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Law E, Wright L, Uhlhorn M, Hernlund E, Nilemo C, Rhodin M. Hypoechoic ultrasonographic findings in the patellar ligaments are common in riding and trotting horses in training (116 cases). Vet Radiol Ultrasound 2024. [PMID: 39377554 DOI: 10.1111/vru.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/07/2024] [Accepted: 09/14/2024] [Indexed: 10/09/2024] Open
Abstract
Patellar ligament (PL) injuries are increasingly being reported in horses, but few studies have described the normal PL ultrasonographic appearance in horses. The aims of this prospective observational study were to describe the ultrasonographic appearance of the PLs and infrapatellar fat pad in a population of horses in training and to relate the ultrasonographic findings to objectively measured movement asymmetry. B-mode and color Doppler ultrasonographic examination of the PLs and infrapatellar fat pad in both hind limbs and objective gait analyses were performed on the 116 riding and trotting horses included in the study. The association between ultrasonographic findings, horse age, and movement asymmetry during the trot was then investigated. Distinct or diffuse hypoechoic regions were commonly found in the intermediate PL (24/116; 20.7%), especially in the caudal aspect of the mid-third of the ligament. The infrapatellar fat pad had a hypoechoic striated appearance in all horses except one, in which it was hyperechoic. No association was found between ultrasonographic findings in the PLs and infrapatellar fat pad and lameness. It is important to recognize that there is biological variation in PL appearance, which may or may not be associated with pain in this area, therefore emphasizing the use of local analgesia to determine the location of the lameness.
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Affiliation(s)
- Ellen Law
- Diagnostic Imaging Clinic, University Animal Hospital, Uppsala, Sweden
| | - Linda Wright
- Department of Animal Biosciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Margareta Uhlhorn
- Diagnostic Imaging Clinic, University Animal Hospital, Uppsala, Sweden
| | - Elin Hernlund
- Department of Animal Biosciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Carolina Nilemo
- Diagnostic Imaging Clinic, University Animal Hospital, Uppsala, Sweden
| | - Marie Rhodin
- Department of Animal Biosciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Neumann AM, Kebbach M, Bader R, Hildebrandt G, Wree A. Evaluation of 3D Footprint Morphology of Knee-Related Muscle Attachments Based on CT Data Reconstruction: A Feasibility Study. Life (Basel) 2024; 14:778. [PMID: 38929760 PMCID: PMC11204608 DOI: 10.3390/life14060778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
A three-dimensional (3D) understanding of muscle attachment footprints became increasingly relevant for musculoskeletal modeling. The established method to project attachments as points ignores patient-specific individuality. Research focuses on investigating certain muscle groups rather than comprehensively studying all muscles spanning a joint. Therefore, we present a reliable method to study several muscle attachments in order to reconstruct the attachment sites in 3D based on CT imaging for future applications in musculoskeletal modeling. For the present feasibility study, 23 knee-related muscle attachments were CT-scanned postmortem from four nonadipose male specimens. For this, the specific muscle attachments were dissected and marked with a barium sulfate containing paint (60 g BaSO4 in 30 mL water and 10 mL acrylic paint). Subsequently, bone geometries and muscle attachments were reconstructed and evaluated from CT datasets. Bone morphology and footprint variations were studied. Exemplarily, variations were high for pes anserinus insertions (mean 56%) and the origins of M. biceps femoris (mean 54%). In contrast, the origins of the vastus muscles as well as the insertion of the Achilles tendon showed low variation (mean 9% and 13%, respectively). Most attachment sites showed variation exceeding the individuality of bone morphology. In summary, the present data were consistent with the few published studies of specific muscle footprints. Our data shed light on the high variability of muscle attachments, which need to be addressed when studying muscle forces and movements through musculoskeletal modeling. This is the first step to achieving a more profound understanding of muscle morphology to be utilized in numerical simulations.
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Affiliation(s)
- Anne-Marie Neumann
- Institute for Anatomy, Rostock University Medical Center, Gertrudenstraße 9, 18057 Rostock, Germany;
- Institute of Molecular and Cellular Anatomy, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany
| | - Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18055 Rostock, Germany; (M.K.); (R.B.)
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18055 Rostock, Germany; (M.K.); (R.B.)
| | - Guido Hildebrandt
- Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Südring 75, 18059 Rostock, Germany;
| | - Andreas Wree
- Institute for Anatomy, Rostock University Medical Center, Gertrudenstraße 9, 18057 Rostock, Germany;
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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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Tazesh B, Mansournia MA, Halabchi F. Additional effects of core stability exercises on pain and function of patients with patellofemoral pain: A randomized controlled trial. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/2210491721989075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background/purpose: Recently, there is more emphasis on the role of core muscles in pathogenesis and rehabilitation of patellofemoral pain (PFP). We aimed to investigate whether increased core muscle strength and endurance improve clinical outcomes. Methods: In a randomized controlled trial, 60 patients (M/F: 25/35, age = 32.28 (5.9) years) with PFP were randomly allocated into two groups of routine exercise (control) and combined core plus routine exercise (intervention). Home exercise was scheduled at least 5 times/week for 12 weeks. We assessed the outcomes of pain (Visual analogue scale) and function (Anterior knee pain score) before and immediately after interventions. Results: Significant improvements were reported in both groups (P < 0.001). There were significant between-group differences in both outcomes in favor of the intervention (Pain: 12.4, CI 95%: 7.1–17.8, P < 0.001; Function: 6.4, CI 95%: 2.2–10.5, P = 0.003). Conclusion: Outcome improvements were significantly greater in intervention group. Inclusion of core stability exercises may lead to additional benefits.
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Affiliation(s)
- Behnaz Tazesh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
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McLean B. Identification of the Infrapatellar Branch of the Saphenous Nerve for Treatment Using a Peripheral Nerve Stimulator: A Technical Report. Cureus 2019; 11:e4668. [PMID: 31328060 PMCID: PMC6634276 DOI: 10.7759/cureus.4668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The infrapatellar branch of the saphenous is becoming a common therapeutic target for the diagnosis and treatment of anterior knee pain. It is a nerve commonly injured during knee surgeries, resulting in neuroma formation and chronic neuropathic pain states, and can also transmit nociceptive input in patients with non-surgical anterior knee pain of multiple etiologies. After diagnosing infrapatellar saphenous neuralgia, the nerve is safely ablated using radiofrequency ablation, neurolytic solutions, and, most recently, cryoablation using the handheld iovera® cryoablation system (Myoscience, Inc. Fremont, CA). The iovera® technology benefits from procedural simplicity in that the nerve doesn't specifically need to be identified and the described technique involves treating a long line over which the infrapatellar branch of the saphenous nerve is expected to course. However, there is significant variability in the course of the nerve and much of the area treated misses the actual location of the nerve, wasting time and potentially increasing patient discomfort and risk of complications. To address these limitations we endeavored to identify a way to more precisely treat the specific location of the nerve thereby optimizing treatment success and procedural simplicity. Using a MiniStim® peripheral nerve stimulator (Halyard Health, Inc., Georgia, US) to scan for the nerve along the previously described treatment line, we have been able to identify a more precise location of the nerve and optimize the treatment target area. This non-invasive identification technique has, to our knowledge, not been previously described.
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Affiliation(s)
- Brian McLean
- Pain Department and Interdisciplinary Pain Management Center, Tripler Army Medical Center, Kaneohe, USA
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Rozenfeld E, Finestone AS, Moran U, Damri E, Kalichman L. The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients. J Bodyw Mov Ther 2019; 24:31-38. [PMID: 31987560 DOI: 10.1016/j.jbmt.2019.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anterior knee pain (AKP) is a widespread problem among young athletes and soldiers. There are many theories on the etiology of AKP but there is little reference to myofascial trigger points (MTrPs) as a possible contributor. AIM To evaluate the association between AKP and prevalence of active and latent MTrPs in the hip and thigh muscles in soldiers. METHODS A cross-sectional study was conducted in the Beer-Sheva military outpatient physical therapy clinic. Subjects were 42 men and 23 women referred for physical therapy, 33 with a diagnosis of AKP (cases) and 32 with upper limb complaints (without AKP, controls). All subjects underwent physical evaluation by an examiner blinded to their identity and medical condition. The following muscles were assessed bilaterally for active or latent MTrPs: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal). RESULTS In six out of eight areas, the cases had a higher prevalence of total active and latent MTrPs than the controls. When summarizing MTrPs by muscle, cases had significantly more MTrPs than controls in each muscle. The largest difference was found in vastus medialis and vastus lateralis; nearly half of the cases had MTrPs in these muscles. CONCLUSIONS Subjects with AKP have a greater prevalence of MTrPs in their hip and thigh muscles than controls, indicating an association between MTrPs and AKP. Further research is necessary to determine whether MTrPs are the cause or the consequence of AKP.
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Affiliation(s)
- Evgeni Rozenfeld
- Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Aharon S Finestone
- Assaf HaRofeh Medical Center, Zeriffin, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Uria Moran
- Israel Defense Force, Medical Corps, Israel
| | - Elad Damri
- Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Halabchi F, Abolhasani M, Mirshahi M, Alizadeh Z. Patellofemoral pain in athletes: clinical perspectives. Open Access J Sports Med 2017; 8:189-203. [PMID: 29070955 PMCID: PMC5640415 DOI: 10.2147/oajsm.s127359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Patellofemoral pain (PFP) is a very common problem in athletes who participate in jumping, cutting and pivoting sports. Several risk factors may play a part in the pathogenesis of PFP. Overuse, trauma and intrinsic risk factors are particularly important among athletes. Physical examination has a key role in PFP diagnosis. Furthermore, common risk factors should be investigated, such as hip muscle dysfunction, poor core muscle endurance, muscular tightness, excessive foot pronation and patellar malalignment. Imaging is seldom needed in special cases. Many possible interventions are recommended for PFP management. Due to the multifactorial nature of PFP, the clinical approach should be individualized, and the contribution of different factors should be considered and managed accordingly. In most cases, activity modification and rehabilitation should be tried before any surgical interventions.
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Affiliation(s)
- Farzin Halabchi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirshahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Logan CA, Bhashyam AR, Tisosky AJ, Haber DB, Jorgensen A, Roy A, Provencher MT. Systematic Review of the Effect of Taping Techniques on Patellofemoral Pain Syndrome. Sports Health 2017; 9:456-461. [PMID: 28617653 PMCID: PMC5582697 DOI: 10.1177/1941738117710938] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Taping is commonly used in the management of several musculoskeletal conditions, including patellofemoral pain syndrome (PFPS). Specific guidelines for taping are unknown. Objective: To investigate the efficacy of knee taping in the management of PFPS. Our hypothesis was that tension taping and exercise would be superior to placebo taping and exercise as well as to exercise or taping alone. Data Sources: The PubMed/MEDLINE, Cochrane, Rehabilitation and Sports Medicine Source, and CINAHL databases were reviewed for English-language randomized controlled trials (RCTs) evaluating the efficacy of various taping techniques that were published between 1995 and April 2015. Keywords utilized included taping, McConnell, kinesio-taping, kinesiotaping, patellofemoral pain, and knee. Study Selection: Studies included consisted of RCTs (level 1 or 2) with participants of all ages who had anterior knee or patellofemoral pain symptoms and had received nonsurgical management using any taping technique. Study Design: Systematic review. Level of Evidence: Level 2. Data Extraction: A checklist method was used to determine selection, performance, detection, and attrition bias for each article. A quality of evidence grading was then referenced using the validated PEDro database for RCTs. Three difference comparison groups were compared: tension taping and exercise versus placebo taping and exercise (group 1), placebo taping and exercise versus exercise alone (group 2), and tension taping and exercise versus taping alone (group 3). Results: Five RCTs with 235 total patients with multiple intervention arms were included. Taping strategies included McConnell and Kinesiotaping. Visual analog scale (VAS) scores indicated improvement in all 3 comparison groups (group 1: 91 patients, 39% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 66 [placebo taping + exercise]; group 2: 56 patients, 24% of total, mean VAS improvement 66 [placebo taping + exercise] vs 47.6 [exercise alone]; and group 3: 112 patients, 48% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 14.1 [taping alone]). Conclusion: This systematic review supports knee taping only as an adjunct to traditional exercise therapy for PFPS; however, it does not support taping in isolation.
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Affiliation(s)
- Catherine A. Logan
- Catherine A. Logan, MD, MBA, MSPT, Massachusetts General Hospital, 15 Fruit Street, Boston, MA 02114 ()
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Althunyan AK, Darwish MA, Abdel Wahab MM. Knee problems and its associated factors among active cyclists in Eastern Province, Saudi Arabia. J Family Community Med 2017; 24:23-29. [PMID: 28163572 PMCID: PMC5248430 DOI: 10.4103/2230-8229.197178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Bicycling is one of the most enjoyable aerobic exercises recommended for the promotion of an individual's health. The Eastern Province of Saudi Arabia has seen a huge increase in the number of people who cycle. People have different goals for bicycling, but the injuries they sustain are common. Most of them relate to overuse, particularly of lower body joints. This study was conducted to determine the prevalence of knee problems and factors associated with knee pain in cyclists. MATERIALS AND METHODS A cross-sectional study was conducted in October 2015, using an online self-administered questionnaire. The questionnaire was based on pertinent literature, was piloted, and validated. A web link was sent to 513 cyclists (professional and amateur) using E-mail, WhatsApp application, or SMS. Three hundred and eleven responses were received, 283 of which were included in the analysis. RESULTS The overall prevalence of knee pain was 25.8%; 27.6% for amateur cyclists and 15.9% for professional cyclists. Only 17.2% knee pain was attributed to cycling, whereas in 32.8% it happened spontaneously and in 25% of cases it occurred while running. Majority of the cyclists reported pain as mild (61.6%) or moderate (28.7%); anterior knee pain accounted for 58.1% knee pain. Different goals of cycling and different bicycle types had statistically significant difference on the rate of knee pain. Of underweight cyclists, 62.2% reported knee pain. Cyclists who run more or participated in football had a higher rate of pain. CONCLUSION Knee injuries are common with cyclists. Factors such as the type of the bicycle, the goal of bicycling, club type, body mass index, and participation in other sports play a significant role in the rate of knee pain.
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Affiliation(s)
- Abdullatif K Althunyan
- Department of Family and Community Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Magdy A Darwish
- Department of Family and Community Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Moataza M Abdel Wahab
- Department of Family and Community Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia; Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Mariani S, La Marra A, Arrigoni F, Necozione S, Splendiani A, Di Cesare E, Barile A, Masciocchi C. Dynamic measurement of patello-femoral joint alignment using weight-bearing magnetic resonance imaging (WB-MRI). Eur J Radiol 2015; 84:2571-8. [DOI: 10.1016/j.ejrad.2015.09.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 01/11/2023]
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The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain. Toxins (Basel) 2015; 7:3388-404. [PMID: 26308056 PMCID: PMC4591644 DOI: 10.3390/toxins7093388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022] Open
Abstract
Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults. Symptoms can recur in more than two thirds of cases, often resulting in activity limitation and reduced participation in employment and recreational pursuits. Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention. Evidence for long term benefit of most conservative treatments or surgical approaches is currently lacking. Injection of Botulinum toxin type A to the distal region of vastus lateralis muscle causes a short term functional “denervation” which moderates the influence of vastus lateralis muscle on the knee extensor mechanism and increases the relative contribution of the vastus medialis muscle. Initial data suggest that, compared with other interventions for anterior knee pain, Botulinum toxin type A injection, in combination with an active exercise programme, can lead to sustained relief of symptoms, reduced health care utilisation and increased activity participation. The procedure is less invasive than surgical intervention, relatively easy to perform, and is time- and cost-effective. Further studies, including larger randomized placebo-controlled trials, are required to confirm the effectiveness of Botulinum toxin type A injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief.
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Abstract
Pediatric overuse injury is a common complaint presenting to pediatricians. Overuse injury can affect the soft tissues or bone, and results from an imbalance between training and load to the tissues and recovery time. In the skeletally immature athlete, physeal and apophyseal tissue is particularly vulnerable to overuse resulting in different patterns of injury compared to adults. Awareness of age-dependent patterns of overuse is necessary for proper recognition, treatment, and prevention of injury. This article reviews the most common pediatric overuse injuries with emphasis on risk factors, diagnosis, and treatment. Guidelines for prevention are included, as this is the key component for successful management of overuse injury in pediatric athletes.
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