petella - shifting?

Good day all.

I hope you are all doing well. I recently have seen a patient which a "knee" problem".

She is currently 23 years old, female. Hx: About when she was 14, she played basket ball, where she fell and someone landed on her knee (R - Laterally) and her knee went adductively. She went for an X-ray, nothing was broken. A MRI scan was not recorded. But the doctor then said she had no # or any ligament damage.

But up until the current day, she cannot sleep with her right knee straight, as she says she feels that her knee is going to "flip over" (Hyper-extension and more) so she tends to walk and stand with her knees bent.

O/E : Patient muscles lengthen is all normal, the only thing is her tight glut max and tight ITB. Other everything is normal. On her knee, she has a bit of a knock knees and when her leg is straight. And the point just under the patella tendon, there is swelling, and when you palpate there or add pressure, it goes from uncomfortable to a slight sharp pain.

I did some read ups, and it sounds like a: Patello-femoral pain syndrome with hoffa's fat pad oedema. But I am not sure. She said it has been like that for about 2 years now.

I would just like to know if anyone could maybe point me in the right direction?

My Rx: as current

• STR of the muscles around the knee
• Release of the glut and ITB
• patella mobilization
• Strapping

She doesn't play basketball anymore, but she plays badminton now. And she is wearing a soft brace (But nothing that gives alot of support. )

I hope this is enough information.

Thanks in advance.

Tak Wing