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Asayama A, Yagi M, Taniguchi M, Hirono T, Kato T, Hayashi R, Ichihashi N. Effect of soft tissue tension around the knee joint on medio-lateral patellar position. J Biomech 2024; 168:112137. [PMID: 38710152 DOI: 10.1016/j.jbiomech.2024.112137] [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: 10/20/2023] [Revised: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Patellofemoral pain (PFP) is one of the most common sports injuries of the knee joint and has a high persistence and recurrence rate. Medio-lateral patellar position in the knee extension position during contraction is associated with PFP. However, soft tissue tension that most influences the medio-lateral patellar position in the knee extension position during contraction in vivo is unclear. We aimed to clarify the relationship between medio-lateral patellar position and soft tissue tension around the knee joint. Twelve patients with PFP and 20 healthy participants were included. Medio-lateral patellar position and tension of the rectus femoris, vastus lateralis (VL), vastus medialis, iliotibial band (ITB), lateral patellofemoral ligament, and medial patellofemoral ligament were measured during contraction and rest. The tensions of the VL and ITB during contraction and the medio-lateral patellar position at rest were significantly associated with medio-lateral patellar position during contraction (β = 0.449, 0.354, and 0.393, respectively). In addition, the tension of ITB was significantly associated with the medio-lateral patellar position at rest (β = 0.646). These relationships were not affected by the presence of PFP. These findings suggest that the patellar position during contraction became more lateral as the tension in the VL and ITB increased, regardless of the presence of PFP. These results may facilitate the prevention and treatment of PFP.
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Affiliation(s)
- Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan; Department of Rehabilitation, Japanese Red Cross Nagahama Hospital, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan.
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan; Research Fellow of the Japan Society for the Promotion of Science Kojimachi Business Center Building, Japan
| | - Takehiro Kato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Remi Hayashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
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Ophey MJ, Westerweel A, van Oort M, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Impaired hemodynamics of the patella in patients with patellofemoral pain: A case-control study. J Exp Orthop 2024; 11:e12009. [PMID: 38455453 PMCID: PMC10900186 DOI: 10.1002/jeo2.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose According to the homeostasis model, patellofemoral pain (PFP) arises as a consequence of disturbed homeostasis of anterior structures of the knee due to vascular insufficiency. Near-infrared spectroscopy (NIRS) allows to measure changes of concentrations (µmol/cm2) of (de)-oxygenated hemoglobine (HHb and O2Hb). The aim was to study differences in patellar hemodynamics between patients and healthy controls. Methods Hemodynamics of patients (n = 30 [female = 20, age = 21.5, BMI = 22.9]) and controls (n = 30 (female = 18, age = 21.4, BMI = 22.4]) were evaluated for two activities ('Prolonged Sitting' and 'Stair Descent'). Blinding for health status was implemented. Results During 'Prolonged Sitting', PFP patients exhibited smaller decreases in mean changes for HHb (PFP [M = -1.5 to -1.9], healthy controls [M = -2.0 to -2.3]) and O2Hb (PFP [M = -2.0 to -3.2], healthy controls [M = -3.4 to -4.1]). However, these differences were statistically non-significant (p = 0.14-0.82 and p = 0.056-0.18, respectively). Conversely, for 'Stair Descent', PFP patients showed statistically significant smaller decreases in mean changes for HHb (PFP [M = -1.9, SD = 1.8], healthy controls [M = -2.5, SD = 1.7], p = 0.043) and O2Hb (PFP [M = -3.2, SD = 3.2], healthy controls [M = -4.9, SD = 2.7], p = 0.004). Conclusions The differences suggest potential impairment in patellar hemodynamics in PFP patients, providing support for the homeostasis model. Evidence-based treatment strategies targeting patellar hemodynamics should be further refined and subjected to evaluation in clinical trials. Level of Evidence Level III.
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Affiliation(s)
- Martin J. Ophey
- IJsveldFysio—Private Physical Therapy ClinicNijmegenThe Netherlands
- Department of Orthopaedic Surgery and Sports MedicineAmsterdam UMC, AMC locationAmsterdamThe Netherlands
- ESP Science and EducationViennaAustria
| | - Anne Westerweel
- Master Biomedical SciencesRU—Radboud UniversityNijmegenThe Netherlands
| | - Maxime van Oort
- Master Biomedical SciencesRU—Radboud UniversityNijmegenThe Netherlands
| | - Robert van den Berg
- ESP Science and EducationViennaAustria
- Physical Therapy DepartmentFH Burgenland—University of Applied SciencePinkafeldAustria
- AIM—Austrian Institute of ManagementAdvanced Physiotherapy & ManagementEisenstadtAustria
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery and Sports MedicineAmsterdam UMC, AMC locationAmsterdamThe Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS)IOC Research CenterAmsterdamThe Netherlands
- Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands
| | - Igor J. R. Tak
- ESP Science and EducationViennaAustria
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS)IOC Research CenterAmsterdamThe Netherlands
- Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands
- Physiotherapy Utrecht Oost—Sports Rehabilitation and Manual TherapyUtrechtThe Netherlands
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Ophey MJ, Westerweel A, van Oort M, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Near-Infrared Spectroscopy measurements are reliable for studying patellar bone hemodynamics and affected by venous occlusion, but not by skin compression. J Exp Orthop 2023; 10:124. [PMID: 38017345 PMCID: PMC10684445 DOI: 10.1186/s40634-023-00709-6] [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: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE According to the homeostasis model, patellofemoral pain (PFP) results from disturbed homeostasis due to vascular insufficiency in the anterior knee. Near-Infrared Spectroscopy (NIRS) measures relative changes in concentrations (in µmol/cm2) of (de-)oxygenated hemoglobine (HHb and O2Hb). The aims were to: 1) investigate the characteristics of the NIRS signal derived from the patella during experiments affecting hemodynamics in healthy controls, and 2) determine the test-retest reliability of NIRS in positions clinically relevant for PFP patients. METHODS Two experiments were conducted on 10 healthy controls and analysed using Student's t-test. Reliability (ICC2,1) was evaluated for two activities ('Prolonged Sitting' and 'Stair Descent') in five PFP patients and 15 healthy controls, performed twice within five days. RESULTS The NIRS signal (HHb and O2Hb) showed a statistically significant increase (p < .001 - .002) on all optodes (30, 35, 40 mm) during 'Venous Occlusion' (M = 1.0 - 2.0), while it showed no statistically significant change (p = .075 - .61) during 'Skin Compression' (M = -0.9 - 0.9) on the 30 and 35 mm optode. Reliability of NIRS (HHb and O2Hb) ranged from moderate to almost perfect (ICC2,1 = .47 - .95) on the 30 mm optode for 'Prolonged Sitting', and from moderate to substantial (ICC2,1 = .50 - .68) on the 35 mm optode for 'Stair Descent'. CONCLUSIONS Patella NIRS measurements are affected by venous occlusion, but not by skin compression, and are sufficiently reliable as research application to compare real-time patellar bone hemodynamics. These insights may assist to improve effectiveness of evidence-based treatment strategies for PFP. TRIAL REGISTRATION ISRCTN Trial Registration under number: 90377123.
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Affiliation(s)
- Martin J Ophey
- IJsveldFysio - Private Physical Therapy Clinic, Nijmegen, The Netherlands.
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- ESP Science and Education, Vienna, Austria.
| | - Anne Westerweel
- RU - Radboud University, Biomedical Sciences, Nijmegen, The Netherlands
| | - Maxime van Oort
- RU - Radboud University, Biomedical Sciences, Nijmegen, The Netherlands
| | - Robert van den Berg
- ESP Science and Education, Vienna, Austria
- FH Burgenland, Physical Therapy Department, University of Applied Science, Pinkafeld, Austria
- AIM - Austrian Institute of Management, Advanced Physiotherapy & Management, Eisenstadt, Austria
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Collaboration On Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Igor J R Tak
- ESP Science and Education, Vienna, Austria
- Amsterdam Collaboration On Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, The Netherlands
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Ophey MJ, Bennink D, Bernsen JE, Blazevic I, van Bergen R, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Patients with patellofemoral pain have lower soft tissue flexibility of the kinetic chain compared to healthy controls: A case-control study. J Bodyw Mov Ther 2023; 36:203-209. [PMID: 37949561 DOI: 10.1016/j.jbmt.2023.06.006] [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: 02/07/2022] [Accepted: 06/05/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Patellofemoral pain (PFP) is a common musculoskeletal condition. Lower limb range of motion (LLROM) evaluates soft tissue flexibility over multiple joints as part of the kinetic chain. The aims were to study: 1) the reliability of a new LLROM test; 2) differences in LLROM between PFP patients and controls; and 3) the relationship between LLROM and pain-free knee function. METHODS Patients with PFP and matched controls were recruited from a university campus and private physiotherapy clinics, while observers were blinded for health status. Testing LLROM for maximal knee flexion and hip adduction and the sum of these (total ROM) were performed. Measures of reliability (ICC2,1) were established. Univariate linear regression between LLROM and health status and multivariate analysis between LLROM and knee function were performed. RESULTS Patients (n = 32 (7 male/25 female, age = 22, BMI = 22.7)) and controls (n = 32 (7 male/25 female, age = 20, BMI = 22.3)) were included. The ICC's for intra- and interobserver reliability ranged from 0.83 (95%CI 0.30-0.93) to 0.89 (0.72-0.95). Symptomatic legs had 7°(3-11, p = 0.014) lower knee flexion, 6°(4-8, p ≤ 0.001) lower hip adduction and 13°(8-17, p ≤ 0.001) lower total ROM than non-symptomatic legs. Multivariate analysis revealed an association between total ROM and pain-free knee function (R2 = 0.438, F = 6.544, p ≤ 0.001). CONCLUSIONS The new LLROM test was found to be reliable. Patients with PFP had lower LLROM, which was associated with impaired pain-free knee function. Whether improving soft tissue flexibility results in enhanced pain-free knee function should be the subject of future research.
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Affiliation(s)
- Martin J Ophey
- IJsveldFysio - Private Physical Therapy Clinic, Nijmegen, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Amsterdam, the Netherlands; ESP Science and Education, Vienna, Austria.
| | - Dide Bennink
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands.
| | - Jessica E Bernsen
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands.
| | - Iris Blazevic
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands.
| | - Rick van Bergen
- IJsveldFysio - Private Physical Therapy Clinic, Nijmegen, the Netherlands; HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands.
| | - Robert van den Berg
- ESP Science and Education, Vienna, Austria; FH Burgenland - University of Applied Science, Physical Therapy Department, Pinkafeld, Austria; AIM - Austrian Institute of Management, Advanced Physiotherapy & Management, Eisenstadt, Austria.
| | - Gino M M J Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS) / IOC Research Center of Excellence, Amsterdam, the Netherlands; Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands.
| | - Igor J R Tak
- ESP Science and Education, Vienna, Austria; Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, the Netherlands; Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands.
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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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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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Luz BC, Dos Santos AF, Serrão FV. Are hip and knee kinematics and training load characteristics relate to pain intensity and physical function level in runners with Patellofemoral Pain? Gait Posture 2021; 84:162-168. [PMID: 33340846 DOI: 10.1016/j.gaitpost.2020.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/26/2020] [Accepted: 11/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is the most common running-related injury. Altered hip and knee kinematics and increases in weekly distance and running pace are often associated with PFP development and exacerbation. RESEARCH QUESTION Are altered movements and training load characteristics (weekly distance and running pace) relate to pain intensity or physical function level in runners with PFP? METHODS Forty recreational runners with PFP (20 males and 20 females) participated in this cross-sectional observational study. Three-dimensional hip and knee kinematics were quantified during the stance phase of running. Weekly distance was defined as the average weekly kilometers of running and running pace as the average pace of the activity measured as minutes per kilometer. A visual analogue scale was used to evaluate worst knee pain during the last week. The anterior knee pain scale (AKPS) was used to evaluate knee functional score. A Pearson correlation matrix was used to investigate the association between each dependent variable (worst pain in the last week and AKPS score) and the independent variables (knee and hip kinematics, weekly distance and running pace). RESULTS There was no significantly correlation between kinematic variables, pain and functional score for both males and females separately and combined. Weekly distance (km/week) was found to positively correlate to pain intensity (r = 0.452; p < 0.05) in females with PFP. A simple linear regression revealed that weekly distance was significant predictor emerged of pain in females with PFP. Females exhibited significantly greater peak hip adduction and hip adduction ROM than the males and males had significantly greater running pace compared to females. SIGNIFICANCE Weekly distance should be considered in the clinical context during rehabilitation of PFP in females runners aiming at pain reduction.
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Affiliation(s)
- Bruna Calazans Luz
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
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Ophey MJ, Crooijmans GAHM, Frieling SMW, Kardos DMA, van den Berg R, Kerkhoffs GMMJ, Tak IJR. Short-term effectiveness of an intervention targeting lower limb range of motion on pain and disability in patellofemoral pain patients: A randomized, non-concurrent multiple-baseline study. J Bodyw Mov Ther 2020; 26:300-308. [PMID: 33992263 DOI: 10.1016/j.jbmt.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/03/2020] [Accepted: 12/19/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Patellofemoral pain (PFP) is a common and often long-standing musculoskeletal condition. Evidence of the effectiveness of interventions addressing soft tissue flexibility is conflicting and of inconsistent scientific quality. However, reduced soft tissue flexibility can negatively affect patellofemoral joint kinematics. Lower limb range of motion (LLROM) reflects soft tissue flexibility throughout the kinetic chain. The aim was to evaluate the short-term effectiveness of an intervention targeting LLROM on pain and disability in patients with PFP. METHODS A randomized, non-concurrent, multiple-baseline single-case design with a two-week intervention phase and baseline and postintervention phase with varying length was conducted. Eight participants (5 females, 3 males) of age 19(±1.6) years, weekly sports participation 12(±3.1) hours and 17(±14) months symptom duration were included. The Anterior Knee Pain Scale - Dutch Version (AKPS-DV) and the Patient Specific Complaint Scale (PSCS) were administered twice a week. After allocating participants to one of four subgroups of reduced LLROM the intervention was applied. The intervention consisted of soft tissue techniques (mobilization, taping, and stretching). RESULTS Participant 3 and 6 showed a medium and small but statistically significant positive effect on the AKPS-DV. Participant 2 showed a large and statistically significant positive effect on the PSCS. CONCLUSIONS This study provides moderate evidence that an intervention targeting LLROM in patients with PFP reduces pain and disability in the short-term. Further research is needed to evaluate the long-term effectiveness and optimize individual treatment outcomes.
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Affiliation(s)
- Martin J Ophey
- IJsveldFysio - Private Physical Therapy Clinic, Nijmegen, the Netherlands; Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ESP Science and Education, Vienna, Austria.
| | - Gwen A H M Crooijmans
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Sophie M W Frieling
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Donja M A Kardos
- HAN - University of Applied Sciences, Physical Therapy Department, Nijmegen, the Netherlands
| | - Robert van den Berg
- ESP Science and Education, Vienna, Austria; FH Burgenland - University of Applied Science, Physical Therapy Department, Pinkafeld, Austria; AIM - Austrian Institute of Management, Advanced Physiotherapy & Management, Eisenstadt, Austria
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS) / IOC Research Center of Excellence, Amsterdam, the Netherlands; Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands
| | - Igor J R Tak
- ESP Science and Education, Vienna, Austria; Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS) / IOC Research Center of Excellence, Amsterdam, the Netherlands; Center for Evidence Based Sports Medicine (ACES), Amsterdam, the Netherlands
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Sisk D, Fredericson M. Taping, Bracing, and Injection Treatment for Patellofemoral Pain and Patellar Tendinopathy. Curr Rev Musculoskelet Med 2020; 13:537-544. [PMID: 32500350 PMCID: PMC7340692 DOI: 10.1007/s12178-020-09646-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This article will focus on additional treatment options for the two most common causes of anterior knee pain, patellofemoral pain syndrome, and patellar tendinopathy. Conservative management is the first-line treatment for these conditions. For clinicians to maximize the efficacy of conservative treatment options for their patients, they must understand the most up-to-date literature evaluating the potential benefit of taping, bracing, and injections as adjunctive treatments for maximizing treatment success. RECENT FINDINGS Recent studies of bracing and taping have found them to be helpful for patients in the short-term management of pain and improving function. However, less is known about their exact mechanism but studies are encouraging that they have a subtle role in changing patellofemoral biomechanics. Injections remain a commonly used treatment for musculoskeletal conditions; however, the evidence for their use in patellofemoral pain and patellar tendinopathy is limited. The use of platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections is an exciting new area in the treatment of patellar tendinopathy. However, evidence at this time to recommend these treatments is lacking, and more well-designed studies are needed. The treatment of patellofemoral pain and patellar tendinopathy consists of a multi-faceted approach of physiotherapy and physical modalities. There is evidence for short-term use of taping and bracing for these conditions. The evidence for injections at this time is limited and remains under investigation. Future well-designed randomized controlled studies will provide insight into the efficacy of several different types of injections in the treatment of patellar tendinopathy. Physicians should feel comfortable integrating taping and bracing into their anterior knee pain treatment paradigm while making cautious use of invasive injections as adjunctive therapy.
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Affiliation(s)
- Daniel Sisk
- Department of Orthopedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford University, Stanford, CA USA
| | - Michael Fredericson
- Department of Orthopedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford University, Stanford, CA USA
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Sisk D, Fredericson M. Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain. Curr Rev Musculoskelet Med 2019; 12:534-541. [PMID: 31773479 DOI: 10.1007/s12178-019-09593-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. RECENT FINDINGS The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.
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Affiliation(s)
- Daniel Sisk
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
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