Diagnosis and treatment of patients with patellofemoral pain

Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study

BACKGROUND

Today, no clinical studies have been undertaken to examine the long-term effects of an open kinetic chain or closed kinetic chain program.

HYPOTHESIS

The long-term follow-up results after a conservative exercise protocol are significantly worse than the short-term results. The long-term effect of closed kinetic chain training is significantly better compared to the effect of open kinetic chain training.

STUDY DESIGN

Prospective randomized clinical trial.

METHODS

Sixty patients were randomized into a 5-week conservative program, consisting of only closed kinetic chain exercises or only open kinetic chain exercises. Assessment of muscular characteristics, subjective symptoms, and functional performance was evaluated in this study at the time of initial physical examination, at the end of the treatment period, and 5 years later.

RESULTS

At the 5-year follow-up, both groups demonstrated maintenance of good subjective and functional outcomes achieved immediately after the conservative treatment. No significant difference between both groups was observed at the 5-year follow-up for the majority of the examined parameters. However, on 3 of the 18 visual analog scales, the open kinetic chain group showed significantly less complaints compared to the closed kinetic chain group.

CONCLUSIONS

On the basis of these results, the authors conclude that both open kinetic chain and closed kinetic chain programs lead to an equal long-term good functional outcome.

Kinematic MRI assessment of McConnell taping before and after exercise

BACKGROUND

The authors assessed the effectiveness of McConnell medial glide taping after exercise using an MRI extremity scanner.

HYPOTHESIS

McConnell taping would not be effective in maintaining medial glide of the patella after exercise.

METHODS

Eighteen healthy women (mean age 22.28 +/- 2.02 years) participated in the study. The patellofemoral joint was imaged at 4 knee flexion angles (0 degrees, 12 degrees, 24 degrees, and 36 degrees ) in 3 conditions (no tape, with McConnell taping-medial glide, and with tape after exercise). Effectiveness was determined by measuring lateral patellar displacement. ANOVA and post hoc paired t tests were used to test for changes in lateral patellar displacement at each knee angle and condition.

RESULTS

Statistical analysis revealed significant differences in lateral patellar displacement at all test angles, between the tape and no tape and between tape and tape after exercise conditions.

CONCLUSIONS

McConnell medial glide taping resulted in significant medial glide of the patellofemoral joint at all 4 knee angles before but not after exercise. However, McConnell medial glide taping may be effective under controlled rehabilitation conditions in which exercise is less intense.

CLINICAL RELEVANCE

Beneficial effects of McConnell medial glide taping may be related to factors other than altered patellar alignment.

Sports and performing arts medicine. 3. Lower-limb injuries in endurance sports

This self-directed learning module highlights new advances in this topic area. It is part of the study guide on sports medicine and performing arts in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on (1) ankle pain in a runner, (2) heel pain in an adolescent, (3) anterior knee pain in a runner, (4) lateral knee pain in a cyclist, (5) shin splints in a runner, (6) buttock pain in a hiker, and (7) collapse of a marathoner from hyponatremia.

OVERALL ARTICLE OBJECTIVE

To summarize lower-limb injuries commonly seen in endurance sports.

Relation between isokinetic muscle strength and functional capacity in recreational athletes with chondromalacia patellae

OBJECTIVES

To investigate the effects of isokinetic exercise on pain and functional test scores of recreational athletes with chondromalacia patellae (CMP) and to examine the correlation between isokinetic parameters and functional tests or pain score.

METHODS

The functional ability of 30 recreational athletes with unilateral CMP was evaluated using six different tests. Pain scores were assessed during daily activities before and after the treatment protocol. Isokinetic exercise sessions were carried out at angular velocities of 60 degrees /s (25-90 degrees range of flexion) and 180 degrees /s (full range). These sessions were repeated three times a week for six weeks.

RESULTS

Quadriceps and hamstring peak torque, total work, and endurance ratios had improved significantly after the treatment, as did the functional parameters and pain scores. There was a poor correlation between the extensor endurance ratio and one leg standing test. A moderate correlation between the visual analogue scale and the extensor endurance ratio or flexion endurance ratio was also found.

CONCLUSIONS

The isokinetic exercise programme used in this study had a positive effect on muscle strength, pain score, and functional ability of knees with CMP. The improvement in the functional capacity did not correlate with the isokinetic parameters.

The effect of bracing on patellofemoral joint stress during free and fast walking

BACKGROUND

Although several studies have demonstrated decreases in patellofemoral pain (PFP) with the application of bracing, the mechanism by which bracing reduces symptoms has not been elucidated.

HYPOTHESIS

Individuals who responded favorably to bracing will exhibit decreased patellofemoral stress during level walking.

STUDY DESIGN

Repeated measures, cross-sectional.

METHODS

Fifteen subjects with a diagnosis of PFP completed two phases of data collection: 1) MRI assessment of patellofemoral contact area and 2) gait analysis. Data were obtained under braced and nonbraced conditions. Variables obtained from both data collection sessions were used as input variables into a mathematical model to quantify patellofemoral stress.

RESULTS

Subjects reported a 56% reduction in pain following bracing. Bracing significantly reduced peak stress during free and fast walking (17% and 27%, respectively). The decrease in stress was the result of increased contact area as patellofemoral joint reaction forces were increased following bracing.

CONCLUSION

Bracing resulted in a larger increase in patellofemoral contact area than the increase in joint reaction force, resulting in a decrease in joint stress.

CLINICAL RELEVANCE

The results of this study suggest a possible mechanism by which bracing may be effective in reducing PFP and provides experimental support for the use of this treatment method.

Hip strength in females with and without patellofemoral pain

STUDY DESIGN

Cross-sectional.

OBJECTIVES

To determine if females with anterior knee pain are more likely to demonstrate hip abduction or external rotation weakness than a similar, asymptomatic, age-matched control group.

BACKGROUND

Diminished hip strength has been implicated as being contributory to lower-extremity malalignment and patellofemoral pain. The identification of reliable and consistent patterns of weakness in this population may assist health care professionals establish a more effective treatment plan.

METHODS AND MEASURES

Hip abduction and external rotation isometric strength measurements were recorded for the injured side of 15 female subjects with patellofemoral joint pain (mean +/- SD age, 15.7 +/- 2.7 years; age range, 12-21 years). These were compared with strength measurements from the corresponding hip of 15 age-matched female control subjects (mean +/- SD age, 15.7 +/- 2.7 years; age range, 12-21 years). All strength measurements were made using hand-held dynamometers.

RESULTS

Subjects with patellofemoral pain demonstrated 26% less hip abduction strength (P<.001) and 36% less hip external rotation strength (P<.001) than similar age-matched controls.

CONCLUSIONS

The results indicate that young women with patellofemoral pain are more likely to demonstrate weakness in hip abduction as well as external rotation than age-matched women who are not symptomatic.

A critical reexamination of the morphology, neurovasculature, and fiber architecture of knee extensor muscles in animal models and humans

The purposes of the present study were to resolve a number of major inconsistencies found in the literature on the structure of the quadriceps femoris muscle and to extend knowledge of its structure using descriptive, qualitative methodology. The quadriceps femoris muscle was investigated in 41 cats, and the findings were confirmed in 6 human cadavers. Two aponeuroses with major biomechanical functions (rectus-vastus and vastus aponeurosis), neither of which had been previously described in the literature, were characterized in both species. The study also resolved many major inconsistencies in the literature: The muscle sometimes described as vastus intermedius (VI) was found to be the articularis genu, the muscle sometimes described as vastus medialis (VM) was found to be the VI, the rectus femoris head was found to have an additional proximal nerve branch not previously recognized, no anomalous 5th head was everfound, and the distal VM were not found to have 2 heads (in either cats or humans). The authors' anatomical descriptions and bimechanical models of the muscles, tendons, and neurovascular should provide a helpful foundation for future studies on the quadriceps. Two general recommendations are made: 1) that the feline model be considered a viable model to elucidate human knee pathomechanics; and 2) that regardless of the anatomical structure of interest, orthopedic nurses, orthopedic surgeons, and research investigators should routinely use the research literature for anatomical guidance instead of standard anatomical textbooks.