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Patella Alta: A Comprehensive Review of Current Knowledge. Physical Therapy: Manual therapy can help to improve the resting position of the kneecap Patellar Taping: taping can also help to correct the position of the patella Ice Packs: regularly applying ice packs can help reduce pain and inflammation with symptomatic patella alta - see the ice wraps section - Running further than you are used to doing too quickly. 164 50 Gardening and yard work can be a great form of both exercise and stress relief if done correctly Jennifer Keitel, a native of Dewitt, Iowa, grew up as an Iowa Hawkeye fan. knbWGAHwbrqIG9zW/FwTowMkE0rH6zgZLXGp5PptLrAR9DaXBwd5jaf9yRgQqwuOs9OLr2+sP1Zh bvHu2Rx93CSmdWSy1/phr2u2h/uaQIIB+lxOvCSnjfrt1nq3T+sU0YOS+ip2O17mtiC4vtE6jwCB 0000008391 00000 n /CA 1 Best Exercises for Patellofemoral Syndrome - WebMD WSA2Gw2Wn9ztykpTsjp+NaG2ZeUTU4ksh9gJZA922t2g9OefNJSOx3TmhpfnZ3vYNrQbQQGONbiQ In this condition, the patella is pushed out to one side of the groove when the knee is bent. Thank you!" Medical Review:William H. Blahd Jr. MD, FACEP - Emergency Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Joan Rigg PT, OCS - Physical Therapy. 0000067195 00000 n In addition to your exercise program, many doctors will recommend using a brace or taping technique to keep your kneecap in proper alignment. Knee braces or arch supports may help improve pain. Adobe InDesign 6.0 >> /XObject << /X1 184 0 R /X2 210 0 R /X4 211 0 R >> >> /BM /Normal 0000001076 00000 n Dont worry! Move back to the starting position, with both feet on the floor. ?V 6PKa 2L)j0)0r*0?M= S(}9RtUy(XY9WH,{EV_,/z_wq04]u[:", ^&4]"mD$6&m*eIeCaXD!:2nYf:4)#';4} QLVkq =BCrtPWw~H)=Xe_CgJoRZFp}SSzIR|([Wr4y `>$ggg+dAv1{f}I4+MO1. xmp.iid:74117FEA2007116883808B8213850D82 0000014147 00000 n uuid:91a0aa47-95d2-452f-b780-8e237f0ee657 Patella Alta is what is known as an idiopathic condition, meaning that the cause of high riding patella is typically unknown. When your knee is bent past this point, your kneecap will have more contact with your thighbone, causing more pressure, pain, and possible cartilage damage. 0000014274 00000 n xmp.iid:0B71896720321168B34BA564586C664B mna4GAe4SErUY09J9T+o5/UK88Z1zrvTbXs3RpuFsxEeCcCtkHT6z/yj0L/04Wf+2OeitY/VX/xL 0000038054 00000 n jQ9jwWua4SCDoQQUlMklKSUpJSklKSUpJSklKSUpJSklKSUpJSklKSUxcxjxte0OHgRISUw+zY/+ xmp.did:61B952D320301168BC05A9DFDBC72DD4 0 0000078771 00000 n /Size 214 January 2012, This site complies with the HONcode Standardfor trustworthyhealth information. /FontFile3 174 0 R Sign In For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. Yc8h4axrCW7QfiI1lLiTwtijqWH6TWMfZaawWOOxznzWG7t+1v0vcPj2TUpT1CgP9PbcT7dRTZHu YOv8UlJWY2A60XnAyBZfaAS6dDBsFh/SENbqfOe0pKWbRg73AdOyGwDcX66mx/ubpZuLiXOMf3iU A lateral view from the side should be used, with the knee in 30 degrees of flexion. Rest for up to 10 seconds between repetitions. >> 67LXiuppe93DWgkn4AIE0kAlT67K9vqNLd43N3AiWnuPJK1EEKYx9jgytpc5xhrWiSSewCSgLU9j Adobe InDesign 6.0 d7g4+nW4O3u2j80TpGuqSmLrumOp9A5uWS6ZsZ6gsO0STLKx+a06/d2SUzy3dOdc+t+ZkU2t9xDH 2011-06-24T11:55:42-07:00 The authors report no declarations of interest. H\n0yCi%V?`:P~6:i(v,?u;[U-+;>veJ.a6wuDt8~C]q7_oM/b?uTWXK-`N[7S:k1c 0000000016 00000 n Treatment of Patella Alta with Taping, Exercise, Mobilization, and Functional Activity Modification: A Case Report. << 0000013982 00000 n G&NO6&"/RH.aX@9@ZM"*\VpiTe=^03;FLw8382#!QAQAjBsMdK yS Adobe InDesign 6.0 /;/metadata 0000000017 00000 n The three lines indicate the superior margin of the patella, the inferior pole of the patella, and the tibial tubercle. LDusBaCHEay7TVJS/wBmxoI9JkE7iNo5JJnjxKSl6MejFr9LHY2pkl21ogAuMmAkpIkpSSlJKUkp WebHOME EXERCISE PROGRAMME This home exercise programme is divided up into specific sections, each addressing different issues that can cause PFPS. hb`````sf`c`*gd@ A lZ50F^,LtvImasf2y=Etso(e+-`](j)32Di] H3 AAy4y4/MpKXDK+AG6+AGsJKW+z48FvpMg8jaIOs/lSUuaajyxpnTgeX9ySlelUdCxvM8DkCPyJKV 167 0 obj -EqD3-%i!} nd8}+-`5znk6]t]3~MTy6zWUx1]+^RkGbwv8_|k\o=Y^\O%/r YJV=&3 7o`})xAS)x saved Brandon, Colin R. Smith, Tom F. Novacheck, i@E-`u$Je| zGx%EA=#kJa6"2yCJr|VeXNR,N>5(A4{`? xmp.iid:D4656DF3201B1168B34BA564586C664B Keep that leg somewhat bent at the knee. /K;M]2b; f tE2Nk4v}g T#ne,V|R4@ts]*6+-3C,pmh_Q $BeyM;t3{] a6GM1#J$OTsa* Not familiar with all this medical jargon? /metadata 0000037501 00000 n HWmo6n >@GU/@In@ADf;%7m Qs|Q6NZxfZ8?E4`~|Rxhf(2vI3|D*sfwjz0:A!Zs /metadata USUr/nT9VP8Ay6wf/Yyv/wBKJKV/zp+qn/l1g/8AsZX/AOlElK/50/VT/wAusH/2Mr/9KJKV/wA6 d3j4JKU7N6NW2u92fkbMhzq2nfYWucxpY7t7fonURqkpnV1PpJoyeoMzbrKccNbaSXQ32tcCGlo5 xmp.iid:74117FE92007116883808B8213850D82 If you do not have a footstool, you can use a thick book, such as a phone book, a dictionary, or an encyclopedia. 2F1v/wAr8r/tmz/yKXuQ7q9nJ+6VfsLrf/lflf8AbNn/AJFL3Id1ezk/dKv2F1v/AMr8r/tmz/yK But/STDXSXGXe4b7GiPmkpHfTivaK3YGZY1oYAQ8iIJeP8ODILufxSUkyW49L3FuFk3faY3vqP7o PmH1frP/ACj0L/04Wf8AtjnrMdtzsSuy7/F5hVVNc97+kVtaxokuJxYAACfjNTDHmBOOXk+dfsLr The patella is therefore at risk of being pulled sideways over the low edge of the groove as the knee bends, and can partially or fully dislocate out of position. Slide a rolled up towel or blanket under one knee so that it is slightly bent. /;/metadata f+nCz/2xz0lMfqr/AOJfof8A4Rxf/PDUlJuqjAcXNybraLRS5wspB3srBhzmkMcAdYREqQRbRDuh HdJSTpOd0uy04uFlWZNj2m0CxznQyvbXpuEDUpKaX1+cW/VrIgwS5oB8ykkPjeHjZZZZ1LFhwxLG Thanks for your help and excellent work." 3 0 obj 0000014990 00000 n WebStep 1: Lie on your side with legs slightly bent and hips stacked. 0000016912 00000 n 0000002787 00000 n SB1NrXS3SGEAe2YHOsHUn8NElMy9grbZ+0PZY/ax/sguBd7Wnv4fJJS7nN2tJzy1g3yTtG4O+jrA ws9QAOBc5w0LjPuJ193+sJKbSSlJKUkpxPrgwWdFe08Gxn5UzJsuhu+cu6XXThekxvrPaGeROwt7 /TrimBox [ 0 0 836.22 595.276 ] 0000001733 00000 n Patellar 72.00 0000036819 00000 n JPEG 169 0 R /GS2 170 0 R >> /Font << /T1_0 171 0 R /T1_1 175 0 R /T1_2 179 0 R :}&*#&F9e5nu.. /Length 327 2011-07-18T12:32:34-07:00 Treatment of patella alta with taping, exercise, Verify here, This is one of the best self-help & info sites of any medical condition I've ever seen. Step The explanations are so clear. 2011-06-24T13:10:17-07:00 /Filter /FlateDecode 0000037314 00000 n Tighten the quadriceps (thigh muscle) within your straightened leg and raise it to a 45-degree angle. 0000006856 00000 n Gk7jMzCmy8rLDr0LW5bn48yKB1G7HGI+20f8Yz/qgomwX0uz+bd/VP5FIxOX1n/lHoX/AKcLP/bH NideY7pKcrK6j0T1b678q3Hdj2Obbte5skse90bZ0iTpqCPFJSfIv6XRkubkZVjXj2moPIDZB7N8 HW[d~_qCCOtH zxRI*ts$O?u.$edJi1(m}~tl*M0>~9=Wxu3/ 2011-06-24T13:04:42-07:00 << sb9ssIEb5B7zMJKa/wCztux7On4xcww0aN2ggs9rg0x7I7eISUmqxTWfbisG39Kwl5dFjtu4NBBg default WebThe patella fits into a groove at the end of the femur (trochlear groove) and slides up and down as the knee bends and straightens. Adobe InDesign 6.0 2006; Flandry and Hommel 2011). Patella Alta: A Comprehensive Review of Current Knowledge Accessibility 0000002504 00000 n 0000001575 00000 n 0BpG7dLp0gRpr2lKa7sy9jrA7EsOxxDNha7e0Cd2pbEnSElLfb7Be2l2LcNxeA/27fY0O/e/OmAk Patella Alta, aka high riding patella, is where the kneecap sits higher than normal on the thigh bone. November 2016, 2. u9SAGbfnf0cep6EueNvhJICE+YEhS6PLcPqbdl5c5Rrnsf8AF0Saep/1afyXJ0Vk3ous/wDKPQv/ Patellar 174 0 obj Lower yourself about 6 inches. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> hbbd``b`$_" SLAb z,P 1+DdH Ab``$@g, ` j; endstream endobj startxref 0 %%EOF 163 0 obj <>stream gcucYA/o/ikcGQC6THmsUjQLZ6t9WPq3Xn9FZX0nBY27OeyxrcaoB7Rh5r9rgGajcwH4hRM6qP8A However, you should begin exercising once your symptoms resolve and youre cleared to exercise by your doctor or physical therapist. pw;xkfM`MM`MM`MoEXDXDX9O'fFS#}0#{37#{37,gxCytCH?go6'8|5e~ endstream endobj 92 0 obj <>stream 0000029835 00000 n 3>*]V%HVx#&n*qUHff |:]wn}pGW_~$x8'T^sQkp:|>s>kG9A:Z;xSL *h"D/s"cV6@h A9i? MrSBRm1alL=0Xte6oANPYg&*[rGMAR;G]9 xmp.iid:EC423A7620251168B34BA564586C664B - Exercise where you have poor balance and control of your lower limb movement can also increase your risk of developing patellar tendinopathy. >> Repeat 20-30 times. Unable to load your collection due to an error, Unable to load your delegates due to an error. u&*1tYem@eF XG=S\ohp7nu"Z$Z&q(V4m|fiL]y^bTL`46ikeF?XbUl. Adobe InDesign 6.0 Kaiser Permanente is not responsible for the content or policies of external websites. xmp.iid:0B71896D20321168B34BA564586C664B >> /SA true Ez7RruSU+c/40H7OvUEmAMNhP/blyaRZXx0Dx1X2rqHTrxU4hz3D0hJAAYQ7T8U8kRkFouUW50n6 Adobe InDesign 6.0 }ylnm?-D*pCrqBvU:3U*8L#itDf'*|;OMv=YGgt.Fj*dHF,:c*|20 c$`1y3I[':b JOn7N#CS%xIBSDeH#Q{>qdz[ > 48UBqOh;luzAwdUDmdS>u2-vsmo S&};umbNC>bInyl>Am+6s64ih6'!FwS=a:Gcolbl- q~!a~7_-J]v endstream endobj 3 0 obj <> endobj 6 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>>>/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 7 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>>>/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 27 0 obj <>stream It has a C-shaped buttress and versatile strapping system, which supports and helps ensure proper movement of your kneecap. paivpz27W9OyK2F7rSHsc0bqtG+0u4cHHaElLZWNg2lr7umZFzrve7byCXSGum1oHw4CSmd1eC5p /SA false saved ifgkpKzpLGOa/wC1ZbiwAe650Ej84gQCTHw8klJnYLXzN10O9QEb9CLBqPl+b4JKQnpDCwtdlZR0 If youre worried about your kneecap subluxing or dislocating again, try wearing a knee brace throughout the day and while exercising to prevent maltracking of your kneecap. eToxEVpkSx6z/wAo9C/9OFn/ALY56chj9ViB9VuiEmAMDFkn/iGpKb1znueHU5LGAD6JggnXlEEI HPLwLN0MdANeyWnTn3j/AFhLgNK4glt6v0+hzm22Fpa4MjY8y5ziwBsN19wjRIQJVYRt670x93ot The patient was a 56 year-old female with bilateral knee pain associated with PA. Pain on the front of the knee after sitting for a long period of time with your knees bent, such as one does in a movie theater or Patella Alta: A Comprehensive Review of Current Knowledge. AFHZKTb8/azYKCY943ujv9H2/BJSz7c8BmwY5cY3gvcIJcPo+3X2z80lMX29RDi1gxmhxIrLnuk8 Attach one end of the loop to a secure object, or shut a door on it to hold it in place. J4 u7jvokprCrp+MwVUdNuHq0gFtNe2Ge5wZu3tAI3u0n+CSkbqOnOAa7pWS5rXOe1pbIJcQ1xg2xr6 Bethesda, MD 20894, Web Policies KdG+i61wdXk2UDa5u1grIJPDvexxkduySkQwcsOn9oZB0iC2iOZ7UD4f7UlLvw8pxBbn3sgNBDW0 /K/7Zs/8il7kO6vZyfulX7C63/5X5X/bNn/kUvch3V7OT90tvpHRusVdWwrLMHJYxmRU5z3UvAaA K12 HD055931/HD/NICHD NIH HHS/United States, UL1 TR000448/TR/NCATS NIH HHS/United States. /T 335078 There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS. 213 0 obj /;/metadata 2011-06-24T13:17:09-07:00 Hhorj3QQC0nzlJSzftHpNsf1hgD2Q1zW07d4Jre5pI19zmiOx8ZhJSau6uH1O6iyw3NDaj+jDmk6 /L 338486 PATELLA STABILIZATION PROTOCOL . $1opLL}wyT:IL4-Gw9YupMWq,&K7U3t6SOiC]wg_5E%Pnp"Vu /Encoding 172 0 R bne2QdSJ2/Id5l1x7Ioqa7LG6tmbS4ktDC5oJBBebGkBwn2RHfQylcVast2V6T2jNo9QuGx5YIAn Adobe InDesign 6.0 pI7Ksa1rhj2OL9NoAke7brrHGqSkL+pPYyx5xLz6UbhDe8cS6DG7VJTdBkA+KSl0lKSUpJSklKSU Lie on your side with the leg you are going to exercise on top. PDF/X-3:2002 Patellar and Quadriceps Mechanism: Clinical, Imaging, and >> 0000036889 00000 n Michael H. Schwartz & Darryl G. Thelen. 0000004237 00000 n To perform this exercise: Lie on your side with your hips, knees, and ankles stacked on top of each other, with your knees bent. 168 0 obj mwhjNSU0mgvAJLZ+zYltjfRva51ANkuENLoc1zQT5FTS5TIcQlW5a8PiGGPMGF7DfxQ1Yz6Kh6kF saved tcXV5fVWZnaGlqa2xtbm9jdHV2d3h5ent8fX5/cRAAICAQIEBAMEBQYHBwYCOwEAAhEDITESBEFR Patellofemoral articulation, along with the attached quadriceps and patellar tendons, forms the extensor mechanism of the knee. Rehabilitation Protocol for Patella/Quad Tendon Repairs hc/V7Edi1Yr3Oc2lljGnzt2y7T4Je4bT7QqkZ+rOPvbY257HNsNp2gQZe20NgzoHMafkl7hR7IX/ Navigation Menu - Opens a Simulated Dialog, William H. Blahd Jr. MD, FACEP - Emergency Medicine, E. Gregory Thompson MD - Internal Medicine. 0000040329 00000 n The Health Encyclopedia contains general health information. 0000002531 00000 n 0000040391 00000 n 0000239475 00000 n Stand on a single-step footstool. created A fluid filled sack that sits below the patella, and can be felt on either side of the patellar tendon (the patellar tendon connects the patella to the tibia). - Excessive plyometric exercises (e.g. /ca 1 6F/6cLP/AGxz0lMfqr/4l+h/+EcX/wA8NSU2uoUUW21erVbY6Za+p9jNu326uqIjSwoiRCCLROpp 6USUr/nT9VP/AC6wf/Yyv/0okpX/ADp+qn/l1g/+xlf/AKUSUr/nT9VP/LrB/wDYyv8A9KJKV/zp /AIS false 0000039340 00000 n saved Around 30% of cases of recurrent patella dislocation are thought to be due to patella alta. Stand with your hands lightly resting on a counter or chair in front of you. Patellar Femoral Pain Syndrome Rehabilitation Exercises 2cn7pV+wut/+V+V/2zZ/5FL3Id1ezk/dKv2F1v8A8r8r/tmz/wAil7kO6vZyfulX7C63/wCV+V/2 saved /Pages 162 0 R Make sure your knees do not go in front of your toes. YIqcBp7TEfBJTmdZ/wCUehf+nCz/ANsc9JTH6q/+Jfof/hHF/wDPDUlOqXuFraxW4tc1zjbLdrSC /;/metadata 2011-06-24T13:13:29-07:00 x+kcCy2XFs1/QPuOjjpCSmTqum+i5r8W9lbIf7W2SSJp0FbtxIH4QeySkX2XpVFm4YVznSHzDnCZ /Resources << /Properties << /MC0 167 0 R >> /ExtGState << /GS0 168 0 R /GS1 b#P .~hU'`yA#dc:@a:5G`YS(%p%4=S,8XB[@4=r. %%EOF AObWONoF1hDSw7XwQfTdvYHRHEn70vcKvZC9X1bw6gIO4tLS0vaCQG+nDdIMD00jkKhhAdRwIpcH Adobe InDesign 6.0 Influence of patellar position on the knee extensor mechanism 2016 Jan;31:74-8. doi: 10.1016/j.clinbiomech.2015.09.018. 0000049429 00000 n Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. 0000049524 00000 n H\n0y )$*&SQ5G 2,(o*@j0CF(D))IyQ*JKEHQr"K$OeyejTO+Uf5Lkf#lq"UU,FZZ,8aq,[n. %PDF-1.4 and transmitted securely. 0000122315 00000 n tltT3Oa+kta8FjiQXucxg0B+kWafLxTuAosL/tbD3sYC+Xtc4ex35jW2EHTna6UuEqtF+3+mm/7O 0000039780 00000 n The patella usually remains somewhat subluxated on the initial radiographs due Wall squat: Stand with your Out of all the others, yours is so informational and easy to read." trailer <<298CE51391CF4952BCD7A0AFE9918AE7>]/Prev 486769/XRefStm 1386>> startxref 0 %%EOF 125 0 obj <>stream 7 Patellar Tracking Exercises That Will Improve Your Life Quadricep Contraction (Quad Sets) Sit with both legs extended in front of you. Patellar 2011-06-24T11:46:16-07:00 You will be told when to start these exercises and which ones will work best for you. 1r6qdN69kDJzX3NcKxVtrc0NLQXO/OY7X3JpiCkSpqVfULo1LG11W5DWsAa0bmaAf9aQ9sLuMpB9 / w91fbv8AFX/3E6f/AOwH/vul93ydlffMPdX27/FX/wBxOn/+wH/vul93ydlffMPdX27/ABV/9xOn Slowly bend your knees so that you squat down like you are going to sit in a chair. Rest for up to 10 seconds between repetitions. 0000009089 00000 n /Contents 183 0 R Incorrect taping method as performed by the patient. xmp.did:D4656DF2201B1168B34BA564586C664B nZX3zD3V9u/xV/8AcTp//sB/77pfd8nZX3zD3V9u/wAVf/cTp/8A7Af++6X3fJ2V98w91fbv8Vf/ 0000248494 00000 n h}pWnKA|@5+F+nb(lV/}Q.fe qPMR5-(U}ci'TZn\0~$c= x0HkYe0J. There are two types of patellar instability. /CapHeight 700 87 39 in normal and crouched walking. /ID [<443d2f177b4ada677ab4e36944422e70><443d2f177b4ada677ab4e36944422e70>] Patellar Instability Picture illustrating the patellar alignment of the right (a) and left (b) knee of the patient. without arching your low SUiNuRDGWZVDbHODm7RG5rR7xDnO7lJS7bcr09b6DY5xDY+j+bA5ng/ikpgLM5un2jHc1vLnc6ci xmp.iid:EC423A7E20251168B34BA564586C664B >> Patellar Femoral Pain Syndrome (PFPS) - OUH /SMask /None Do not drop your hip back. !xuWpP\"aGUCYGl$g7E&V{dul_yx(YIz-a _2T:"y$c$tffE^ 9')YzAF) HR]2b.4(Pvr/T`*}w`I(\?xx0=)Y]Gz2u*3g9$K:' *q8GvxzRzO}WqPC.PAce1KF2O4 S*qD[vTU{nbF ]zv3]! /FirstChar 1 /FontWeight 300 164 0 obj However, this exercise will increase rectus femoris activation (Soderberg and Cook, 1983) and as a result, it may worsen patella alta in patients with this disorder. Patella alta is one of the factors which can cause knee pain (Holtzman and Harris-Hayes, 2012). Stress is force divided by the area the force is applied over. 2011-06-24T13:12:55-07:00 *.o^(di%^A5}[-W}z/>p__Oy>s|Xi~\,OL) I>Gk?c6ITS'??eUhFuon58QP[c%b~Vs. Careers. Keeping your back straight, step up with your affected leg. WebLift the lower part of your affected leg until your leg is straight. WebPatellar Tendon Mobilization. pVMW1YRx35DM7NFdn6MOJdLd2zVrX1+HeOCSEuPwVTC63pn6EjLyK9tLHuDGWb7KYuZXIayQS8zx a7MDoP2Glz2Y3omvGdXkC6b35D3sF9b6/U0aAXfmiEeKdrRDHwjatPtS9LwuhZ2RmG+nDqoZe7Ha 0000002021 00000 n See this image and copyright information in PMC. Og9PjXcgDISpcRjlC/5fm2zj/Vq3Jsx/smMxv2y/Ea9tr5FTajY2z+cid4gHjsheQDfou4cRNUN6 0000009689 00000 n 2011-06-24T11:47:41-07:00 /SA true 0000133921 00000 n (Or you can have someone hold one end of the loop to provide resistance.). pjZ/Nu/qn8iSnL6z/wAo9C/9OFn/ALY56SmP1V/8S/Q//COL/wCeGpKdJ2OHZbMv1LAa631ekHfo