4, 8, 10, 15, 50. See also IPR Recurrent dislocation of the patella, 7, 16, 77 Referred pain, Reflex sympathetic dystrophy. See RSD Resurfacing techniques, autologous chondrocyte implantation, biomaterials, tissue engineering, cartilage repair stimulating factors, 216 mosaicplasty, osteochondral allograft transplantation, , osteochondral autograft transplantation, 217 perichondrium transplantation, periosteal flapping, single block transplantation, Risk factors, 148 AKP relating to, , extrinsic, intrinsic, , ROM (range of motion), , 315 Rotational malalignment, Rotational plane alignment bone torsion relating to, TT-TG relating to, RSD (reflex sympathetic dystrophy), 8, 94, 105 Running, impact of, S Sagittal plane alignment, 190 Sagittal spatial plane, Schwann cells, 39, 42 44, Scientific program, for AKP, prevention of, SEMG analysis, Sensory nerve complications, Shock absorption, 56 Single block transplantation, Skeletal malalignment. See AKP, skeletal malalignment and SMR (superficial medial retinaculum), 78 Soft tissue tightness, 168 Spatial planes, SP-fibers, Sports, pain relating to, Sport-specific exercises, 155 Strength, loss of, , 315 Stress fractures, 117, 122 Stretching, 155, , 180 Subchondral bone morphology, 8, 70 Subchondral bone overload, 55 Subluxation, 7, 16, 69, 85, 106, 107, 126, 129 Superficial medial retinaculum. See SMR Surgery ACL relating to, 61, 298 AKP relating to, 298 for arthrofibrosis, for autologous periosteum transplantation, 232, 235 extensor mechanism, 7 for isolated symptomatic PFM, 22 for patellar dislocation, 77 patellar tendinopathy relating to, patellofemoral, realignment, 4 Swimming, pain relating to, 64 Synovitis chemical, 70 chronic, 124 localized pigmented villonodular, 117, 119 T Taping and bracing, for AKP, patellar, Tegner activity level, 22, 24, 198 TEM (transmission electron microscope), Tendinopathy, 3, 48. See also Patellar tendinopathy Tendinosis, 3 Tendonitis, 3, 257, 259. See also Patellar tendonitis Tibial external torsion, Tibial tubercle, anterior, oscicles in, 117, 123 Tibial tubercle transfer, Tibial tuberosity-trochlear groove. See TT-TG Tinels point, 366 Tissue deep, massage of, 277 soft, tightness of, 168 Tissue engineering, 216 Tissue homeostasis, PFM v., 3 17 Tissue homeostasis theory, Envelope of Function relating to Zone of Homeostasis within, 11 Zone of Supraphysiological Overload within, 11 PFM theory v., 13 Tissue impingement, 262 Transmission electron microscope. See TEM Transversal spatial plane, Treatment protocol, for AKP, Trochlea. See also Patella and trochlea, cartilage defects of femoral, 10 Trochlear dysplasia, 67, 190 TT-TG (tibial tuberosity-trochlear groove), 87, Tumors, ,

7 Index 381 U Ultrasonography. See US Ultrasound, Doppler, Ultrastructural examinations, Unloading, 175 Unmyelinated nerve fibers, 37 US (ultrasonography), 272, V Vascular bending, 44, 48 Vascular endothelial growth factor. See VEGF Vascular innervation, 42 Vascular models of pain, Vastus lateralis, vastus medialis v., Vastus medialis obliquus. See VMO Vastus medialis, vastus lateralis v., VEGF (vascular endothelial growth factor), 45 46, Victorian Institute of Sport Assessment. See VISA VISA (Victorian Institute of Sport Assessment) score, 272, 273 VMO (vastus medialis obliquus), 14, 15, insufficiency of, 65 67, 70 relating to MPFL, 81, training of, VMO, training of, Z Zone of Homeostasis, 11 Zone of Supraphysiological Overload, 11