Am still in the USA.
Sounds multifactorial. Would be nice to know how well aligned the PFJ is
after that tranverse fracture. The patella cartilage might be pretty rough.
If so this could be irritating both cartilaginous surfaces of PFJ.
As to why the orthopod did the medial shift of the patella....hmmm
considering the history, sounds like he mightn't have had any better ideas,
especially if she didn't have tracking problems previous to the fracture.
If most of the pain is on the medial side, you can assume the medial PFJ
has been overloaded due to this operation, which is reinforced by you being
able to reproduce pain with prssure on medial condyle. Which would
accentuate the need to rest the PFJ so cartilage can recover sufficiently.
And as this is a slow slow process needing relative rest followed by a
graduated increase of activity, your patient is going to have to learn
The fact that you have a positive McMurray's also suggests the medial
meniscus is involved. If you stablize (lateral glide) the pfj when
performing the test this should help rule out any confounding contribution
from this structure. It is possible her pfj pain is unrelated or coincident
with the menisucs locking at specific knee flexion range.