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Karacif D, Karacif O, Turk AC, Bayraktar HEN. Comparison of ultrasonography findings of patients with patellofemoral pain and healthy controls. Knee 2025; 54:329-339. [PMID: 40174416 DOI: 10.1016/j.knee.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 03/02/2025] [Accepted: 03/10/2025] [Indexed: 04/04/2025]
Abstract
BACKGROUND The aim of this study was to compare knee ultrasonography findings in patients with Patellofemoral Pain (PFP) and healthy controls. METHODS Our cross-sectional study included 54 participants, 27 patients with PFP and 27 healthy controls. Medial and lateral retinaculum thickness, trochlear cartilage thickness and patellofemoral distances were measured by ultrasonography In the PFP group, pain intensity at rest and during activity was assessed by Visual Analogue Scale (VAS, 0-10 cm), functional status was assessed by Kujala Patellofemoral Pain Scoring system. The quality of life of both groups was evaluated with the Short Form-36 (SF-36). RESULTS The groups were similar in terms of age, gender, body mass index (BMI), marital status, educational level and dominant extremity. In the PFP group, medial and lateral retinaculum thickness, medial patellofemoral distance were found to be significantly higher (mean difference [MD]:1.08; 95% confidence interval [CI]:0.87-1.28, MD:0.80; 95%CI:0.59-1.01, MD:5.65; 95%CI:4.68-6.61, respectively), while medial and lateral cartilage thickness were found to be significantly lower than the control group (MD:1.32; 95%CI:1.0-1.64, MD:-1.56; 95%CI:-1.86--1.26, respectively). There was no significant difference in lateral patellofemoral distance between the two groups (p = 0.752). No statistically significant correlation was found between ultrasonography measurements and age, BMI, pain duration, Kujala score, VAS scores at rest and during activity and SF-36 subgroup scores in the PFP group. CONCLUSION In our study, medial retinaculum thickness, lateral retinaculum thickness and medial patellofemoral distance were statistically significantly higher and medial and lateral trochlear cartilage thickness were lower in the PFP group compared to the control group.
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Affiliation(s)
- Derya Karacif
- Erol Olçok Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Corum, Turkey.
| | - Onur Karacif
- Erol Olçok Training and Research Hospital, Department of Radiology, Corum, Turkey
| | - Ayla Cagliyan Turk
- Hitit University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Corum, Turkey
| | - Handan Elif Nur Bayraktar
- Samsun Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Samsun, Turkey
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Fernandes LP, Araújo IVS, Spinoso DH. Body fat and skeletal muscle mass predict knee strength and pain in young women with patellofemoral pain. J Bodyw Mov Ther 2025; 42:186-191. [PMID: 40325667 DOI: 10.1016/j.jbmt.2024.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 11/04/2024] [Accepted: 12/08/2024] [Indexed: 05/07/2025]
Abstract
INTRODUCTION Patellofemoral pain (PFP) is a chronic dysfunction, with a high prevalence in young women and characterized by complaints of recurrent pain and a poor long-term prognosis. With a multifactorial characteristic, recent studies point to a possible association between body composition and PFP outcomes, however the results are still unclear. OBJECTIVE to investigate whether there is an association between BMI, skeletal muscle mass and body fat with physical function, knee strength and pain in women with PFP. METHODS Twenty-four women, aged between 18 and 35 years, diagnosed with PFP, were recruited for this study. Body fat and skeletal muscle mass were quantified using tetrapolar bioimpedance systems. Pressure hyperalgesia was evaluated using an algometer. Maximal strength during concentric contraction of the knee extensors was measured with an isokinetic dynamometer. Objective function assessment included the single-leg hop test, step-down test, single-legged chair stand test, and side hop. The Pearson correlation test was utilized, with a significance level set at p < 0.05. RESULTS Significant negative correlations were found between BMI and body fat with knee extensor torque. There was a positive correlation between skeletal muscle mass and knee extensor torque. For objective function, there was a negative correlation between body fat and performance in the side hope, single leg hop test and stair climbing test. Local pressure hyperalgesia was associated with skeletal muscle mass and body fat. CONCLUSION Body composition should be factored into the evaluation and management of young women with PFP, as it correlates with deficiencies in functional performance, muscle torque, and pain.
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Affiliation(s)
- Luísa Pereira Fernandes
- Graduate in Physical Therapy. Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Isabela Vitória Souza Araújo
- Graduate in Physical Therapy. Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil
| | - Deborah Hebling Spinoso
- Physical Therapy and Occupational Therapy Department, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marília, São Paulo, Brazil.
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Steinberg N, Sitton Y, Shenhar M, Siev-Ner I. Lower-extremity asymmetry and patellofemoral pain in young female dancers: A 2-year follow-up. PM R 2025. [PMID: 40377427 DOI: 10.1002/pmrj.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 01/27/2025] [Accepted: 02/12/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent injury in young dancers, with low recovery rates. This study aimed to assess PFP in young female dancers over a 2-year period while examining associations between lower-limb asymmetry and PFP. METHODS Thirty-two female dancers (aged 13.6 ± 2.9 years) were clinically examined for PFP at the baseline, 12 months later (first follow-up), and 24 months later (second follow-up). Dancers were also assessed for anthropometric measurements, joint range of movement (ROM), and muscle strength. RESULTS PFP was identified in 46.9%, 53.1%, and 46.9% of the dancers at the three time points, respectively. When comparing the baseline to the second follow-up, 21.9% of the dancers had recovered, 21.9% had developed PFP, and 25.0% had remained with PFP. Only 31.3% had remained healthy throughout this period. Examining muscle-strength-asymmetry in the four groups of dancers, significant interactions (time × group) were found for ankle plantar-flexor, knee extensor, hip abductor, and hip extensor muscle strength (p < .001), indicating that dancers in the developed-PFP or remained-PFP groups had greater muscle-strength-asymmetry at baseline than the recovered or healthy groups. Significant differences in the prevalence of asymmetry between the four groups were found for joint ROM (ankle en-pointe, hip abduction, hip external rotation, and hip internal rotation) (p < .05); and significant differences in the prevalence of asymmetry between the three time points were found for joint ROM (ankle en-pointe, ankle dorsiflexion, hip extension, hip abduction, and hip external rotation) (p = .05). DISCUSSION A high prevalence of dancers had PFP, with a limited prevalence of recovery. Dancers who developed PFP or remained with PFP had greater muscle strength and joint ROM asymmetry than their healthy or recovered counterparts. CONCLUSION Screening for and addressing asymmetries in strength measures may modify the risk for PFP in dancers.
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Affiliation(s)
- Nili Steinberg
- The Academic College Levinsky-Wingate at the Wingate Institute, Netanya, Israel
| | - Yael Sitton
- The Academic College Levinsky-Wingate at the Wingate Institute, Netanya, Israel
| | - Michal Shenhar
- The Academic College Levinsky-Wingate at the Wingate Institute, Netanya, Israel
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Sun Z, Liu R. Therapeutic effects of dry needling for patellofemoral pain syndrome: a systematic review and meta-analysis. Complement Ther Clin Pract 2025; 59:101938. [PMID: 39837157 DOI: 10.1016/j.ctcp.2025.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 01/06/2025] [Accepted: 01/08/2025] [Indexed: 01/23/2025]
Abstract
BACKGROUND AND PURPOSE Dry needling has been increasingly used as an adjunctive therapy for patellofemoral pain syndrome in clinical practice. This study aimed to summarize the available evidence about the effects of dry needling in managing patellofemoral pain syndrome. METHODS Seven English-language databases and three Chinese-language databases were searched. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the PEDro scale and the Cochrane Risk of Bias Assessment Tool. The quality of evidence was evaluated using the GRADE approach. RESULTS A total of 12 studies were included, involving 624 participants. Dry needling significantly improved knee pain (MD = -0.86, 95%CI -1.17 to -0.55) and physical function (MD = 5.33, 95%CI 3.88 to 6.78) compared to comparative groups. When combined with exercise therapy, dry needling resulted in large reduction in knee pain(MD = -2.02, 95%CI -2.36 to -1.67) and small improvement in physical function (MD = 9.56, 95%CI 7.84 to 11.27) compared to exercise therapy alone. However, negligible or no additional benefits were observed when dry needling was added to extracorporeal shock wave therapy or multimodal interventions. Furthermore, dry needling showed no significant advantage over other trigger point therapies in terms of pain reduction and functional improvement. CONCLUSION Dry needling is effective in reducing pain and improving function for patients with patellofemoral pain syndrome, particularly when combined with exercise therapy. However, more high-quality studies are required to draw a definitive conclusion. CLINICAL TRIAL REGISTRATION NUMBER CRD42023490627 on PROSPERO.
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Affiliation(s)
- Zilin Sun
- School of Physical Education, China University of Geosciences(Wuhan), Wuhan, China
| | - Renyi Liu
- School of Physical Education, China University of Geosciences(Wuhan), Wuhan, China
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Rix L, Tushingham S, Wright K, Snow M. Assessing SPECT/CT for the identification of cartilage lesions in the knee joint: A systematic review. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100577. [PMID: 39995588 PMCID: PMC11849615 DOI: 10.1016/j.ocarto.2025.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 01/26/2025] [Indexed: 02/26/2025] Open
Abstract
Background Single-photon emission computerised tomography with conventional computer tomography (SPECT/CT) is an emerging technology which may hold clinical value for the identification of cartilage lesions in the knee joint. The intensity and distribution of SPECT/CT uptake tracer may identify physiological and structural information in the absence of structural change on other imaging modalities. Objectives To systematically assess the utility of SPECT/CT in the detection of chondral lesions within the knee joint, in patients presenting with knee pain, with or without structural change. Results PubMed, Science Direct, Web of Knowledge, and NHS databases were searched for English language articles focusing on the diagnostic value of SPECT/CT for knee chondral lesions and knee pain. Animal studies, cadaver studies, comparator radiological technique other than SPECT/CT or patients with a pathology other than knee chondral lesions were excluded. From the search, 11,982 manuscripts were identified, and screened for relevance. Seven studies were identified and scored low on QUADAS-2 bias review. SPECT/CT correlated with lesions found on other imaging modalities and during intraoperative assessment. Furthermore, in some cases, SPECT/CT out-performed other modalities in the detection of cartilage lesions. Conclusion Evidence suggests SPECT/CT may be a useful tool for the detection and localisation of cartilage lesions, particularly in discrepant cases when there is an absence of lesions on other imaging modalities, or a lack of correlation with patients' symptoms. Further studies are required to confirm the conclusions of this review.
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Affiliation(s)
- Larissa Rix
- The Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, SY10 7AG, United Kingdom
- Centre for Regenerative Medicine Research, Keele University, Staffordshire, ST5 5BG, United Kingdom
| | | | - Karina Wright
- The Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, SY10 7AG, United Kingdom
- Centre for Regenerative Medicine Research, Keele University, Staffordshire, ST5 5BG, United Kingdom
| | - Martyn Snow
- The Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, SY10 7AG, United Kingdom
- Centre for Regenerative Medicine Research, Keele University, Staffordshire, ST5 5BG, United Kingdom
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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Metsavaht L, Gonzalez FF, Locks R, França B, Machado M, Guadagnin EC, Chahla J, Leporace G. A biokinetic approach in primary knee osteoarthritis prevention and management-exploring movement profiles and kinetic chain interactions: Current concepts. J ISAKOS 2025; 10:100381. [PMID: 39743209 DOI: 10.1016/j.jisako.2024.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 11/13/2024] [Accepted: 12/17/2024] [Indexed: 01/04/2025]
Abstract
Knee osteoarthritis (OA) is a chronic disease characterized by increasing prevalence and significant physical, psychological, and economic burdens. Despite extensive research, the definition, risk factors, and effective cost-efficient treatments for knee OA remain unclear. This article aims to revisit primary knee OA, understanding its etiology, and focusing on prevention and individualized nonoperative treatment modalities. This study reviews various aspects of knee OA, including its global prevalence, economic impact, and current treatment strategies. It explores the role of mechanical loading pathways in the disease's onset, highlighting the importance of considering not only the knee but the entire kinetic chain in diagnosis and treatment. Also, it discusses knee anatomy and biomechanics during functional activities, emphasizing the role of neuromuscular control and the influence of proximal and distal joints on knee health. Current treatments focus mainly on symptom management, with limited success in disease prevention and curative interventions. This review underlines the importance of understanding the biomechanical risk factors contributing to knee OA and the necessity of individualized interventions based on biokinetic profile analysis. Knee OA management and prevention necessitate a paradigm shift from viewing it as a localized knee disease to recognizing related mechanical overloads of the human complex motion system. Identifying individual inductive elements is paramount for effective knee OA prevention, management, and rehabilitation. Future research should endeavor to identify movement profile subgroups to establish an early-stage prognosis and the impact of interventions for each group. LEVEL OF EVIDENCE V: Expert opinion based on nonsystematic review.
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Affiliation(s)
- Leonardo Metsavaht
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil; Universidade Federal de São Paulo, Department of Diagnostic Imaging, São Paulo, SP, Brazil
| | - Felipe F Gonzalez
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil; Universidade Federal de São Paulo, Department of Diagnostic Imaging, São Paulo, SP, Brazil; Midwest Orthopaedics at Rush, Department of Sports Medicine, Chicago, IL, USA
| | - Renato Locks
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil; Universidade Federal de São Paulo, Department of Diagnostic Imaging, São Paulo, SP, Brazil
| | - Braulio França
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil
| | - Mariana Machado
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil
| | - Eliane Celina Guadagnin
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Department of Sports Medicine, Chicago, IL, USA
| | - Gustavo Leporace
- Instituto Brasil de Tecnologias da Saúde (IBTS), Department of Research in Biomechanics, Rio de Janeiro, RJ, Brazil; Universidade Federal de São Paulo, Department of Diagnostic Imaging, São Paulo, SP, Brazil.
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Moros I, Boutsikari EC, Plakoutsis G, Paraskevopoulos E, Koumantakis GA, Papandreou M. Reliability and Validity Measures of the Patellofemoral Subscale KOOS-PF in Greek Patients with Patellofemoral Pain. J Funct Morphol Kinesiol 2025; 10:44. [PMID: 39982284 PMCID: PMC11843890 DOI: 10.3390/jfmk10010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 02/22/2025] Open
Abstract
Background: Patellofemoral pain (PFP) is one of the most common multifactorial musculoskeletal pathologies affecting the knee joint. The prevalence of PFP in the general population ranges from 11% to 17%, with higher rates observed in specific groups such as females, runners, military personnel, and young athletes. To assess symptoms associated with PFP, the patellofemoral subscale (KOOS-PF) was developed, consisting of 11 questions that evaluate pain, stiffness, and quality of life. The KOOS-PF scale has already been validated and shown to be reliable in both its Spanish and Arabic versions. Objectives: The aim of this study was to assess the reliability and validity of the KOOS-PF scale in the Greek language among the Greek population with patellofemoral pain. Methods: Fifty-five participants aged 18-65 years who suffered from PFP were evaluated in two phases on the first and third days to determine the reliability and validity of the measures of KOOS-PF in the Greek language. Construct validity was assessed using the knee outcome survey scale-activities of daily living scale (KOS-ADLS). Reliability was measured through repeated measurements (test-retest) using intraclass coefficient correlation (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD). Internal consistency was evaluated using Cronbach's coefficient a. The significance level was set at 5% (α = 0.05). Results: The KOOS-PF measures showed high internal consistency reliability (Cronbach's alpha 0.87, p = 0.05) and high test-retest reliability (ICC = 0.95, p = 0.05, SEM = 3.7, SDC = 13.57). Additionally, the Greek version of the KOOS-PF exhibited high construct validity when correlated with the KOS-ADLS scale (r = 0.72, p = 0.001). Conclusions: The KOOS-PF scale displayed high reliability and construct validity for measuring patellofemoral pain in the Greek population.
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Affiliation(s)
- Ioannis Moros
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (I.M.); (G.A.K.)
| | - Eleni C. Boutsikari
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - George Plakoutsis
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (I.M.); (G.A.K.)
| | - Elefterios Paraskevopoulos
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, 17237 Dafne, Greece;
| | - George A. Koumantakis
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (I.M.); (G.A.K.)
| | - Maria Papandreou
- Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (I.M.); (G.A.K.)
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Santilli G, Martino M, Pacini P, Agostini F, Bernetti A, Giuliani L, Del Gaudio G, Mangone M, Colonna V, Vetrano M, Vulpiani MC, Stella G, Ciccarelli A, Taurone S, Franchitto A, Ottonello C, Cantisani V, Paoloni M, Fiore P, Gimigliano F. Patellofemoral Pain Syndrome: Focused Vibrations Plus Kinesiotaping with Insights into Radiological Influences-An Observational Study. J Funct Morphol Kinesiol 2024; 10:2. [PMID: 39846643 PMCID: PMC11755631 DOI: 10.3390/jfmk10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/15/2024] [Accepted: 12/23/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND This observational study investigates the efficacy of combining local muscle vibration (LMV) therapy and kinesiotaping using the McConnell method (KMcCM) in patients with patellofemoral pain syndrome (PFPS). PFPS is a prevalent knee condition characterized by anterior or medial knee pain exacerbated by activities that overload the patellofemoral joint. OBJECTIVE The primary aim of this study was to evaluate the effectiveness of LMV combined with KMcCM in reducing pain and improving function in PFPS patients. METHODS A total of 52 participants, aged 25-85, with PFPS were included. Participants underwent LMV and KMcCM treatments three times weekly for three weeks. Pain and function were assessed using the Visual Analog Scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline (T0) and six months post-treatment (T1). Radiological assessments of patellar alignment and biomechanics were also conducted through dynamic MRI. RESULTS Significant pain reduction and functional improvements were observed across all age groups. Notably, younger participants showed greater improvement compared to older participants. Among women, those in the younger age group experienced more substantial reductions in VAS scores compared to their older counterparts. KOOS scores improved significantly, indicating enhanced knee function overall. A significant decrease in VAS scores from T0 to T1 was observed across all patellar alignment groups, signifying a reduction in pain levels. However, Group 2 (Laxation and Subluxation) experienced the most substantial reduction in VAS scores at T1 compared to the other groups. These results suggest that the combination of LMV and KMcCM may be particularly effective in addressing biomechanical abnormalities associated with patellar maltracking and enhancing VMO muscle contraction, leading to more substantial improvements in these patients. CONCLUSIONS The combination of LMV and KMcCM demonstrates promising efficacy in reducing pain and improving knee function in PFPS patients, with age and gender influencing treatment outcomes. The most significant improvements were observed in younger individuals and those with specific patellar alignment issues, highlighting the potential of this combined approach for the targeted treatment of PFPS.
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Affiliation(s)
- Gabriele Santilli
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Milvia Martino
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy
| | - Luca Giuliani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Vincenzo Colonna
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Giulia Stella
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Samanta Taurone
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Antonio Franchitto
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Carlo Ottonello
- Fisiocard Medical Centre, Via Francesco Tovaglieri 17, 00155 Rome, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Institute of Bari, Istituti Clinici Scientifici Maugeri IRCCS, 70124 Bari, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
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Nilmart P, Vongsirinavarat M, Khawsuwan P, Chumthong K, Tadein R, Komalasari DR. Impact of telehealth-based therapeutic exercise on pain, functional performance and dynamic knee valgus in young adult females with patellofemoral pain: a randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e001939. [PMID: 39720152 PMCID: PMC11667270 DOI: 10.1136/bmjsem-2024-001939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 11/18/2024] [Indexed: 12/26/2024] Open
Abstract
Objectives This study aimed to evaluate the effectiveness of a telehealth-based therapeutic exercise (TTE) programme with real-time video conference supervision for young adult females with patellofemoral pain (PFP). Methods The study design was a randomised controlled trial. Forty-two participants with PFP were allocated to either the TTE group or the control (C) group. The TTE group received a 4-week telehealth-based exercise programme supervised through real-time video conferencing, while the C group followed a self-guided stretching exercise. Pain intensity was assessed using the Visual Analogue Scale, while functional performance was evaluated with hop tests and the step-down test. Dynamic knee valgus was measured by the frontal plane projection angle during a single-leg squat. In addition, the study used a specific health questionnaire which evaluated knee pain and function, including the self-administered Kujala Patellofemoral Questionnaire (KPQ). All outcomes were assessed both before and after the intervention. Results After the 4-week interventions, the results showed a significant interaction between the group and the time of pain intensity, functional performance and dynamic knee valgus (p<0.001). The TTE group demonstrated significant pain reduction (p<0.001) and improved KPQ score (p<0.001), while the C group showed no significant changes. TTE participants also exhibited improved functional performance in the hop and step-down tests. Additionally, dynamic knee valgus was significantly decreased in the TTE group. Conclusion The telehealth-based exercise programmes offer a convenient and effective alternative for managing PFP symptoms, providing remotely accessible and specialised care.
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Affiliation(s)
- Patcharin Nilmart
- Faculty of Physical Therapy, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | | | - Pimpaka Khawsuwan
- Physical Therapy, Walailak University, Thasala, Nakhon Sri Thammarat, Thailand
| | - Kiatrada Chumthong
- Physical Therapy, Walailak University, Thasala, Nakhon Sri Thammarat, Thailand
| | - Russareeta Tadein
- Physical Therapy, Walailak University, Thasala, Nakhon Sri Thammarat, Thailand
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Than CA, Adra M, Curtis TJ, Khair YJ, Milchem H, Lee SYC, Şanli G, Smayra K, Nakanishi H, Dannawi Z, Beck BR. Prolonged Taping with Exercise Therapy for Patellofemoral Pain in Adults: A Systematic Review and Single-Arm Meta-Analysis. J Clin Med 2024; 13:7476. [PMID: 39685933 DOI: 10.3390/jcm13237476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/10/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024] Open
Abstract
Purpose: To investigate the effects of prolonged taping on patellofemoral pain (PFP). Methods: A literature search of PubMed, EMBASE (Elsevier), CiNAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to 28 June 2024. Eligible studies reported PFP patients over 18 years of age undergoing an exercise protocol with additional taping that was maintained outside of exercise sessions (PROSPERO ID: CRD42023422792). Results: Seventeen studies met the eligibility criteria with 348 patients (n = 221 Kinesio taping, McConnell taping n = 127). For pain, the Kinesio baseline scores were 5.73 (95% CI: 4.73-6.73, I2= 97%), and the McConnell scores were 5.05 (95% CI: 3.82-6.28, I2 = 95%). At the combined recent follow-up, the Kinesio scores were 2.14 (95% CI: 1.11-3.18, I2 = 98%), and the McConnell scores were 2.58 (95% CI: 0.79-4.37, I2 = 98%). For functionality, the Kinesio baseline scores were 64.19 (95% CI: 53.70-74.68, I2 = 98%), and the McConnell scores were 68.02 (95% CI: 65.76-70.28, I2 = 0%). At the combined recent follow-up, the Kinesio scores were 84.23 (95% CI: 79.44-89.01, I2 = 95%), and the McConnell scores were 86.00 (95% CI: 83.82-88.17, I2 = 0%). The minimum clinically important difference (MCID) was achieved for both modalities at 6 weeks and beyond. Conclusions: Prolonged taping that remains on PFP patients outside of isolated exercise sessions appears beneficial in reducing pain and increasing functionality.
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Affiliation(s)
- Christian A Than
- Faculty of Medicine, St. George's University of London, London SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane, QLD 4072, Australia
| | - Maamoun Adra
- Faculty of Medicine, St. George's University of London, London SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
| | - Tom J Curtis
- Frimley Health NHS Foundation Trust, Frimley GU16 7UJ, UK
| | - Yasmine J Khair
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
| | - Hugh Milchem
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
| | - Sum-Yu C Lee
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
| | - Goktug Şanli
- Faculty of Sports Sciences, Marmara University, 34722 Istanbul, Turkey
| | - Karen Smayra
- Faculty of Medicine, St. George's University of London, London SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
| | - Hayato Nakanishi
- Faculty of Medicine, St. George's University of London, London SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417 Nicosia, Cyprus
| | - Zaher Dannawi
- Mid and South Essex NHS Foundation Trust, Essex SS0 0RY, UK
| | - Belinda R Beck
- School of Health Sciences and Social Work, Menzies Health Institute, Gold Coast, QLD 4222, Australia
- The Bone Clinic Pty Ltd., 26 Turbo Drive, Coorparoo, QLD 4151, Australia
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Pacheco-Garcia LM, Martín-Domínguez LA, Perelli S, Monllau JC, Simón-Sánchez FJ, Gutiérrez-de la O J, Messa LAM, Espregueira-Mendes J, Martínez-Guajardo KV, Morales-Avalos R. Combination of the medial patellofemoral ligament reconstruction with the quasi-anatomic technique, tibial tuberosity osteotomy, lateral retinaculum release and mosaicplasty produces satisfactory results for patients with patello-femoral instability. 2-Year follow-up. Knee 2024; 51:44-57. [PMID: 39236637 DOI: 10.1016/j.knee.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/21/2024] [Accepted: 08/09/2024] [Indexed: 09/07/2024]
Abstract
INTRODUCTION This study aimed to evaluate the effectiveness and safety of a combined surgical approach for treating complex patellofemoral instability. This approach combines four procedures: medial patellofemoral ligament (MPFL) reconstruction with the quasi-anatomic technique, lateral retinaculum release, anteromedialization and distalization of tibial tuberosity and patellar/femoral mosaicplasty. MATERIAL AND METHODS Between August and November 2021, we enrolled 27 patients in the study (21 females, 6 males, average age 28.6 years). All with patella alta, recurrent patellar instability, severe cartilage focal damage, and increased tibial tubercle-trochlear groove distance. All underwent the combined procedure during this period. We assessed their pain and functional scores before surgery and at 6, 12, and 24 months after surgery using standardized scoring systems. RESULTS Patients initially reported significant pain and functional limitations. However, at 24 months, their pain scores significantly reduced, averaging 1.5 compared to 8.2 pre-surgery. Similarly, their functional scores substantially improved, with Lysholm, Tegner, Kujala, BPII scores reaching 87.44, 8.44, 90.03, 86.07 compared to 56.4, 3.7, 42.48, 23 pre-surgery, respectively. Importantly, no cases of recurrent instability occurred, and 96.3% of patients reported complete satisfaction. CONCLUSIONS This combined surgical approach has a high rate of success for patients with patella alta, recurrent lateral patellar instability, severe focal chondral lesions, and increased TT-TG distance. Moreover, 26 out of 27 patients (96.3%) reported total satisfaction. Therefore, we conclude that although this procedure combination is not simple, it is a safe, reproducible, and alleviates pain at 24 months postoperatively, and significantly improves functional scores.
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Affiliation(s)
- Luis Miguel Pacheco-Garcia
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Lidia A Martín-Domínguez
- Departamento de Cirugia, Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Simone Perelli
- ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Monllau
- ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Jorge Gutiérrez-de la O
- Department of Traumatology, Medical Services of the Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Human Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - João Espregueira-Mendes
- FIFA Medical Centre of Excellence, Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal; School of Medicine, Minho University, Braga, Portugal
| | - Karla V Martínez-Guajardo
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rodolfo Morales-Avalos
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Traumatology, Medical Services of the Universidad Autónoma de Nuevo León, Monterrey, Mexico.
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12
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Neculăeș M, Hernandez-Lucas P, Ioana-Bianca I, Lucaci P. Contribution of Shockwave Therapy in the Functional Rehabilitation Program of Patients with Patellofemoral Pain Syndrome. J Clin Med 2024; 13:7260. [PMID: 39685719 DOI: 10.3390/jcm13237260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 11/19/2024] [Accepted: 11/27/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Patellofemoral pain syndrome is a condition with an increasing incidence in recent years, being known as the most common cause of knee pain in adults and adolescents. Undiagnosed and untreated, this condition can worsen over time. The aggravation leads to an increase in the intensity of the pain and the risk of injury, along with an increase in stress on the other joints of the lower limb. The objective of this study was to evaluate the contribution of shockwave therapy to a functional rehabilitation programme for patients with patellofemoral pain syndrome. Materials and Methods: The study was carried out on a group of 64 subjects (32 males and 32 females), aged between 20 and 39 years. The subjects were divided into two groups: 32 subjects who followed a program of functional rehabilitation based on low- and medium-frequency electrotherapy, ultrasound and laser therapy, along with a physical therapy program lasting approximately 3 weeks, and 32 subjects who followed a functional rehabilitation program based on shockwave therapy and specific physical therapy exercises lasting approximately 3 weeks. Results: Following the protocols applied to the two groups, the pain reported by the patients decreased, while the functional parameters of the knee improved, better results being obtained in the group that performed shock wave therapy together with specific physical therapy programs (Cohen Index 5916, p < 0.001). Conclusions: This study indicates that radial shockwave therapy combined with physiotherapy may provide additional benefits for patellofemoral syndrome, including greater pain reduction and improved joint mobility, compared to traditional treatments. However, further research is needed to confirm these findings and their broader clinical applicability.
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Affiliation(s)
- Marius Neculăeș
- Faculty of Physical Education and Sport, "Alexandru Ioan Cuza" University of Iași, 3 Toma Cozma Street, 700554 Iasi, Romania
| | - Pablo Hernandez-Lucas
- Faculty of Physiotherapy, University of Vigo, Campus a Xunqueira, s/n., 36005 Pontevedra, Spain
| | - Ioja Ioana-Bianca
- Faculty of Physical Education and Sport, "Alexandru Ioan Cuza" University of Iași, 3 Toma Cozma Street, 700554 Iasi, Romania
| | - Paul Lucaci
- Faculty of Physical Education and Sport, "Alexandru Ioan Cuza" University of Iași, 3 Toma Cozma Street, 700554 Iasi, Romania
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13
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Peterson JR, Sanders CR, Reynolds NS, Alford CA, Platt MJ, Parr JJ, Twum F, Burns JR, Dolbow DR. Running Cadence and the Influence on Frontal Plane Knee Deviations. Clin Pract 2024; 14:2491-2498. [PMID: 39585023 PMCID: PMC11586936 DOI: 10.3390/clinpract14060195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/04/2024] [Accepted: 11/13/2024] [Indexed: 11/26/2024] Open
Abstract
Background: Patellofemoral pain is one of the most common injuries in recreational runners, with significant implications for dynamic knee valgus. The knee valgus angle can be corrected surgically or with a more conservative non-operative approach. Increasing running cadence may be an effective biomechanical gait retraining intervention to reduce knee valgus and thus patellofemoral pain. The primary purpose of this study was to examine if an increase in cadence could change the knee valgus angle. Methods: Ten asymptomatic recreational runners were recorded running on a treadmill during control and experimental intervals. Each interval lasted five minutes, and participants ran at 100% and 110% of their baseline cadence. Peak angles of knee valgus were compared between both intervals using the video analysis software application Dartfish Express. A paired sample, a two-tailed t-test, was used to determine the significant difference between bilateral frontal plane knee angle measurements during both intervals. Results: The average decrease in knee valgus measured in control versus experimental intervals was 2.23° for the right leg and 2.05° for the left leg, with a significance of p < 0.001 and p < 0.001, respectively. Conclusion: The results indicated a statistically significant decrease in angles of dynamic knee valgus, attributable to increased cadence. These changes in knee valgus angle are likely to have a positive impact on preventing and reducing pain associated with PFP.
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Affiliation(s)
- Jacob R. Peterson
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
| | - Collin R. Sanders
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
| | - Nathan S. Reynolds
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
| | - Conner A. Alford
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
| | - Michael J. Platt
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
| | - Jeffrey J. Parr
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA;
| | - Felix Twum
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA;
| | - James R. Burns
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
| | - David R. Dolbow
- Physical Therapy Department, William Carey University, Hattiesburg, MS 39401, USA (J.R.B.); (D.R.D.)
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
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14
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Vedrine B, Fernandes D. Patellar groove replacement in patellar maltracking with patellofemoral cartilage erosion in bulldogs. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2024; 65:1136-1140. [PMID: 39494187 PMCID: PMC11486165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Abstract
This retrospective case series reports on French bulldogs diagnosed with patellar maltracking without patellar luxation. We describe clinical presentation, joint exploration, and surgical treatment with patellar groove replacement to alleviate maltracking in the first attempt. Three French bulldogs were included. Clinical presentation was similar in all cases, with intermittent skipping lameness of 1 hind limb, absence of patellar luxation, and patellar maltracking. Joint exploration revealed abnormal conflict between the patella and medial ridge of the trochlea, with secondary severe erosion of articular cartilages of both patella and medial ridge of the trochlea. Patellar groove replacement was completed without perioperative or postoperative complications. Follow-up results and owner satisfaction were excellent in all cases. Patellar maltracking should be included as a differential diagnosis for stifle lameness in French bulldogs. Patellar groove replacement should be considered to alleviate maltracking associated with secondary severe patellofemoral erosion. Key clinical message: Patellar maltracking seems to be a misdiagnosed component of patellar luxation in the dog, particularly in the French bulldog. Patellar groove replacement may be a first-attempt surgical treatment to alleviate the maltracking.
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Affiliation(s)
- Bertrand Vedrine
- Clinique vétérinaire SeineVet, 26, rue de la République, 76520 Boos, France
| | - David Fernandes
- Clinique vétérinaire SeineVet, 26, rue de la République, 76520 Boos, France
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15
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Germain F, Mayet A, Perrin R. What mechanical and proprioceptive structures are involved in quadriceps stretching? Why is it important for patella travel? J Bodyw Mov Ther 2024; 40:2001-2010. [PMID: 39593557 DOI: 10.1016/j.jbmt.2024.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 10/03/2024] [Accepted: 10/22/2024] [Indexed: 11/28/2024]
Abstract
OBJECTIVE Ely's, Ober's, and modified Thomas' tests are widely used. Stretching the front thigh involves two layers of tissue: the rectus femoris and its overlying fascia lata (FL). However, to our knowledge, no biomechanical study has analyzed these tests. Therefore, this study tries to determine the structures affected during the stretching of the front thigh. METHODS An observational study of the front thigh was conducted. The directions and intensities of the reaction forces were recorded. The patellar travel was used to determine the average coordinates of the stretched structures at hip level in the horizontal plane. The participants indicated the stretched area. The stretch of a patient with a complete tear of his left rectus femoris was recorded. RESULTS The reaction force of the thigh was oriented at 33° (standard deviation [SD]: 6°) sideways and its intensity was 60 N m (SD: 19 N m). The centroid coordinates of all stretched structures were stable. The registered average external rotational torque of 6 N m (SD: 3.7 N m) could only be mediated by the FL. The stretched area indicated by the participants could be anywhere on the FL. The tolerated reaction force increased in the same way on the disinserted rectus femoris thigh and on the uninjured thigh. CONCLUSION Ober's, Modified Thomas', and Ely's tests are three potential means of assessing FL extensibility. A lateral patellar tilt may be triggered by the FL's reaction force to stretching. Stretch tolerance seems to be limited by the FL, the fascia profundis of the thigh.
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Affiliation(s)
- Franck Germain
- Kinéquipe, Maison de santé, 24 rue Carnot, 39200, St Claude, France.
| | - Arthur Mayet
- IFMK Montbéliard: Filière Kinésithérapie-Physiothérapie, I.F.M.S. (Institut de formation des métiers de la santé) Hôpital de Nord Franche-Comté, 2 rue du Docteur Flamand, 25200, Monbéliard, France.
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16
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Kultur Y, Harbiyeli E, Botanlioglu H, Ozsahin MK, Ozturhalli S, Aydingoz O, Erginer MR. Evaluation of the results of closed kinetic chain exercises applied in the conservative treatment of patellofemoral pain syndrome by means of shear wave elastography: A randomized controlled trial. J Orthop Surg (Hong Kong) 2024; 32:10225536241280384. [PMID: 39483049 DOI: 10.1177/10225536241280384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2024] Open
Abstract
PURPOSE Non-selective closed kinetic chain exercises (NSKCE) and or selective closed kinetic chain exercises (SCKCE) has been shown to increase Vastus medialis obliquus (VMO) muscle power in patellofemoral pain syndrome (PFPS). However, the superiority of the exercises to each other has not been shown. This study aimed to evaluating the effects of different exercises on the stiffness of the VMO and vastus lateralis (VL) muscles, pain management, functional scores, and thigh circumferences. METHODS One hundred 60 knees of 80 patients followed up in our outpatient clinic between December 2016 and February 2018 were included in the study. Patients were divided into two groups as 40 patients with single-sided PFPS (20 male and 20 female patients) and 40 healthy controls (20 male and 20 female patients). The patients in each group were divided into subgroups according to NSCKCE or SCKCE. VMO and VL muscles were measured by shear wave elastography (SWE) before and after a 6-weeks therapy. RESULTS There was a significant decrease in Visual Analog Scale (VAS) score while a significant increase was found in Lysholm Knee Scale (LKS), however, no statistically difference was found between the two exercise groups in PFPS patients. The effect of both exercises on pain and functional improvement was similar. CONCLUSION Decrease in VAS scores, increase in LKS scores, increase in thigh circumference measurements, and increase in the stiffness of VMO and VL muscles were observed in both groups who received SCKCE and NSCKCE on PFPS patients. TRIAL REGISTRATION Study registered at ClinicalTrials.gov (registration number: NCT05427357). DESIGN Randomized controlled trial.
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Affiliation(s)
- Yigit Kultur
- Orthopedics and Traumatology, Yeni Yuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Emir Harbiyeli
- Orthopedics and Traumatology, Corlu State Hospital, Istanbul, Turkey
| | | | - Mahmut K Ozsahin
- Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sude Ozturhalli
- Physical Therapy and Rehabilitation, Biruni University, Istanbul, Turkey
| | - Onder Aydingoz
- Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mehmet R Erginer
- Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Sanchis GJB, Nascimento JASD, Santana RDC, Santos VMD, Cunha VLD, Assis SJCD, Cavalcanti RL, Guedes TSR, Oliveira AGRDC, Guedes MBOG. Biomechanical factors associated with patellofemoral pain in children and adolescents. Sci Rep 2024; 14:15490. [PMID: 38969665 PMCID: PMC11226601 DOI: 10.1038/s41598-024-64394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/07/2024] [Indexed: 07/07/2024] Open
Abstract
To investigate the biomechanical factors associated with patellofemoral pain in children and adolescents. A cross-sectional, population-based study conducted in Brazil from 2019 to 2023, involving students from public schools. Adjusted prevalence ratios and their respective 95% confidence intervals for the outcome in relation to independent variables were calculated for association analysis, adopting a significance level of 5%. Out of the total of 283 students, 152 were female and 182 were aged between 16 and 18 years old. A positive association was observed between the presence of patellofemoral pain and a poor movement quality in both lower limbs (right side: p = 0.04 and left side: p = 0.04) as well as with dynamic valgus of the left lower limb (p < 0.01). Patellofemoral pain in children and adolescents is associated with poor movement quality in the lower limbs and dynamic valgus of the left lower limb. Actions targeting these biomechanical factors may be crucial for early diagnosis and clinical treatment of this disfunction.
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Affiliation(s)
- Gerônimo J B Sanchis
- Brazil Federal University of Minas Gerais, Belo Horizonte, Brazil
- Universidad de Valencia, Valencia, Spain
| | | | - Rebeca de C Santana
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Vagner M Dos Santos
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Vitor L da Cunha
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Sanderson J C de Assis
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Rafael L Cavalcanti
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Thaís S R Guedes
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Angelo G R da C Oliveira
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
| | - Marcello B O G Guedes
- Federal University of Rio Grande Do Norte, Lagoa Nova, University Campus, Natal, RN, 59078-900, Brazil
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Horii M, Kimura S, Akagi R, Watanabe S, Yamaguchi S, Ohtori S, Sasho T. Referential values for lower limb flexibility in healthy children and adolescents in Japan: A five-year cross-sectional study. J Orthop Sci 2024; 29:891-896. [PMID: 37055271 DOI: 10.1016/j.jos.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Lower limb flexibility (LLF) is an essential motor function. However, assessing LLF during adolescence is difficult because of the influence of marked physical changes. We, therefore, assessed LLF and investigated the relationship between LLF and sex and age in healthy children and adolescents. METHODS We conducted a five-year cross-sectional study with students aged 8-14 years at a single school in Japan. We evaluated the heel-buttock distance (HBD), straight leg raising angle (SLRA), and dorsiflexion angle of the ankle joint (DFA) at the beginning of each year. We conducted a comparative analysis on the performance of the HBD, SLRA, and DFA techniques, stratified by both sex and age. The statistical significance of observed differences was assessed through the application of Mann-Whitney U and Kruskal-Wallis tests. Furthermore, we analyzed the effects of sex, age, height, and weight on LLF using a multivariable linear regression model. RESULTS Of the 4221 initial study participants, 3370 were analyzed. Mean HBD, SLRA, and DFA values were 1.6 cm, 77.0°, and 15.7°, respectively. Girls showed significantly higher HBD and lower SLRA and DFA values than boys and 14-year-olds (p < 0.01). Median HBD value for girls was 0 cm, whereas for boys, it exceeded 0 cm after age 13. The median SLRA value for girls was 80-85°, while for boys, it was 70-75°. The median DFA value for girls was 15-19°, and for boys, it was 12-15°. A multivariable linear regression model indicated that boys had significantly greater tightness than girls (p < 0.01). CONCLUSIONS The reference values of HBD, SLRA, and DFA differed according to age and sex. Furthermore, we showed that sex differences were significantly associated with LLF. Data in this study provide the reference value for assessing LLF in children and adolescents.
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Affiliation(s)
- Manato Horii
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Seiji Kimura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Ryuichiro Akagi
- Oyumino Central Hospital, Knee Surgery and Sports Medicine Center, 6-49-9 Oyumino-Minami, Midori-ku, Chiba, Chiba, 266-0033, Japan
| | - Shotaro Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Satoshi Yamaguchi
- Graduate School of Global and Transdisciplinary Studies, Chiba University, 1-33 Yayoi, Inage-ku, Chiba, Chiba, 263-8522, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takahisa Sasho
- Center for Preventive Medical Sciences, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Yurova A, Lychagin A, Kalinsky E, Vassilevski Y, Elizarov M, Garkavi A. Automated personalization of biomechanical knee model. Int J Comput Assist Radiol Surg 2024; 19:891-902. [PMID: 38402535 DOI: 10.1007/s11548-024-03075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Patient-specific biomechanical models of the knee joint can effectively aid in understanding the reasons for pathologies and improve diagnostic methods and treatment procedures. For deeper research of knee diseases, the development of biomechanical models with appropriate configurations is essential. In this study, we mainly focus on the development of a personalized biomechanical model for the investigation of knee joint pathologies related to patellar motion using automated methods. METHODS This study presents a biomechanical model created for patellar motion pathologies research and some techniques for automating the generation of the biomechanical model. To generate geometric models of bones, the U-Net neural network was adapted for 3D input datasets. The method uses the same neural network for segmentation of femur, tibia, patella and fibula. The total size of the train/validation (75/25%) dataset is 18,183 3D volumes of size 512 × 512 × 4 voxels. The configuration of the biomechanical knee model proposed in the paper includes six degrees of freedom for the tibiofemoral and patellofemoral joints, lateral and medial contact surfaces for femur and tibia, and ligaments, representing, among other things, the medial and lateral stabilizers of the knee cap. The development of the personalized biomechanical model was carried out using the OpenSim software system. The automated model generation was implemented using OpenSim Python scripting commands. RESULTS The neural network for bones segmentation achieves mean DICE 0.9838. A biomechanical model for realistic simulation of patellar movement within the trochlear groove was proposed. Generation of personalized biomechanical models was automated. CONCLUSIONS In this paper, we have implemented a neural network for the segmentation of 3D CT scans of the knee joint to produce a biomechanical model for the study of knee cap motion pathologies. Most stages of the generation process have been automated and can be used to generate patient-specific models.
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Affiliation(s)
- Alexandra Yurova
- Marchuk Institute of Numerical Mathematics, Russian Academy of Sciences, 8 Gubkin Str., Moscow, 119333, Russia.
| | - Alexey Lychagin
- Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russia
| | - Eugene Kalinsky
- Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russia
| | - Yuri Vassilevski
- Marchuk Institute of Numerical Mathematics, Russian Academy of Sciences, 8 Gubkin Str., Moscow, 119333, Russia
- Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russia
- Center for IT &AI, Sirius University, 1 Olympiyskii pr., Sochi, 354340, Russia
| | - Mikhail Elizarov
- Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russia
| | - Andrey Garkavi
- Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russia
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Chamorro-Moriana G, Espuny-Ruiz F, Ridao-Fernández C, Magni E. Clinical value of questionnaires & physical tests for patellofemoral pain: Validity, reliability and predictive capacity. PLoS One 2024; 19:e0302215. [PMID: 38630735 PMCID: PMC11023591 DOI: 10.1371/journal.pone.0302215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES To determine the most appropriate method of functional assessment for "patellofemoral pain" (PFP)/"chondromalacia patella" for its diagnostic value, (validity, reliability, sensitivity, specificity, predictive value and clinical applicability); to outline initial interpretations of the questionnaires and their appropriateness, through the cut-off points determined in their scores based on physical test and Magnetic Resonance Imaging (MRI); to establish which methods should be used in conjunction with each other to obtain clinical diagnoses that are robust effective and efficient. METHODS (1)Intra- and inter-observer reliability and of the relationship among PFP questionnaires/physical tests validated. (2)Predictive capacity of the questionnaires. Subject: 113 knees with PFP, assessed using "Knee-injury-and-Osteoarthritis Outcome-Score-for-Patellofemoral-pain-and-osteoarthritis" (KOOS-PF), "Kujala-Patellofemoral-Score" (KPS), "Victorian-Institute-of-Sports-Assessment-for-Patellar-tendons-questionnaire" (VISA-P), and the physical tests: "patellar-palpation", "patellar-tilt", "patellar-apprehension", "Clarke" and "squat". RESULTS Questionnaires correlations themselves was 0.78 CONCLUSIONS KOOS-PF, KPS and VISA-P demonstrated their diagnostic value in PFP/chondromalacia (validity, reliability, sensitivity, specificity, predictive value and clinical applicability). KOOS-PF was the most versatile, and the most appropriate in mild cases and for early detection and prevention. Squat was the best due to its reliability and clinical relationship with the questionnaires, which predicted it correctly. The functional assessment tools discussed should be applied by combining them with each other.
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Affiliation(s)
- Gema Chamorro-Moriana
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Research Group “Area of Physiotherapy CTS305”, Spain
| | - Fernando Espuny-Ruiz
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Carmen Ridao-Fernández
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Research Group “Area of Physiotherapy CTS305”, Spain
| | - Eleonora Magni
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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21
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Flevas DA, Brenneis M, Nocon A, Gkiatas I, Pirzada W, Tsakotos G, Sculco PK. Incidence of patella baja and pseudopatella baja in aseptic revision total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:1703-1712. [PMID: 38488903 DOI: 10.1007/s00402-024-05234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION There are two variants regarding the low location of the patella in relation to the tibio-femoral joint line: patella baja (PB) and pseudo-patella baja (PPB). The purpose of this study is to investigate the incidence of PB and PPB in a cohort of patients that underwent revision total knee arthroplasty (rTKA) for aseptic reasons and describe any differences in each group's ROM. METHODS This retrospective study included 114 patients that underwent aseptic revision TKA surgery between 2017 and 2022. Patients were revised either for stiffness (Group 1) or aseptic loosening/instability (Group 2). The Insall-Salvati ratio (ISR) and Blackburne-Peel ratio (BPR) were used to evaluate the patellar position. ISR < 0.8 defined PB, while cases with ISR ≥ 0.8 and BPI < 0.54 were defined as PPB. ROM was measured and a subanalysis was conducted to investigate the progression of the values of ISR and BPR. RESULTS 55 patients comprised Group 1, and 59 patients comprised Group 2. Overall, 13 cases (11.4%) had PB before rTKA and 24 (21%) had PB after rTKA. Cases with PPB were 13 (11.4%) before and 34 (29.9%) after rTKA. Group 1 patients presented with more PB before and after rTKA (12.8% vs 10.2% and 27.3% vs 15.2% respectively). However, after rTKA Group 1 patients presented with less PPB (20%) compared to Group 2 (39%) (p = 0.02). In Group 1, patients with PPB after rTKA had less ROM compared to those without PPB [83.2 (± 21.9) vs 102.1 (± 19.9) (p = 0.025)]. The subanalysis (69 patients) showed a statistically significant decrease in ISR before and after rTKA (p = 0.041), and from the native knee to post-rTKA (p = 0.001). There was a statistically significant decrease in BPR before and after rTKA (p = 0.001) and from the native knee to both pre- and post-rTKA (p < 001). CONCLUSION After undergoing rTKA, the incidences of both patella baja (PB) and pseudo-patella baja (PPB) increased. Stiffness in the knee was associated with a higher incidence of PB, while non-stiffness cases showed a significantly higher incidence of PPB. Patients with stiff knees and PPB after rTKA experienced a significant reduction in range of motion (ROM). Additionally, the study revealed a noteworthy decrease in ISR and BPR with each subsequent surgery. This information is crucial for healthcare providers, as it sheds light on potential risks and outcomes of rTKA, allowing for improved patient management and surgical decision-making. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dimitrios A Flevas
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA.
| | - Marco Brenneis
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt, Main, Germany
| | - Allina Nocon
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
| | - Ioannis Gkiatas
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Wali Pirzada
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
| | - Georgios Tsakotos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter K Sculco
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, 535 East 70th Street, New York, NY, 10021, USA
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22
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Xu J, Cai Z, Chen M, Wang X, Luo X, Wang Y. Global research trends and hotspots in patellofemoral pain syndrome from 2000 to 2023: a bibliometric and visualization study. Front Med (Lausanne) 2024; 11:1370258. [PMID: 38566926 PMCID: PMC10985266 DOI: 10.3389/fmed.2024.1370258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is a prevalent condition in sports medicine, and as sports competitions become more popular, the incidence of sports injuries is on the rise. Despite the increasing research on PFPS, there remains a lack of bibliometric analyses on this topic. The aim of this study was to identify the research hotspots and trends in the field of PFPS by reviewing 23 years of literature in this field. Methods By analyzing the literature on PFPS research from 2000 to 2023 in the core dataset of the Web of Science database and utilizing bibliometric tools like CiteSpace 6.1, VOSviewer 1.6.18, R-bibliometrix 4.6.1, Pajek 5.16, and Scimago Graphica 1.0.26, our aim was to gain insights into the current status and key areas of PFPS research. The study examined various aspects including the number of publications, countries, institutions, journals, authors, collaborative networks, keywords, and more. Through the visualization of relevant data, we also attempted to forecast future trends in the field. Results There were 2,444 publications were included in this visualization study, published in 322 journals by 1,247 authors from 818 institutions in 67 countries. The Journal of Orthopaedic and Sports Physical Therapy had the highest number of publications, with the USA leading in article count. La Trobe University contributed the most articles, while Rathleff MS and Barton CJ emerged as the most prolific authors. Hip and knee strength and core strength, lower extremity kinematics and biomechanics, females (runners), muscle activation, risk factors, gait retraining, clinical practice guidelines, and rehabilitation were research hotspot keywords. Conclusion Current research suggests that there is still significant potential for the development of PFPS research. Key areas of focus include the clinical effectiveness of combined hip and knee strengthening to address PFPS, characterization of lower limb kinematics and biomechanics, gait retraining, risk factors, and clinical practice guidelines. Future research could explore the effectiveness of innovative exercise therapies such as blood flow restricting training, gait retraining, and neuromuscular control training for PFPS improvement. Further investigation into gait retraining for runners, particularly females, and clinical efficacy study of a novel PRP formulation for the treatment of PFPS.
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Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Zijuan Cai
- College of Physical Education and Health, Geely University of China, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Xin Wang
- Health Science Center, Peking University, Beijing, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Yanjie Wang
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
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23
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Wei Z, Hou X, Qi Y, Wang L. Influence of foot strike patterns and cadences on patellofemoral joint stress in male runners with patellofemoral pain. Phys Ther Sport 2024; 65:1-6. [PMID: 37976905 DOI: 10.1016/j.ptsp.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This study aimed to determine the effect of foot strike patterns and cadences in male runners with patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING Biomechanics lab. METHODS 20 male runners with PFP were instructed to randomly complete six running conditions (three cadence conditions in rearfoot strike pattern (RFS) or forefoot strike (FFS)) under a preferred running speed. MAIN OUTCOME MEASURES The primary outcomes were peak knee joint and moment, and secondary outcomes were patellofemoral joint stress. RESULTS Running with increased cadence has a lower flexion angle (P = 0.027, η2 = 0.45), lower extension moment (P = 0.011, η2 = 0.29), lower internal rotation moment (P = 0.040, η2 = 0.17), lower patellofemoral stress (P = 0.029, η2 = 0.52) than preferred cadence. FFS running performed significantly lower flexion angle (P = 0.003, η2 = 0.39), lower extension moment (P < 0.001, η2 = 0.91), lower adduction moment (P = 0.020, η2 = 0.25) lower patellofemoral stress (P < 0.001, η2 = 0.81) than RFS running for all cadence. CONCLUSIONS Preliminary findings provide new perspectives for male runners with PFP to unload patellofemoral joint stress in managing PFP through the combination of the FFS pattern and increased cadence.
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Affiliation(s)
- Zhen Wei
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, 200438, China.
| | - Xihe Hou
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, 200438, China; School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China.
| | - Yujie Qi
- Shanghai Nanxiang Community Health Service Center, Shanghai, China.
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, 200438, China.
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24
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Hong QM, Wang HN, Liu XH, Zhou WQ, Zhang X, Luo XB. Home-based exercise program and Health education in patients with patellofemoral pain: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:896. [PMID: 37980477 PMCID: PMC10657019 DOI: 10.1186/s12891-023-07027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is one of the most common disorders of the knee joint. Home-based exercise is an effective intervention to achieve self-management for chronic diseases. This study evaluated the effects of home-based exercise and health education in patients with PFP. METHODS Patients who had PFP were randomly allocated to an intervention group (IG) or control group (CG). Patients in the IG received a 6-week tailored home-based exercise program with health education via remote support, while patients in the CG group only received health education. Clinical outcomes were compared using the Anterior Knee Pain Scale (AKPS) to measure function and the Visual Analog Scale (VAS) to measure "worst pain" and "pain with daily activity". Muscle strength was measured according to the peak torque of the knee muscles using an isokinetic system. RESULTS Among a total of 112 participants screened for eligibility, 38 were randomized and analyzed, including 19 participants in the intervention group and 19 participants in the control group. There were no significant differences in baseline characteristics between the groups. At 6-week follow-up, the intervention group showed a greater worst pain reduction (between-group difference, -19.3 [95%CI, -23.2 to -15.5]; P < 0.01) and pain with daily activity (between-group difference, -22.9 [95%CI, -28.3 to -17.4]; P < 0.01) than the control group. Similarly, the intervention group had better improvements in AKPS (between-group difference, 9.0 [95%CI, 4.1 to 13.9]; P < 0.01) and knee extensor strength (between-group difference, 20.1 [95%CI, 14.5 to 25.8]; P < 0.01), compared to the control group. No adverse events were reported. CONCLUSION Home-based exercise and health education resulted in less pain, better function, and higher knee muscle strength compared with no exercise in patients with PFP. A large randomized controlled trial with long-term follow-up is required to confirm these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056224 ( https://www.chictr.org.cn/showproj.aspx?proj=135506 ). Registered on February 1, 2022.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Faculty of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao Zhang
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China.
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25
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Kim S, Han S, Kim S, Moon J. The effects of knee ligament load using simulated hip abductor and hamstring muscle strengthening during cutting maneuver. Medicine (Baltimore) 2023; 102:e35742. [PMID: 37986289 PMCID: PMC10659627 DOI: 10.1097/md.0000000000035742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/03/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND This study aimed to analyze knee ligament of load and joint moment to simulate the strengthening of the hip abductor and hamstring muscles using musculoskeletal modeling, thereby contributing to decrease of knee ligament load. METHODS Forty participants (age: 21.85 ± 1.90 years; height: 1.76 ± 0.06 m; body mass: 68.5 ± 7.06 kg) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their feet on the force plate, and perform the cutting maneuver on the left. In the musculoskeletal modeling, the hip abductor and hamstring muscles were targeted to construct a model with a 30% increase in the contraction force of the hip abductor, hamstring, and both 2 muscles. The variables were the ligament force and knee joint moment. One-way repeated measure ANOVA and Bonferroni test were used to compare the abductor/hamstring, abductor, hamstring and control models. RESULTS There were significant differences in anterior bundle of the anterior cruciate ligament (ACL) (P = .001), inferior bundle of the superficial layer of the medial collateral ligament (MCL) (P = .016), and posterior bundle of the superficial layer of the MCL (P = .022) force. The post hoc showed that the hamstring model had lower anterior bundle of the ACL and inferior bundle of the superficial layer of the MCL than the abductor/hamstring and abductor models (P < .05) and lower posterior bundle of the superficial layer of the MCL than the abductor and control models (P < .05). There was a significant difference in the adduction (P = .028) and internal rotation moments (P = .014). The post hoc showed that both moments were lower in the hamstring model than in the other models (P < .05). CONCLUSIONS The hamstring strengthening may contribute significantly to preventing ACL or MCL injury by reducing knee ligament load.
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Affiliation(s)
- Sungmin Kim
- Institute of School Physical Education, Korea National University of Education, Chungbuk, Republic of Korea
| | - Sanghyuk Han
- Human Performance Laboratory, Descente Innovation Studio Complex, Busan, Republic of Korea
| | - Seongyong Kim
- Futures R&D Center, SSG LANDERS, Incheon, Republic of Korea
| | - Jeheon Moon
- Department of Physical Education, Korea National University of Education, Chungbuk, Republic of Korea
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Liu Y, Wang Y. A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain. Front Med (Lausanne) 2023; 10:1305733. [PMID: 38020090 PMCID: PMC10679753 DOI: 10.3389/fmed.2023.1305733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion. Methods In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed. Results There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility. Conclusion Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period. Clinical trial registration www.isrctn.com, ISRCTN88098928.
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Affiliation(s)
- Yang Liu
- SchoolGraduate School of Wuhan Sports University, Wuhan Sports University, Wuhan, China
| | - Yidan Wang
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
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27
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Nair T, Kumar GP. Correlation Between Severity of Symptoms and Quality of Life in Patellofemoral Pain Syndromes: A Cross-Sectional Study. Cureus 2023; 15:e49094. [PMID: 38125224 PMCID: PMC10731623 DOI: 10.7759/cureus.49094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is one of the conditions frequently encountered by musculoskeletal physiotherapists. The intensity and severity of pain and symptoms seen in PFPS affect the quality of life (QOL). This concept has not yet been investigated with the use of reliable and valid scales. Hence, the objective of this study is to find out the correlation between the severity of symptoms and QOL in patients with PFPS. Methodology In this cross-sectional study, 63 patients with PFPS, aged between 40 and 60 years, who visited Sir Sayajirao General Hospital, Vadodara, from December 2018 to June 2019, were included. The questionnaires included in the study comprised the Numerical Pain Rating Scale (NPRS), the Knee Osteoarthritis Outcome Survey-Patellofemoral Subscale (KOOS-PF), and the Short Form-36 (SF-36). Spearman's rank correlation coefficient was used to find the correlation. Results NPRS was found to have a fairly positive correlation with the functional scale KOOS-PF, with a P-value of 0.008. Among the eight components of SF-36, Physical Function and General Health scores exhibited a fairly positive correlation with NPRS, with p-values of 0.016 and <0.001, respectively. However, no correlation was observed between NPRS and the other components of SF-36. Conclusions This study concluded that patients with PFPS with different levels of pain exhibit different functional and QOL limitations. Furthermore, studies investigating the causes of the negative correlation should be conducted to have a better understanding of QOL in PFPS.
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Affiliation(s)
- Tushara Nair
- College of Physiotherapy, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, IND
| | - G Palani Kumar
- College of Physiotherapy, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, IND
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28
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Wu CC. Patellar malalignment: A common disorder associated with knee pain. Biomed J 2023; 46:100658. [PMID: 37678711 PMCID: PMC10550501 DOI: 10.1016/j.bj.2023.100658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
Pain-associated knee joint disorders are common in daily life. Practically, knee pain should be divided into the origin from the isolated tibiofemoral (TF), isolated patellofemoral (PF) joint, or a combination thereof. The TF joint controls the actions of level walking, while the PF joint controls knee flexion-extension. Owing to its sufficient inherent stability, non-traumatic disorders of the isolated TF joint in young individuals are uncommon. In contrast, because of its insufficient inherent stability, non-traumatic disorders of the isolated PF joint are common in young individuals. Patellar malalignment (PM) associated with knee pain is common in all age groups, and the most common predisposing factor is imbalanced peripatellar soft-tissue tension. The outward forces acting on the patella are caused by pulling from the quadriceps femoris during knee flexion to extension (manifested by the quadriceps angle [Q-angle]), and sliding backward of the iliotibial band (ITB) during knee extension to flexion. Once the muscle power of the vastus medialis (especially the vastus medialis obliquus [VMO]) decreases, which lowers the counteracting effect against outward forces, the patella displaces or rotates laterally. The reduced contact surface between the patella and the femoral condyle significantly increases the compressive pressure and injures the articular cartilage. Subsequently, progressive PF degeneration occurs. Although other factors may also cause PM, they are relatively uncommon. In principle, nonsurgical treatment of PM should be considered first, while surgical treatment should follow established indications. Some nonsurgical techniques are currently widely used that feature high satisfaction rates. Surgical techniques are continuously being developed, and their success rates have gradually improved. This study aimed to review the current literature for relevant studies and report related publications of the author's institution to emphasize the universality and importance of PM management. Conceptually, simply focusing on problems of the TF joint cannot treat all knee disorders.
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Sannasi R, Rajashekar A, Hegde NS. Association of patellofemoral pain syndrome (PFPS) with quadratus lumborum and lower limb muscle tightness a cross-sectional study. J Orthop 2023; 42:1-5. [PMID: 37416861 PMCID: PMC10319640 DOI: 10.1016/j.jor.2023.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is characterized by peripatellar or retro patellar pain, as a result of changes in the physical and biochemical components of the patellofemoral joint. The main contributory factor is being the excessive load on the patellofemoral joint. The change in the flexibility of lower limb muscles is one of the factors for developing PFPS. Objective To find the association of quadratus lumborum (QL) and lower limb muscles tightness in patients with unilateral PFPS. Materials and methods 50 PFPS participants (21 male and 29 female) were included and assessed for muscle tightness on both affected and unaffected side. The QL, rectus femoris, hamstring, iliotibial band (ITB) and gastrocnemius tightness were measured using inch tape and mobile inclinometer. A Chi Square test and phi crammer's v criteria were used to check the association and the strength of it. Results A significant association was found between tightness of rectus femoris (PFPS-right Chi 19.99 p < 0.001; Phi-0.632, PFPS-left Chi-5.52 p = 0.019 and Phi- 0.332), gastrocnemius (PFPS-right Chi 8.78 p = 0.003; Phi-0.419, PFPS-left Chi- 11.41 p = 0.001; Phi- 0.478), iliotibial band (PFPS-right Chi 7.83 p = 0.005; Phi-0.396, PFPS left Chi-3.68 p = 0.055; Phi- 0.27). There was no significant association of hamstring tightness (PFPS-right Chi - 3.68 p = 0.055; Phi-0.055, PFPS left Chi-1.11 p = 0.291; Phi- 0.019) and QL (PFPS right Chi - 1.10 p = 0.293; Phi-0.293, PFPS left Chi-0.79 p = 0.372; Phi- 0.372). Conclusion PFPS was associated with tightness of rectus femoris, gastrocnemius, ITB and no association found between hamstring and QL muscle tightness and PFPS.
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Song K, Scattone Silva R, Hullfish TJ, Silbernagel KG, Baxter JR. Patellofemoral Joint Loading Progression Across 35 Weightbearing Rehabilitation Exercises and Activities of Daily Living. Am J Sports Med 2023; 51:2110-2119. [PMID: 37272685 PMCID: PMC10315869 DOI: 10.1177/03635465231175160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint loading is scarce for a majority of common weightbearing rehabilitation exercises. PURPOSE To define a loading index to quantify, compare, rank, and categorize overall loading levels in the patellofemoral joint across 35 types of weightbearing rehabilitation exercises and activities of daily living. STUDY DESIGN Descriptive laboratory study. METHODS Model-estimated knee flexion angles and extension moments based on motion capture and ground-reaction force data were used to quantify patellofemoral joint loading in 20 healthy participants who performed each exercise. A loading index was computed via a weighted sum of loading peak and cumulative loading impulse for each exercise. The 35 rehabilitation exercises and daily living activities were then ranked and categorized into low, moderate, and high "loading tiers" according to the loading index. RESULTS Overall patellofemoral loading levels varied substantially across the exercises and activities, with loading peak ranging from 0.6 times body weight during walking to 8.2 times body weight during single-leg decline squat. Most rehabilitation exercises generated a moderate level of patellofemoral joint loading. Few weightbearing exercises provided low-level loading that resembled walking or high-level loading with both high magnitude and duration. Exercises with high knee flexion tended to generate higher patellofemoral joint loading compared with high-intensity exercises. CONCLUSION This study quantified patellofemoral joint loading across a large collection of weightbearing exercises in the same cohort. CLINICAL RELEVANCE The visualized loading index ranks and modifiable worksheet may assist clinicians in planning patient-specific exercise programs for patellofemoral pain rehabilitation.
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Affiliation(s)
- Ke Song
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rodrigo Scattone Silva
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Todd J. Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Josh R. Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Arslan T, Gültekin MZ. Is Cam Pincer Deformity a Predisposing Factor for Patellofemoral Pain Syndrome? Indian J Orthop 2023; 57:1139-1146. [PMID: 37383997 PMCID: PMC10293500 DOI: 10.1007/s43465-023-00902-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/27/2023] [Indexed: 06/30/2023]
Abstract
Purpose This study aimed to investigate whether cam and pincer deformities (CPDs) are a risk factor for patellofemoral pain syndrome (PFPS) in women. In addition, it sought to compare the hip joint range of motion and the hip muscle strength of extremities with and without CPDs and PFPS. Materials and Methods A total of 82 hips of 41 women with PFPS were included in the study. The mean age of participants was 32.07 ± 7.13 years. The presence of CPDs was detected on digital anterior pelvis radiographs. Pain was evaluated using the visual analog scale, and function using the Kujala scoring system. Maximum isometric muscle strength around the hips was measured using a hand-held dynamometer. Hip joint range of movement angles were measured in all three planes using a universal goniometer. Results CPDs were found to predict PFPS in women (p = 0.011, p = 0.048). The rate of CPDs was significantly higher in extremities with PFPS compared to those without PFPS (p = 0.007). The Kujala scores of extremities with cam deformity were significantly lower than those of extremities without pincer deformity (p = 0.043). The internal/external muscle strength ratio was greater, and the abduction/adduction muscle strength ratio was lower in extremities with cam and PFPS than in those without (p = 0.040, p = 0.049). The external rotation and abduction range of movement angles were significantly smaller in extremities with pincer and PFPS compared to those without (p = 0.043, p = 0.035). Conclusion CPDs may be a structural predisposing factor in the development of PFPS in women. CPDs assessment when evaluating predisposing factors for PFPS may present an opportunity for the management of PFPS.
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Affiliation(s)
- Tuğba Arslan
- Department of Occupational Therapy, Faculty of Health Science, Karatekin University, Çankırı, Turkey
- Aksu Mah. Sıhhıye Sok. No:11 18200, Çankırı, Turkey
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He L, Eastburn M, Smirk J, Zhao H. Smart Chemical Sensor and Biosensor Networks for Healthcare 4.0. SENSORS (BASEL, SWITZERLAND) 2023; 23:5754. [PMID: 37420917 DOI: 10.3390/s23125754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023]
Abstract
Driven by technological advances from Industry 4.0, Healthcare 4.0 synthesizes medical sensors, artificial intelligence (AI), big data, the Internet of things (IoT), machine learning, and augmented reality (AR) to transform the healthcare sector. Healthcare 4.0 creates a smart health network by connecting patients, medical devices, hospitals, clinics, medical suppliers, and other healthcare-related components. Body chemical sensor and biosensor networks (BSNs) provide the necessary platform for Healthcare 4.0 to collect various medical data from patients. BSN is the foundation of Healthcare 4.0 in raw data detection and information collecting. This paper proposes a BSN architecture with chemical sensors and biosensors to detect and communicate physiological measurements of human bodies. These measurement data help healthcare professionals to monitor patient vital signs and other medical conditions. The collected data facilitates disease diagnosis and injury detection at an early stage. Our work further formulates the problem of sensor deployment in BSNs as a mathematical model. This model includes parameter and constraint sets to describe patient body characteristics, BSN sensor features, as well as biomedical readout requirements. The proposed model's performance is evaluated by multiple sets of simulations on different parts of the human body. Simulations are designed to represent typical BSN applications in Healthcare 4.0. Simulation results demonstrate the impact of various biofactors and measurement time on sensor selections and readout performance.
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Affiliation(s)
- Lawrence He
- Princeton High School, Princeton, NJ 08540, USA
| | | | - James Smirk
- Princeton High School, Princeton, NJ 08540, USA
| | - Hong Zhao
- Gildart Haase School of Computer Sciences and Engineering, Fairleigh Dickinson University, Teaneck, NJ 07666, USA
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Trejo-Chavez O, Priego-Quesada JI, Gonzalez-Hernandez MP, Morales-Hernandez LA, Cruz-Albarran IA. Knee skin temperature response of patients with bilateral patellofemoral syndrome before and after heat and cold stress. J Therm Biol 2023; 115:103601. [PMID: 37327617 DOI: 10.1016/j.jtherbio.2023.103601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/18/2023]
Abstract
Patellofemoral Pain Syndrome is characterized by the presence of pain in the front area of the knee, which occurs when performing common activities such as climbing stairs, and bending the knees, among others. The objective of this research was to evaluate the detection capability of infrared thermography in patients with Patellofemoral Pain Syndrome, in the baseline state, as well as after the application of thermal stress. The investigation was conducted in 48 patients, who were subdivided into four groups (n = 12). Two subgroups were healthy patients and two with Patellofemoral Pain Syndrome. For the diagnosis of the syndrome, a manual evaluation was performed using the Zohlen test and Q angle measurement. Subsequently, cold stress was applied for 10 min to a healthy subgroup and an experimental subgroup. The remaining two subgroups were subjected to heat stress for 15 min. Thermographic images of the lower extremities were acquired at seven time points, at baseline, immediately after application of thermal stress and then every 3 min until 15 min were completed. It was observed that patients presented Patellofemoral Pain Syndrome bilaterally. After statistical analysis, it was found that there were no significant differences in baseline temperature between the groups. However, for heat stress, a higher temperature was observed in the group with Patellofemoral Pain Syndrome (p < 0.05) in the recovery period, and in the case of cold stress, only a lower temperature in the left knee immediately after the application. In conclusion, it is not possible to detect patellofemoral syndrome bilaterally in the baseline state by thermography and neither is it evident in cold stress. However, after heat stress, thermal recovery is lower for the PFPS group, so it would be susceptible to detection.
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Affiliation(s)
- Omar Trejo-Chavez
- Mechatronics, Engineering Faculty, Campus San Juan del Río, Autonomous University of Queretaro, San Juan del Rio, Queretaro, 76806, Mexico
| | - Jose I Priego-Quesada
- Research Group in Sport Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, Valencia, Spain
| | | | - Luis A Morales-Hernandez
- Mechatronics, Engineering Faculty, Campus San Juan del Río, Autonomous University of Queretaro, San Juan del Rio, Queretaro, 76806, Mexico
| | - Irving A Cruz-Albarran
- Mechatronics, Engineering Faculty, Campus San Juan del Río, Autonomous University of Queretaro, San Juan del Rio, Queretaro, 76806, Mexico.
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Pacini P, Martino M, Giuliani L, Santilli G, Agostini F, Del Gaudio G, Bernetti A, Mangone M, Paoloni M, Toscano M, De Vito C, Ottonello C, Santilli V, Cantisani V. Patello-Femoral Pain Syndrome: Magnetic Resonance Imaging versus Ultrasound. Diagnostics (Basel) 2023; 13:diagnostics13081496. [PMID: 37189597 DOI: 10.3390/diagnostics13081496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) and Ultrasound (US) in combination with clinical data could contribute to the diagnosis, staging and follow-up of Patello-Femoral Syndrome (PFS), which often overlaps with other pathologies of the knee. PURPOSE OF THE STUDY To evaluate the diagnostic role of MRI and US findings associated with PFS and define the range values of instrumental measurements obtained in pathological cases and healthy controls, the performance of the two methods in comparison, and the correlation with clinical data. MATERIALS AND METHODS 100 subjects were examined: 60 patients with a high suspicion of PFS at the clinical evaluation and 40 healthy controls. All measurements obtained by MRI and US examination were correlated with clinical data. A descriptive analysis of all measurements was stratified for pathological cases and healthy controls. A Student's t-test for continuous variables was used to compare patients to controls and US to MRI. Logistic regression analysis was applied to test the correlation between MRI and US measurements with clinical data. RESULTS Statistical descriptive analysis determined the MRI and US range values of medial patello-femoral distance and the thickness of retinacles and cartilages in pathological cases and healthy controls. In pathological cases, the retinacle results of both increased; the medial appeared to be slightly more increased than the lateral. Furthermore, in some cases, the thickness of the cartilage decreased in both techniques; the medial cartilage was more thinned than the lateral. According to logistic regression analyses, the best diagnostic parameter was the medial patello-femoral distance due to the overlapping results of the US and MRI. Furthermore, all clinical data obtained by different tests showed a good correlation with patello-femoral distance. In particular, the correlation between medial patello-femoral distance and the VAS score is direct and equal to 97-99%, which is statistically significant (p < 0.001), and the correlation with the KOOS score is inverse and equal to 96-98%, which is statistically significant. CONCLUSIONS MRI and Ultrasound examination in combination with clinical data demonstrated high-value results in the diagnosis of PFS.
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Affiliation(s)
- Patrizia Pacini
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Milvia Martino
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Luca Giuliani
- San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Vetoio Stree, 67100 L'Aquila, Italy
| | - Gabriele Santilli
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Francesco Agostini
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Giovanni Del Gaudio
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Andrea Bernetti
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Massimiliano Mangone
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Marco Paoloni
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Martina Toscano
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Corrado De Vito
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
| | - Carlo Ottonello
- Fisiocard Medical Centre, Via Francesco Tovaglieri 17, 00155 Rome, Italy
| | - Valter Santilli
- Policlinico Umberto I Hospital, Department of Anatomical, Histological and Legal Medical Sciences and of Locomotor System, Sapienza University, Aldo Moro Square 3, 00185 Rome, Italy
| | - Vito Cantisani
- Policlinico Umberto I Hospital, Department of Radiological and Oncological Sciences and Pathological Anatomy, Sapienza University, Policlinico Avenue 155, 00161 Rome, Italy
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You S, Shen Y, Liu Q, Cicchella A. Patellofemoral Pain, Q-Angle, and Performance in Female Chinese Collegiate Soccer Players. Medicina (B Aires) 2023; 59:medicina59030589. [PMID: 36984590 PMCID: PMC10054743 DOI: 10.3390/medicina59030589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background and objective: Female sports injuries have been neglected by science, and few relevant studies have considered female subjects. Knee pain in female soccer players is more common than in male soccer players. The number of days of absence from training and competition has been shown to be higher in females than males. The reporting of knee pain is common in female soccer players, but whether knee pain is associated with morphological features is unclear. The Q-angle of the knee has been hypothesized to be a causal factor in knee pain. Asian females have shown higher levels of valgus than non-sporting Caucasian populations, but no data exist for female Chinese players. The aim of our study was to investigate whether there are associations between knee pain, the Q-angle of the lower limb, jump performance, play time, and perceived exertion in female Chinese collegiate soccer players. Materials and Methods: We measured the Q-angle, patellofemoral/anterior knee pain (SNAPPS questionnaire), and CMJ and SJ performance of 21 subjects (age: 20.09 ± 1.13 years, weight: 56.9 ± 6.26 kg, height: 164.24 ± 4.48 cm, and >10 years of practice) before and after a match; Borg scale and play time results were also recorded. Results: We found that our studied group had higher Q-angles in comparison to other ethnic groups reported in the literature, as well as an association of the Q-angle with the age, height, and weight of the players; however, contrary to other studies, we did not find any association between the Q-angle and knee pain, jumps, play time, or perceived exertion. Knee pain was not associated with any of the measured variables. Conclusions: Female Chinese soccer players showed higher Q-angles than players of other ethnic groups, a result that was associated with anthropometrics. The Q-angle was not found to be associated with knee pain, for which the sole determinant was body height.
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Affiliation(s)
- Songhui You
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
| | - Yinhao Shen
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
| | - Qingguang Liu
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
| | - Antonio Cicchella
- Siping Road Campus, International College of Football, Tongji University, Shanghai 200092, China
- Department for Quality-of-Life Studies, University of Bologna, 47921 Rimini, Italy
- Correspondence:
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Patellofemoral Syndrome: a Review of Diagnosis and Treatment. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Abstract
Purpose of Review
Patellofemoral syndrome (PFS) is a common condition seen in people with anterior knee pain. This review explores patient presentations and exam maneuvers used for diagnosis, as well as established/up-and-coming treatment interventions.
Recent Findings
Pain reduction and prevention are the main goals for PFS as they negatively affect quality of life. Combination hip and knee exercises have been found to be most beneficial during therapy due to the multifactorial etiology of PFS. Combining exercise therapy with patellar taping has also shown a reduction in acute pain. Ultrasound may be used to evaluate for associated findings. Blood flow restriction and trigger point injections are options that may be helpful for pain reduction but further research is required.
Summary
PFS is a common clinical diagnosis requiring a robust patient history, supported by various physical exam maneuvers. Treatment involves a patient tailored approach, often with combinations of conservative management and interventional procedures.
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Vignaud E, Menu P, Daley P, Grondin J, Dauty M, Fouasson-Chailloux A. Artistic Swimming Injuries in Young Elite Athletes: An 11-year Follow-Up. Clin J Sport Med 2023; 33:00042752-990000000-00105. [PMID: 36877656 DOI: 10.1097/jsm.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Artistic swimming is a highly challenging discipline, requiring physical skills and creativity. There are almost no published data on trauma. We aimed to assess the incidence and the nature of injuries in artistic swimmers. DESIGN An 11-year retrospective single-center cohort study. SETTING Department of Sport Medicine of a University Hospital. PATIENTS One hundred and twenty-four elite female artistic swimmers aged 12.9 ± 1.6 years. INTERVENTIONS The cohort was divided into 3 groups according to the competition categories (from 9 to 12 years old called "future", 12-15 years old called "youth", 15-19 years old called "junior"). MAIN OUTCOME MEASURES Injury rate per season and per athlete was assessed. RESULTS The injury rate was 0.95 injuries/season/athlete and 1.05 injuries/1000 hours of practice. The most frequent injuries were rotator cuff tendinopathy (13.6%), acute low back pain (13.6%), and patellofemoral syndrome (11.9%). Swimmers in the youth and junior categories had significantly more injuries than those in the future category (P = 0.009), possibly because of more training hours (P < 0.001). Twelve major injuries occurred, all in the same group of youth swimmers. CONCLUSION This is the first study investigating trauma during artistic swimming practice. A better knowledge of the main injuries is necessary for the physician to provide optimal care for athletes and to develop prevention. Attention should be particularly paid to the swimmers' shoulders and knees.
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Affiliation(s)
- Emeline Vignaud
- Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes Université, France
- Service de Rhumatologie, CHU Nantes, Nantes Université, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes Université, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton-Nantes Université, France; and
- Institut Régional de Médecine du Sport, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes Université, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes Université, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, France
| | - Marc Dauty
- Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes Université, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton-Nantes Université, France; and
- Institut Régional de Médecine du Sport, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes Université, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, France
- INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton-Nantes Université, France; and
- Institut Régional de Médecine du Sport, Nantes, France
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Seijas-Otero D, Alonso-Calvete A, Cuña-Carrera ID, Justo-Cousiño LA. Effects of taping in patellofemoral pain syndrome: A systematic review. J Back Musculoskelet Rehabil 2023; 36:261-269. [PMID: 35964172 DOI: 10.3233/bmr-220099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patellofemoral pain syndrome (PPS) is defined as a condition in the patellofemoral joint that can present with pain, functional deficit, crepitus, and instability. Its etiology appears to lie in excessive loading of the patellofemoral joint due to mispositioning of the patella. The application of taping has recently increased, to manage PPS. However, the level of scientific evidence in this sense is unknown. OBJECTIVE To determine the effect of different types of taping in subjects with PPS. METHODS A bibliographic search was carried out in January and February 2021 in Scopus, Web of Science, PubMed, Medline, SPORTDiscus, PEDro and CINAHL. RESULTS A total of 13 studies were included for qualitative analysis. The mean score on the PEDro scale was 5.30 points. Most of the articles reflect a decrease in pain after the taping intervention, while variables such as functionality, muscle activity and biomechanical modification do not show positive effects. CONCLUSION Taping appears to have positive effects on pain in subjects with PPS. However, the evidence is contradictory with the rest of the variables studied.
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Affiliation(s)
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo, Pontevedra, Spain.,REMOSS Research Group. Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
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Wang J, Wang X, Sun B, Yuan L, Zhang K, Yang B. 3D-printed patient-specific instrumentation decreases the variability of patellar height in total knee arthroplasty. Front Surg 2023; 9:954517. [PMID: 36704513 PMCID: PMC9871753 DOI: 10.3389/fsurg.2022.954517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Three-dimensionally (3D) printed patient-specific instrumentation (PSI) might help in this regard with individual design and more accurate osteotomy, but whether the utility of such instrumentations minimizes the variability of patellar height in total knee arthroplasty (TKA) and the reasons for this effect are unknown. Our aim is to compare and analyze the variability of patellar height with PSI and conventional instrumentation (CI) in TKA. Methods Between March 2018 and November 2021, 215 patients with severe knee osteoarthritis who were treated with primary unilateral TKA were identified for this observational study. The patients were divided into the CI-TKA group and PSI-TKA group according to the osteotomy tools used in TKA. Preoperative and postoperative radiographic parameters including hip-knee-ankle angle (HKA), posterior tibial slope (PTS), Insall-Salvati ratio, modified Caton-Deschamps (mCD) ratio, anterior condylar offset (ACO), and posterior condylar offset (PCO) were evaluated. Results The groups were similar in patients' demographic data, clinical scores, and radiographic parameters preoperatively. Overall, according to the results of the Insall-Salvati ratio, postoperative patellar height reduction was noted in 140 patients (65.1%). Interestingly, the variability of patellar height was smaller in the PSI-TKA group. Radiographic evaluation revealed that the Insall-Salvati ratio after TKA had a minor change in the PSI-TKA group (p = 0.005). Similarly, the mCD ratio after TKA also had a minor change in the PSI-TKA group (p < 0.001). Compared to those in the CI-TKA group, the ACO (p < 0.001) and PCO (p = 0.011) after TKA had a minor change in the PSI-TKA group, but no minor PTS change (p = 0.951) was achieved in the PSI-TKA group after TKA. However, even with 3D-printed patient-specific instrumentation, there were still significant reductions in patellar height, ACO, PCO, and PTS after TKA (p < 0.001). Conclusion The variability of patellar height was sufficiently minimized with more accurate anterior and posterior femoral condyle osteotomy when 3D printed PSI was used. Furthermore, there was a trend in over-resection of the femoral anterior and posterior condyle and a marked reduction in PTS during TKA, which could lead to a change in patellar height and might result in more patellofemoral complications following TKA. Level of evidence Level II.
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Yoon SW, Son HH. Effects of McConnell and Kinesio taping on kinematic variables during stair descent in patients with patellofemoral pain syndrome. J Back Musculoskelet Rehabil 2023; 36:1307-1316. [PMID: 37482975 DOI: 10.3233/bmr-220244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Studies regarding effects of therapeutic tapings when patients with patellofemoral pain syndrome (PFPS) descend stairs are limited. OBJECTIVE The purpose of this study was to investigate the effect of McConnell taping (MT) and Kinesio taping (KT) on kinematic variables when patients with PFPS descend stairs. METHODS Fifty PFPS patients were randomly assigned to either the MT group or the KT group. Pain and lower extremities joint angles were measured while descending stairs before and after the intervention. All outcomes measured were analyzed using either paired t tests or independent t tests to compare the difference within or between groups, respectively. RESULTS There was a statistically significant difference in both groups in anterior knee pain scale score (p< 0.05). As a result of analysis of lower extremities joint angles at initial contact, loading response, and terminal stance, there were statistically significant within-group differences in hip, knee flexion, abduction and lateral rotation angles in both groups (p< 0.05). There were statistically significant within-group differences in hip flexion, knee flexion, and dorsiflexion angles in pre-swing (p< 0.05). There was a statistically significant difference between the groups in the following events: (1) knee lateral rotation angle at initial contact; (2) hip flexion angle at loading response; (3) and hip flexion at terminal stance angle (p< 0.05). CONCLUSION MT and KT were effective in lowering knee pain and improving lower extremities joint angle when patients with PFPS descend stairs. In the comparison between the groups, the MT group showed significantly reduced anterior knee pain and increased range of motion of the lower extremities joint compared to the KT group.
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Tang ACW, Chen CK, Wu SY, Tang SFT. Improvement of Pain and Function by Using Botulinum Toxin Type A Injection in Patients with an Osteoarthritic Knee with Patellar Malalignment: An Electromyographic Study. Life (Basel) 2022; 13:life13010095. [PMID: 36676044 PMCID: PMC9863177 DOI: 10.3390/life13010095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Objective: To determine the pain and electromyographic (EMG) amplitude ratio of the vastus medialis oblique (VMO) to the vastus lateralis (VL) after botulinum toxin type A (BTA) was injected in the bilateral osteoarthritic knee of patients with patellar malalignment for analysis. Material and methods: A total of fifteen patients were recruited; the more symptomatic knee of each patient received a BTA injection (BTA side). The other set of patients were left untreated. In all, fifteen healthy participants comprised the control group. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and numeric rating scale (NRS) for pain were assessed. The EMG amplitude of VL and VMO activity was recorded using an isokinetic dynamometer and synchronized using the BIOPAC MP100. The data were collected before and at 4, 8, and 12 weeks post−BTA injection. Results: The EMG ratios of the patient group were lower than those of the control group at all testing velocities (p < 0.05). The VMO/VL ratio improved significantly on the BTA side only. The VMO/VL ratios on the BTA side were higher than those on the untreated side (p < 0.05). Knee pain decreased significantly after the BTA injection. The EMG ratios were negatively correlated with the NRS and WOMAC scores. Conclusion: BTA injection effectively reduces knee pain and restores the EMG ratio between the VMO and VL.
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Affiliation(s)
- Alice Chu Wen Tang
- Department of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital, New Taipei City 234, Taiwan
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan
| | - Szu Yuan Wu
- Division of Radiation Oncology and Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265501, Taiwan
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 24205, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan
| | - Simon F. T. Tang
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan 265501, Taiwan
- Correspondence: ; Tel.: +886-3-9543131 (ext. 3300); Fax: +886-3-9565042
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de Albuquerque CE, Bibin F, Bussarolo JM, Dalmolin EB, Ricardo Flor Bertolini G, Nuñez SC. The influence of iliotibial tract thickness on clinical outcomes in women with patellofemoral pain. Knee 2022; 39:319-324. [PMID: 36347136 DOI: 10.1016/j.knee.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 09/12/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The assessment of iliotibial tract thickness by ultrasonography may help identify a key, previously unexplored factor that may contribute directly to the homeostasis imbalance of the femoropatellar joint in people with patellofemoral pain (PFP). OBJECTIVES To compare the iliotibial tract thickness of people with PFP and asymptomatic people; and to correlate the iliotibial tract thickness with self-reported pain and function of people with PFP. METHODS Eighty women, separated into two groups: PFP group (n = 40) and control group consisting of asymptomatic participants (CG; n = 40). The participants answered the Anterior Knee Pain Scale (AKPS) questionnaire, to identify the self-reported knee function; they evaluated the pain in millimeters by the Visual Analog Scale for pain (VAS). For the imaging evaluation, an ultrasound was used, with a linear transducer at the distal portion of the iliotibial tract (coronal plane), with the participants positioned in dorsal decubitus, with 20° of knee flexion. The iliotibial band was visualized in its long axis, and three sequential images were recorded between the lateral femoral condyle and the lateral tibial condyle. The measurements were normalized and correlated. RESULTS The groups had no differences (P > 0.001) between participants for: age/weight/height/IMC. Participants in the PFP group had moderate levels of pain (58 + 2.1 mm), considerable self-reported functional limitation (d = 3.05) and greater iliotibial tract thickness compared with the CG (d = 2.41). CONCLUSION The iliotibial tract of women diagnosed with PFP have greater thickness compared with asymptomatic women. There was no association between iliotibial tract thickness and subjective measures of pain and function.
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Affiliation(s)
| | - Fernanda Bibin
- Universidade Estadual do Oeste do Paraná, Cascavel, Paraná, Brazil
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A Review of Functional Outcomes after the App-Based Rehabilitation of Patients with TKA and THA. J Pers Med 2022; 12:jpm12081342. [PMID: 36013291 PMCID: PMC9409922 DOI: 10.3390/jpm12081342] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Following the outbreak of SARS-CoV-2, several elective surgeries were cancelled, and rehabilitation units were closed. This has led to difficulties for patients seeking access to rehabilitation in order to achieve the best possible outcome. New applications with or without sensors were developed to address this need, but the outcome has not been examined in detail yet. The aim of this study was to perform a systematic literature review on smart phone applications for patients suffering from hip and knee osteoarthritis after arthroplasty. The MEDLINE/PubMed and Google databases were queried using the search term “[APP] AND [ORTHOPEDIC]” according to PRISMA guidelines. All prospective studies investigating rehabilitation applications reporting the functional outcome in hip and knee osteoarthritis after arthroplasty were included. The initial search yielded 420 entries, but only 9 publications met the inclusion criteria, accounting for 1067 patients. In total, 518 patients were in the intervention group, and 549 patients were in the control group. The average follow-up was 9.5 ± 8.1 months (range: 3 to 23.4 months). Overall, significantly lower A-VAS values were observed for the interventional group in the short term (p = 0.002). There were no other significant differences observed between the two groups. Smart phone applications provide an alternative to in-person sessions that may improve access for patients after total joint arthroplasty. Our study found there are significant improvements in the short term by using this approach. In combination with a blue-tooth-enabled sensor for isometric exercises, patients can even receive real-time feedback after total knee arthroplasty.
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Xiong B, OuYang Y, Chang Y, Mao G, Du M, Liu B, Xu Y. A fused biometrics information graph convolutional neural network for effective classification of patellofemoral pain syndrome. Front Neurosci 2022; 16:976249. [PMID: 35968371 PMCID: PMC9372351 DOI: 10.3389/fnins.2022.976249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Patellofemoral pain syndrome (PFPS) is a common, yet misunderstood, knee pathology. Early accurate diagnosis can help avoid the deterioration of the disease. However, the existing intelligent auxiliary diagnosis methods of PFPS mainly focused on the biosignal of individuals but neglected the common biometrics of patients. In this paper, we propose a PFPS classification method based on the fused biometrics information Graph Convolution Neural Networks (FBI-GCN) which focuses on both the biosignal information of individuals and the common characteristics of patients. The method first constructs a graph which uses each subject as a node and fuses the biometrics information (demographics and gait biosignal) of different subjects as edges. Then, the graph and node information [biosignal information, including the joint kinematics and surface electromyography (sEMG)] are used as the inputs to the GCN for diagnosis and classification of PFPS. The method is tested on a public dataset which contain walking and running data from 26 PFPS patients and 15 pain-free controls. The results suggest that our method can classify PFPS and pain-free with higher accuracy (mean accuracy = 0.8531 ± 0.047) than other methods with the biosignal information of individuals as input (mean accuracy = 0.813 ± 0.048). After optimal selection of input variables, the highest classification accuracy (mean accuracy = 0.9245 ± 0.034) can be obtained, and a high accuracy can still be obtained with a 40% reduction in test variables (mean accuracy = 0.8802 ± 0.035). Accordingly, the method effectively reflects the association between subjects, provides a simple and effective aid for physicians to diagnose PFPS, and gives new ideas for studying and validating risk factors related to PFPS.
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Affiliation(s)
- Baoping Xiong
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
| | - Yaozong OuYang
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
| | - Yiran Chang
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
| | - Guoju Mao
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
- *Correspondence: Guoju Mao,
| | - Min Du
- Fujian Provincial Key Laboratory of Eco-Industrial Green Technology, Wuyi University, Wuyishan, China
| | - Bijing Liu
- State Grid Electric Power Research Institute, Beijing, China
- Bijing Liu,
| | - Yong Xu
- School of Computer Science and Mathematics, Fujian University of Technology, Fuzhou, China
- Fujian Provincial Key Laboratory of Big Data Mining and Applications, Fujian University of Technology, Fuzhou, China
- Yong Xu,
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Effects of Patellofemoral Pain Syndrome on Changes in Dynamic Postural Stability during Landing in Adult Women. Appl Bionics Biomech 2022; 2022:7452229. [PMID: 35592870 PMCID: PMC9113904 DOI: 10.1155/2022/7452229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study investigated the effects of lower limb movements on dynamic postural stability (DPS) during drop landing in adult women with patellofemoral pain syndrome (PFPS). Methods Thirty-eight adult women were recruited and divided into two groups, the PFPS group and the control group. The study participants performed a single-leg drop landing from a 30 cm box, and their lower limb movements and DPS were measured. Differences between groups were examined using independent sample t-tests. In addition, stepwise multiple linear regression was used to examine the kinematic parameters that contribute to the DPS. Results The PFPS group had significantly lower hip flexion, internal rotation, knee flexion, ankle external rotation, pelvic oblique, tilt, rotation, and higher hip abduction, knee valgus, and ankle plantarflexion. In terms of DPS, the PFPS group had a significantly higher anteroposterior and a lower mediolateral than that of the control group. In the control group, regression analysis revealed a controlled anteroposterior using knee flexion, while the PFPS group controlled mediolateral through ankle plantarflexion. Conclusions Patients with PFPS experienced more shock on their knee joint during landing than patients in the control group with greater anteroposterior instability and lower mediolateral instability.
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Horii M, Akagi R, Takahashi S, Watanabe S, Ogawa Y, Kimura S, Yamaguchi S, Ohtori S, Sasho T. Risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents: a prospective cohort study of 3 years. BMC Musculoskelet Disord 2022; 23:389. [PMID: 35473612 PMCID: PMC9044608 DOI: 10.1186/s12891-022-05349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patellar and patellar tendon pain is a common limitation to children’s participation in social and physical activities. Some factors have been implicated in the occurrence and protraction of knee pain, but the causal relationship is unknown. The purpose of this study was to investigate whether participants’ physical characteristics and activity level are risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents. Methods A three-year prospective cohort study was conducted with healthy students who were aged 8–14 years old, in Japan. Height, weight, heel-buttock distance, straight leg raising angle, and dorsiflexion angle of the ankle joint were collected as individual physical factors at the beginning of each year. The presence of self-reported patellar and patellar tendon pain and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was collected every month. Protraction was defined as either (1) pain lasting for more than three continuous months or (2) recurrent pain after more than three months of complete recovery. Participants who did not have any pain at the beginning of the observation period were included in the analysis. We analyzed the odds ratio (OR) of pain occurrence within a year of registration and protraction throughout the study period for all physical factors and HSS Pedi-FABS. Results We included 1133 participants in the analysis and 252 participants developed knee pain within a year. 34.8% of participants with pain experienced protraction during the follow-up period. A high HSS Pedi-FABS significantly predicted knee pain occurrence (OR 1.03, 95% confidence interval [CI] 1.01–1.05) and protraction (OR 1.03, 95% CI 1.00–1.05). In addition, younger children and girls were at a significantly higher risk of patellar and patellar tendon pain protraction (age, OR 0.81, 95% CI, 0.73–0.90; sex, OR 1.69, 95% CI, 1.09–2.64). Other physical factors did not significantly predict the occurrence or protraction of knee pain. Conclusions This study showed that a greater physical activity level was a risk factor for the occurrence and protraction of patellar and patellar tendon pain in childhood. In addition, younger age and female sex predicted higher risk of protraction of pain. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05349-y.
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Affiliation(s)
- Manato Horii
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Ryuichiro Akagi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan. .,Sports Medics Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Sho Takahashi
- Clinical Research Support Center, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shotaro Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yuya Ogawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Seiji Kimura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Satoshi Yamaguchi
- Sports Medics Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.,Graduate School of Global and Transdisciplinary Studies, Chiba University, 1-33 Yayoi, Inage-ku, Chiba, Chiba, 263-8522, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.,Sports Medics Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takahisa Sasho
- Sports Medics Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.,Center for Preventive Medical Sciences, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Fang B, Kim YH, Choi MY. Effects of High-Intensity Aquatic or Bicycling Training in Athletes with Unilateral Patellofemoral Pain Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084675. [PMID: 35457543 PMCID: PMC9028389 DOI: 10.3390/ijerph19084675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Patellofemoral pain syndrome (PFPS) is one of the most common overuse injuries experienced by athletes. It is characterized by pain and functional deficits that lead to decreased performance, thereby limiting sports activity. Therefore, optimal training interventions are required to improve physical fitness and function while minimizing pain due to PFPS. This study aimed to compare and analyze the effects of high-intensity aquatic training (AT) and bicycling training (BT) in male athletes with PFPS. Fifty-four athletes with PFPS were divided into AT and BT intervention groups. Intervention training was conducted three times per week for 8 weeks. Cardiorespiratory fitness was evaluated using the graded exercise test (GXT) based on peak oxygen uptake (VO2 peak), and anaerobic threshold. For the knee strength test, extension and flexion were performed and measured using isokinetic equipment. One-leg hop tests and the Y-balance test (YBT) were performed to evaluate dynamic balance, and the International Knee Documentation Committee (IKDC) scoring system was used for subjective knee evaluation. The GXT, YBT, and IKDC scores were reported according to the group and duration of the intervention. After training, VO2 peak, YBT, knee extension strength, and IKDC score improved significantly in both the AT and BT groups compared with the pre-training values. Furthermore, the AT group exhibited significant improvement compared with the BT group. We demonstrated that AT and BT effectively improved the symptoms and muscle strength of athletes with PFPS who were only able to engage in limited high-intensity field training. AT produced a modestly better effect than BT.
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Affiliation(s)
- Bin Fang
- College of Physical Education, Luoyang Normal University, Luoyang 471934, China;
| | - Yong-hwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Korea;
| | - Moon-young Choi
- Department of Sports Science Convergence, Dongguk University, Seoul 04620, Korea
- Correspondence: ; Tel.: +82-2-2260-8741; Fax: +82-2-2260-3741
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Peng J, Xiao F, Zhu J, Shen C, Li Y, Han X, Cui Y, Chen X. Characteristics of the patellofemoral joint of patients with DDH and the effects of Bernese periacetabular osteotomy on the patellofemoral joint. BMC Musculoskelet Disord 2022; 23:337. [PMID: 35395939 PMCID: PMC8991590 DOI: 10.1186/s12891-022-05291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some patients with developmental dysplasia of the hip (DDH) complained of anterior knee pain (AKP) before and after Bernese periacetabular osteotomy (PAO) surgery. The purpose of this study was to (1) identify the characteristics of patellofemoral joint (PFJ) deformities in patients with DDH and (2) to determine the effects of PAO on the PFJ. METHODS Seventy patients (86 hips) were included in the DDH group. Thirty-three patients (33 knees) without AKP and hip pain were included in the control group. All patients underwent simultaneous CT scans of the hip and knee joints before PAO and after hardware removal surgery. The distance from the anterior inferior iliac spine to the ilioischial line (DAI), was measured in DDH patients. Imaging parameters of knees, including the sulcus angle (SA), femoral trochlear depth (FTD), patellar width (PW), tibial tuberosity-trochlear groove (TT-TG), patellar tilt angle (PTA) and lateral shift of the patella (LSP) were measured in patients in both the DDH and control group. TT-TG, PTA, and LSP of DDH patients were measured before PAO and after hardware removal. The DAI, PTA, LSP and TT-TG of all DDH patients before and after Bernese PAO were compared using paired t-tests. The FTD, PW, and SA of the DDH patients and the control group were analyzed using independent t-tests. PTA, TT-TG, and LSP between the control group and preoperative DDH patients, between the control group and post PAO patients were compared using independent t-tests. RESULTS The DAI changed from 4.04 ± 0.61 mm before PAO surgery to 5.44 ± 0.63 mm after PAO surgery. The SA of the DDH group (140.69 ± 11.30 degree) was greater than that of the control group (130.82 ± 6.43 degree). The FTD and the PW of the DDH group (5.45 ± 1.59 mm, 4.16 ± 0.36 mm) were smaller than that of the control group (7.39 ± 1.20 mm, 4.24 ± 0.38 mm). The changes in LSP, PTA, and TT-TG before and after surgery were not statistically significant. Both before and after PAO, there was no statistically significant difference in the parameters of LSP, PTA, and TT-TG compared with the control group. CONCLUSION The knee joints of DDH patients presented a certain degree of femur trochlear groove dysplasia and patellofemoral instability. PAO surgery did not change PFJ stability, although the origination point of the rectus femoris muscle moved laterally during PAO surgery.
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Affiliation(s)
- Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Fei Xiao
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiuguo Han
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yimin Cui
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China.
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Sbardelotto GAEB, Weisshahn NK, Benincá IL, de Estéfani D, e Lima KMM, Haupenthal A. Hold-relax PNF is more effective than unilateral lumbar mobilization on increasing hamstring flexibility: A randomized clinical trial. J Bodyw Mov Ther 2022; 32:36-42. [DOI: 10.1016/j.jbmt.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 02/14/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
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Patella-patellar tendon angle in relation to the medial patellar plica syndrome, chondromalacia patella, and infrapatellar fat pad syndrome. PLoS One 2022; 17:e0265331. [PMID: 35298516 PMCID: PMC8929550 DOI: 10.1371/journal.pone.0265331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
The patella-patellar tendon angle (PPTA) assessing the sagittal patellar tilt was reported to be related with anterior knee pain. Herein, clinical effect of PPTA in patients with medial patellar plica (MPP) syndrome, chondromalacia patella, and infrapatellar fat pad (IPFP) syndrome, the most common causes of anterior knee pain, was evaluated. In this retrospective study, 156 patients with anterior knee pain who underwent magnetic resonance imaging (MRI) and arthroscopic surgery that confirmed isolated MPP syndrome, chondromalacia patella, or IPFP syndrome from June 2011 to January 2021 were included in the study group and 118 patients without knee pathology on MRI during the same period were included in the control group. The PPTA was measured on knee MRI and compared between the two groups. A receiver operating characteristic (ROC) analysis was used to evaluate the value of PPTA for predicting the risk of patellofemoral joint disorder. The mean PPTA was significantly smaller in study group (138.1 ± 4.2°) than control group (142.1 ± 4.3°) (p < 0.001). However, there was no significant difference in PPTA among the patients with MPP syndrome, chondromalacia patella, and IPFP syndrome. Furthermore, the ROC analysis revealed that the area under curve, sensitivity, and specificity for predicting the risk of patellofemoral joint disorders were 0.696, 70.3% and 57.6%, respectively, at a PPTA cutoff of 138.3°. Therefore, the smaller PPTA may be associated with MPP syndrome, chondromalacia patella, and IPFP syndrome. Furthermore, PPTA could be a predictive factor for the risk of patellofemoral joint disease in patients with anterior knee pain.
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