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Kaya Keles CS, Ates F. How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy-a narrative review. Front Bioeng Biotechnol 2023; 11:1287385. [PMID: 38116195 PMCID: PMC10728775 DOI: 10.3389/fbioe.2023.1287385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians' decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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Bartsch A, Nüesch C, Rieger B, Mündermann A, Egloff C. Dynamic versus static medial patellofemoral ligament reconstruction technique in the treatment of recurrent patellar dislocation: a randomized clinical trial protocol. J Orthop Surg Res 2022; 17:345. [PMID: 35818060 PMCID: PMC9275045 DOI: 10.1186/s13018-022-03158-6] [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: 12/08/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The redislocation rate of conservatively treated patella instability is high. One of the leading surgical strategies is medial patellofemoral ligament reconstruction. Over-tensioning is one of the most challenging complications in static medial patellofemoral ligament reconstruction as the graft used for reconstruction is isometric and the anatomical MPFL is a mostly dynamic structure. As an alternative to established static reconstruction techniques, dynamic graft techniques have been introduced for stabilizing the patella with the aim of providing a more physiological reconstruction of the medial patellofemoral ligament. To date, data on clinical outcomes are scarce and on biomechanical outcomes of the dynamic MPFL reconstruction are lacking. Here, we present the protocol of a randomized clinical trial for comparing clinical and biomechanical outcomes of dynamic versus static medial patellofemoral ligament reconstruction. METHODS This study is a prospective, single blinded, randomized, multicenter, multimodal (clinical and biomechanical) clinical trial. Patients with recurrent patella dislocation requiring isolated MPFL reconstruction will be recruited and randomized to the dynamic or static reconstruction technique. Participants will be followed up for 2 years with a total of five follow-ups. Preoperative magnetic resonance imaging, upright radiographs, surgical reports and patient records will be evaluated, and clinical and functional outcomes will be measured. Patient-reported knee function and anterior knee pain as assessed with the Kujala score will serve as primary outcome. For biomechanical outcome, pre- and postoperative evaluations will be performed to assess isokinetic muscle strength, gait asymmetry, joint kinematics and kinetics, and timing of muscle activity. DISCUSSION The results of the study will clarify whether the reported surgery success for patella stabilization via dynamic MPFL reconstruction is due to muscle contraction or to the passive tenodesis effect combined with clinical outcome measures. With this study, we will provide much needed information on knee biomechanics after dynamic versus static MPFL reconstruction to provide evidence to support orthopedic surgeons in evidence-based decision-making in their quest for surgical techniques most favorable for their patients. Trial registration The study protocol was registered at clinicaltrials.gov (NCT04849130). Registered 19 April 2021, https://clinicaltrials.gov/ct2/show/NCT04849130 .
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Affiliation(s)
- Anna Bartsch
- Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Department of Biomedical Engineering, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Bertram Rieger
- Orthopedic Surgery and Sportsmedicine, ALTIUS Swiss Sportmed Center, Rheinfelden, Switzerland
| | - Annegret Mündermann
- Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Department of Biomedical Engineering, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Department of Clinical Research, University of Basel, Basel, Switzerland.
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Hosseini Nasab SH, Smith CR, Maas A, Vollenweider A, Dymke J, Schütz P, Damm P, Trepczynski A, Taylor WR. Uncertainty in Muscle–Tendon Parameters can Greatly Influence the Accuracy of Knee Contact Force Estimates of Musculoskeletal Models. Front Bioeng Biotechnol 2022; 10:808027. [PMID: 35721846 PMCID: PMC9204520 DOI: 10.3389/fbioe.2022.808027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/03/2022] [Indexed: 01/07/2023] Open
Abstract
Understanding the sources of error is critical before models of the musculoskeletal system can be usefully translated. Using in vivo measured tibiofemoral forces, the impact of uncertainty in muscle–tendon parameters on the accuracy of knee contact force estimates of a generic musculoskeletal model was investigated following a probabilistic approach. Population variability was introduced to the routine musculoskeletal modeling framework by perturbing input parameters of the lower limb muscles around their baseline values. Using ground reaction force and skin marker trajectory data collected from six subjects performing body-weight squat, the knee contact force was calculated for the perturbed models. The combined impact of input uncertainties resulted in a considerable variation in the knee contact force estimates (up to 2.1 BW change in the predicted force), especially at larger knee flexion angles, hence explaining up to 70% of the simulation error. Although individual muscle groups exhibited different contributions to the overall error, variation in the maximum isometric force and pathway of the muscles showed the highest impacts on the model outcomes. Importantly, this study highlights parameters that should be personalized in order to achieve the best possible predictions when using generic musculoskeletal models for activities involving deep knee flexion.
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Affiliation(s)
- Seyyed Hamed Hosseini Nasab
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
- *Correspondence: Seyyed Hamed Hosseini Nasab, ; William R. Taylor,
| | - Colin R. Smith
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Allan Maas
- Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | | | - Jörn Dymke
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Pascal Schütz
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Philipp Damm
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - William R. Taylor
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
- *Correspondence: Seyyed Hamed Hosseini Nasab, ; William R. Taylor,
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Procedures for obtaining muscle physiology parameters during a gracilis free-functioning muscle transfer in adult patients with brachial plexus injury. Sci Rep 2022; 12:6095. [PMID: 35414165 PMCID: PMC9005531 DOI: 10.1038/s41598-022-09861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/08/2022] [Indexed: 11/08/2022] Open
Abstract
A complete understanding of muscle mechanics allows for the creation of models that closely mimic human muscle function so they can be used to study human locomotion and evaluate surgical intervention. This includes knowledge of muscle-tendon parameters required for accurate prediction of muscle forces. However, few studies report experimental data obtained directly from whole human muscle due to the invasive nature of these experiments. This article presents an intraoperative, in vivo measurement protocol for whole muscle-tendon parameters that include muscle-tendon unit length, sarcomere length, passive tension, and active tension in response to external stimulation. The advantage of this protocol is the ability to obtain these rare experimental data in situ in addition to muscle volume and weight since the gracilis is also completely removed from the leg. The entire protocol including the surgical steps for gracilis harvest takes ~ 3 h. Actual testing of the gracilis where experimental data is measured takes place within a 30-min window during surgery.
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Ateş F, Coleman-Wood K, Litchy W, Kaufman KR. Intramuscular pressure of human tibialis anterior muscle detects age-related changes in muscle performance. J Electromyogr Kinesiol 2021; 60:102587. [PMID: 34428670 DOI: 10.1016/j.jelekin.2021.102587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023] Open
Abstract
Intramuscular pressure (IMP) reflects forces produced by a muscle. Age is one of the determinants of skeletal muscle performance. The present study aimed to test whether IMP mirrors known age-related muscular changes. We simultaneously measured the tibialis anterior (TA) IMP, compound muscle action potential (CMAP), and ankle torque in thirteen older adults (60-80 years old) in vivo by applying different stimulation intensities and frequencies. We found significant positive correlations between the stimulation intensity and IMP and CMAP. Increasing stimulation frequency caused ankle torque and IMP to increase. The electromechanical delay (EMD) (36 ms) was longer than the onset of IMP (IMPD) (29 ms). Compared to the previously published data collected from young adults (21-40 years old) in identical conditions, the TA CMAP and IMP of older adults at maximum intensity of stimulation were 23.8% and 39.6% lower, respectively. For different stimulation frequencies, CMAP, IMP, as well as ankle torque of older adults were 20.5%, 24.2%, and 13.2% lower, respectively. Surprisingly, the EMD did not exhibit any difference between young and older adults and the IMPD was consistent with the EMD. Data supporting the hypotheses suggest that IMP measurement is an indicator of muscle performance in older adults.
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Affiliation(s)
- Filiz Ateş
- Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany; Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Krista Coleman-Wood
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - William Litchy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Kaya CS, Bilgili F, Akalan NE, Yucesoy CA. Intraoperative testing of passive and active state mechanics of spastic semitendinosus in conditions involving intermuscular mechanical interactions and gait relevant joint positions. J Biomech 2020; 103:109755. [PMID: 32204891 DOI: 10.1016/j.jbiomech.2020.109755] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Abstract
In cerebral palsy (CP) patients suffering pathological knee joint motion, spastic muscle's passive state forces have not been quantified intraoperatively. Besides, assessment of spastic muscle's active state forces in conditions involving intermuscular mechanical interactions and gait relevant joint positions is lacking. Therefore, the source of flexor forces limiting joint motion remains unclear. The aim was to test the following hypotheses: (i) in both passive and active states, spastic semitendinosus (ST) per se shows its highest forces within gait relevant knee angle (KA) range and (ii) due to intermuscular mechanical interactions, the active state forces elevate. Isometric forces (seven children with CP, GMFCS-II) were measured during surgery over a range of KA from flexion to full extension, at hip angle (HA) = 45° and 20°, in four conditions: (I) passive state, (II) individual stimulation of the ST, simultaneous stimulation of the ST (III) with its synergists, and (IV) also with an antagonist. Gait analyses: intraoperative data for KA = 17-61° (HA = 45°) and KA = 0-33° (HA = 20°) represent the loading response and terminal swing, and mid/terminal stance phases of gait, respectively. Intraoperative tests: Passive forces maximally approximated half of peak force in condition II (HA = 45°). Added muscle activations did increase muscle forces significantly (HA = 45°: on average by 42.0% and 72.5%; HA = 20°: maximally by 131.8% and 123.7%, respectively in conditions III and IV, p < 0.01). In conclusion, intermuscular mechanical interactions yield elevated active state forces, which are well above passive state forces. This indicates that intermuscular mechanical interactions may be a source of high flexor forces in CP.
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Affiliation(s)
- Cemre S Kaya
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Fuat Bilgili
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - N Ekin Akalan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Kültür University, Istanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey.
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Kaya CS, Bilgili F, Akalan NE, Temelli Y, Ateş F, Yucesoy CA. Intraoperative experiments combined with gait analyses indicate that active state rather than passive dominates the spastic gracilis muscle's joint movement limiting effect in cerebral palsy. Clin Biomech (Bristol, Avon) 2019; 68:151-157. [PMID: 31212210 DOI: 10.1016/j.clinbiomech.2019.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In cerebral palsy, spastic muscle's passive forces are considered to be high but have not been assessed directly. Although activated spastic muscle's force-joint angle relations were studied, this was independent of gait relevant joint positions. The aim was to test the following hypotheses intraoperatively: (i) spastic gracilis passive forces are high even in flexed knee positions, (ii) its active state forces attain high amplitudes within the gait relevant knee angle range, and (iii) increase with added activations of other muscles. METHODS Isometric forces (seven children with cerebral palsy, gross motor function classification score = II) were measured during surgery from knee flexion to full extension, at hip angles of 45° and 20° and in four conditions: (I) passive state, after gracilis was stimulated (II) alone, (III) simultaneously with its synergists, and (IV) also with an antagonist. FINDINGS Directly measured peak passive force of spastic gracilis was only a certain fraction of the peak active state forces (maximally 26%) measured in condition II. Conditions III and IV caused gracilis forces to increase (for hip angle = 45°, by 32.8% and 71.9%, and for hip angle = 20°, by 24.5% and 45.1%, respectively). Gait analyses indicated that intraoperative data for knee angles 61-17° and 33-0° (for hip angles 45° and 20°, respectively) are particularly relevant, where active state force approximates its peak values. INTERPRETATION Active state muscular mechanics, rather than passive, of spastic gracilis present a capacity to limit joint movement. The findings can be highly relevant for diagnosis and orthopaedic surgery in individuals with cerebral palsy.
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Affiliation(s)
- Cemre S Kaya
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Fuat Bilgili
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - N Ekin Akalan
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey; Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Kültür University, Istanbul, Turkey
| | - Yener Temelli
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - Filiz Ateş
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey; Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey.
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Murray MM, Kalish LA, Fleming BC, Flutie B, Freiberger C, Henderson RN, Perrone GS, Thurber LG, Proffen BL, Ecklund K, Kramer DE, Yen YM, Micheli LJ. Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-Year Results of a First-in-Human Study. Orthop J Sports Med 2019; 7:2325967118824356. [PMID: 30923725 PMCID: PMC6431773 DOI: 10.1177/2325967118824356] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Bridge-enhanced anterior cruciate ligament repair (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with a specific extracellular matrix scaffold (the BEAR scaffold) that is placed in the gap between the torn ends of the ACL to facilitate ligament healing. Purpose/Hypothesis The purpose of this study was to report the 12- and 24-month outcomes of patients who underwent the BEAR procedure compared with a nonrandomized concurrent control group who underwent ACL reconstruction (ACLR) with an autograft. We hypothesized that the BEAR group would have physical examination findings, patient-reported outcomes, and adverse events that were similar to those of the ACLR group. Study Design Cohort study; Level of evidence, 2. Methods Ten patients underwent BEAR, and 10 underwent ACLR with a 4-stranded hamstring autograft. At 24 months, 9 of the 10 BEAR patients and 7 of the 10 ACLR patients completed a study visit. Outcomes reported included International Knee Documentation Committee (IKDC) subjective and objective results, knee anteroposterior (AP) laxity findings via an arthrometer, and functional outcomes. Results There were no graft or repair failures in the first 24 months after surgery. The IKDC subjective scores in both groups improved significantly from baseline (P < .0001) at 12 and 24 months, to 84.6 ± 17.2 in the ACLR group and to 91.7 ± 11.7 in the BEAR group. An IKDC objective grade of A (normal) was found in 44% of patients in the BEAR group and in 29% of patients in the ACLR group at 24 months; no patients in either group had C (abnormal) or D (severely abnormal) grades. Arthrometer testing demonstrated mean side-to-side differences in AP laxity that were similar in the 2 groups at 24 months (BEAR, 1.94 ± 2.08 mm; ACLR, 3.14 ± 2.66 mm). Functional hop testing results were similar in the 2 groups at 12 and 24 months after surgery. Hamstring strength indices were significantly higher in the BEAR group compared with the ACLR group (P = .0001). Conclusion In this small, first-in-human study, BEAR produced similar outcomes to ACLR with a hamstring autograft. BEAR may result in knee stability and patient-reported outcomes at 2 years sufficient to warrant longer term studies of efficacy in larger groups of patients.
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Affiliation(s)
- Martha M Murray
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leslie A Kalish
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Braden C Fleming
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Brett Flutie
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christina Freiberger
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachael N Henderson
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gabriel S Perrone
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Laura G Thurber
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benedikt L Proffen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kirsten Ecklund
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
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Mechanical interaction between neighboring muscles in human upper limb: Evidence for epimuscular myofascial force transmission in humans. J Biomech 2018; 74:150-155. [DOI: 10.1016/j.jbiomech.2018.04.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 11/23/2022]
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Ko CY, Choi HJ, Ryu J, Kim G. Between-day reliability of MyotonPRO for the non-invasive measurement of muscle material properties in the lower extremities of patients with a chronic spinal cord injury. J Biomech 2018; 73:60-65. [PMID: 29599041 DOI: 10.1016/j.jbiomech.2018.03.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 01/17/2018] [Accepted: 03/09/2018] [Indexed: 11/28/2022]
Abstract
Measuring the muscle properties of patients with spinal cord injuries (SCIs) is important to better understand their biomechanical features. In this study, we sought to evaluate the between-day reliability of MyotonPRO, a handheld device that can measure muscle mechanical properties, and assess whether it is reliable to measure muscle properties over time in patients with SCI. Thirteen men with complete SCIs (age 53.9 ± 6.3 years, height 171.0 ± 5.2 cm, weight 66.1 ± 5.8 kg), and injury levels ranging from L1 to T12, were enrolled. Oscillation frequency; logarithmic decrement; dynamic stiffness; mechanical stress relaxation time; and creep of the biceps femoris, medial and lateral gastrocnemius, rectus femoris, tibialis anterior, and Achilles tendon were measured on consecutive days using MyotonPRO. The intraclass coefficient for most muscles and the Achilles tendon ranged from 0.53 to 0.99 for all parameters. The percentage standard error of the measurement for many parameters in most muscles and the Achilles tendon was less than 10%. Bland-Altman analysis showed a high agreement for all mechanical properties. No significant differences were observed in any muscle or Achilles tendon properties between days (all p > 0.05). These results indicate that the MyotonPRO is reliable for between-day measurements of the mechanical properties of lower limb muscles and Achilles tendon in patients with SCI.
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Affiliation(s)
- Chang-Yong Ko
- Rehabilitation Engineering Research Institute, 10, Gyeongin-ro, Bupyeong-gu, Incheon 403-120, Republic of Korea.
| | - Hyuk-Jae Choi
- Rehabilitation Engineering Research Institute, 10, Gyeongin-ro, Bupyeong-gu, Incheon 403-120, Republic of Korea
| | - Jeicheong Ryu
- Rehabilitation Engineering Research Institute, 10, Gyeongin-ro, Bupyeong-gu, Incheon 403-120, Republic of Korea
| | - Gyoosuk Kim
- Rehabilitation Engineering Research Institute, 10, Gyeongin-ro, Bupyeong-gu, Incheon 403-120, Republic of Korea
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Effects of antagonistic and synergistic muscles’ co-activation on mechanics of activated spastic semitendinosus in children with cerebral palsy. Hum Mov Sci 2018; 57:103-110. [DOI: 10.1016/j.humov.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/13/2017] [Accepted: 11/26/2017] [Indexed: 01/09/2023]
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Kaya CS, Temelli Y, Ates F, Yucesoy CA. Effects of inter-synergistic mechanical interactions on the mechanical behaviour of activated spastic semitendinosus muscle of patients with cerebral palsy. J Mech Behav Biomed Mater 2018; 77:78-84. [DOI: 10.1016/j.jmbbm.2017.08.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/26/2022]
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Yucesoy CA, Temelli Y, Ateş F. Intra-operatively measured spastic semimembranosus forces of children with cerebral palsy. J Electromyogr Kinesiol 2017; 36:49-55. [DOI: 10.1016/j.jelekin.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 05/24/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022] Open
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Karakuzu A, Pamuk U, Ozturk C, Acar B, Yucesoy CA. Magnetic resonance and diffusion tensor imaging analyses indicate heterogeneous strains along human medial gastrocnemius fascicles caused by submaximal plantar-flexion activity. J Biomech 2017; 57:69-78. [DOI: 10.1016/j.jbiomech.2017.03.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/27/2016] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
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Herbort M, Michel P, Raschke MJ, Vogel N, Schulze M, Zoll A, Fink C, Petersen W, Domnick C. Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles. Am J Sports Med 2017; 45:819-825. [PMID: 28029798 DOI: 10.1177/0363546516677728] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). HYPOTHESES First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. STUDY DESIGN Controlled laboratory study. METHODS The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. RESULTS Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). CONCLUSION In this human cadaveric study, semitendinosus and gracilis muscles successfully stabilize valgus moments applied to the MCL-insufficient knee when the knee is near extension. CLINICAL RELEVANCE In the valgus-unstable knee, these data suggest that the hamstring muscles should be preserved in (multi-) ligament surgery when possible.
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Affiliation(s)
- Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Philipp Michel
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Nils Vogel
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Martin Schulze
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Alexander Zoll
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Christian Fink
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, Institute of Sports and Alpine Medicine, University of Hall in Tirol, Tirol, Austria
| | - Wolf Petersen
- Department of Orthopedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Christoph Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
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Ateş F, Temelli Y, Yucesoy CA. The mechanics of activated semitendinosus are not representative of the pathological knee joint condition of children with cerebral palsy. J Electromyogr Kinesiol 2016; 28:130-6. [DOI: 10.1016/j.jelekin.2016.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
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Snoeck O, Beyer B, Feipel V, Salvia P, Sterckx JL, Rooze M, Van Sint Jan S. Tendon and fascial structure contributions to knee muscle excursions and knee joint displacement. Clin Biomech (Bristol, Avon) 2014; 29:1070-6. [PMID: 25168083 DOI: 10.1016/j.clinbiomech.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, and a limited decrease of hamstring muscles force is observed postoperatively despite important changes. The goal was to quantify the influence of the myofascial structures on excursions and moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations. METHODS Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each steps of the surgery. FINDINGS No significant difference was demonstrated for excursions and moment arms after tenotomies and gracilis tendon harvesting (P≥0.05). The first significant semitendinosus excursion (P<1.17×10(-4)) and moment arm (P<6.88×10(-5)) decrease was observed after semitendinosus tendon harvesting (46% of the initial excursion). INTERPRETATION Gracilis and semitendinosus myofascial pathway is crucial for force transmission towards the knee joint.
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Affiliation(s)
- O Snoeck
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
| | - B Beyer
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - V Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium
| | - P Salvia
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium
| | - J-L Sterckx
- Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium
| | - M Rooze
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Functional Anatomy, Université Libre de Bruxelles, Bruxelles, Belgium; Department of Orthopedic Surgery, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - S Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Ateş F, Temelli Y, Yucesoy CA. Intraoperative experiments show relevance of inter-antagonistic mechanical interaction for spastic muscle's contribution to joint movement disorder. Clin Biomech (Bristol, Avon) 2014; 29:943-9. [PMID: 25001327 DOI: 10.1016/j.clinbiomech.2014.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 06/12/2014] [Accepted: 06/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent intra-operative knee angle-muscle force data showed no abnormal muscular mechanics (i.e., a narrow joint range of muscle force exertion and peak muscle force availability at flexed joint positions), if the spastic gracilis muscle was stimulated alone. This can limit inter-muscular mechanical interactions, which have been shown to affect muscular mechanics substantially. We aimed at testing the hypothesis that the knee angle-muscle force curves of the spastic gracilis muscle activated simultaneously with a knee extensor are representative of joint movement disorder. METHODS Experiments were performed during remedial surgery of spastic cerebral palsy patients (n=6, 10 limbs tested). Condition-I: muscle forces were measured in flexed knee positions (120° and 90°) after activating the gracilis exclusively. Condition-II: knee angle-muscle force data were measured from 120° to full extension after activating the vastus medialis, simultaneously. FINDINGS Condition-II vs. I: Inter-antagonistic interaction did not consistently cause a gracilis force increase. Condition-II: Peak muscle force=mean 47.92 N (SD 22.08 N). Seven limbs showed availability of high muscle force in flexed knee positions (with minimally 84.8% of peak force at 120°). Knee angle-muscle force curves of four of them showed a local minimum followed by an increasing force (explained by an increasing passive force, indicating muscle lengths unfavorable for active force exertion). High active gracilis forces measured at flexed knee positions and narrow operational joint range of force exertion do indicate abnormality. The remainder of the limbs showed no such abnormality. INTERPRETATION Our hypothesis is confirmed for most, but not all limbs tested. Therefore, tested inter-antagonistic mechanical interaction can certainly, but not exclusively be a factor for abnormal mechanics of the spastic muscle.
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Affiliation(s)
- Filiz Ateş
- Biomedical Engineering Institute, Boğaziçi University, Istanbul, Turkey
| | - Yener Temelli
- Istanbul University, Istanbul School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Can A Yucesoy
- Biomedical Engineering Institute, Boğaziçi University, Istanbul, Turkey.
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Maas H, Baan GC, Huijing PA. Dissection of a single rat muscle-tendon complex changes joint moments exerted by neighboring muscles: implications for invasive surgical interventions. PLoS One 2013; 8:e73510. [PMID: 23967344 PMCID: PMC3742526 DOI: 10.1371/journal.pone.0073510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/20/2013] [Indexed: 11/30/2022] Open
Abstract
The aim of this paper is to investigate mechanical functioning of a single skeletal muscle, active within a group of (previously) synergistic muscles. For this purpose, we assessed wrist angle-active moment characteristics exerted by a group of wrist flexion muscles in the rat for three conditions: (i) after resection of the upper arm skin; (ii) after subsequent distal tenotomy of flexor carpi ulnaris muscle (FCU); and (iii) after subsequent freeing of FCU distal tendon and muscle belly from surrounding tissues (MT dissection). Measurements were performed for a control group and for an experimental group after recovery (5 weeks) from tendon transfer of FCU to extensor carpi radialis (ECR) insertion. To assess if FCU tenotomy and MT dissection affects FCU contributions to wrist moments exclusively or also those of neighboring wrist flexion muscles, these data were compared to wrist angle-moment characteristics of selectively activated FCU. FCU tenotomy and MT dissection decreased wrist moments of the control group at all wrist angles tested, including also angles for which no or minimal wrist moments were measured when activating FCU exclusively. For the tendon transfer group, wrist flexion moment increased after FCU tenotomy, but to a greater extent than can be expected based on wrist extension moments exerted by selectively excited transferred FCU. We conclude that dissection of a single muscle in any surgical treatment does not only affect mechanical characteristics of the target muscle, but also those of other muscles within the same compartment. Our results demonstrate also that even after agonistic-to-antagonistic tendon transfer, mechanical interactions with previously synergistic muscles do remain present.
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Affiliation(s)
- Huub Maas
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands.
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Ateş F, Temelli Y, Yucesoy CA. Human spastic Gracilis muscle isometric forces measured intraoperatively as a function of knee angle show no abnormal muscular mechanics. Clin Biomech (Bristol, Avon) 2013; 28:48-54. [PMID: 23021616 DOI: 10.1016/j.clinbiomech.2012.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/23/2012] [Accepted: 08/30/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND To show whether mechanics of activated spastic muscle are representative of the functional deficiencies clearly apparent in the joints, our goal was to test the following hypotheses: (1) The muscle's joint range of force exertion is narrow, and (2) high muscle forces are available at low muscle length. METHODS During remedial surgery, we measured the forces of the Gracilis muscle of spastic cerebral palsy patients (n=7, 10 limbs tested) as a function of knee joint angle from flexion (120°) to full extension (0°). FINDINGS The spastic Gracilis exerted non-zero forces for the entire knee angles studied. For four limbs, the peak force was exerted at the highest length. For the remainder limbs, the closest knee angle of peak force exertion to 120° was 66°. Maximally 79.1%, and for most limbs only a much lower percentage (minimally 22.4%) of peak Gracilis force (mean 41.59N (SD 41.76N)) was available at 120° knee flexion. Moreover, a clinical metric was obtained showing that the occurrence of a contracture was not correlated significantly with key determinants of knee angle-Gracilis force characteristics. INTERPRETATION Our hypotheses are rejected: the spastic Gracilis has no narrow operational joint range of force exertion and no supreme active resistance capacity to stretch at low length. We conclude that if activated alone, spastic muscle shows no abnormal mechanics representative of joint movement disorder. Simultaneous stimulation of other muscles as in daily activities may change this situation.
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Affiliation(s)
- Filiz Ateş
- Biomedical Engineering Institute, Boğaziçi University, Istanbul, Turkey.
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Moyano FR, Valenza MC, Martin LM, Caballero YC, Gonzalez-Jimenez E, Demet GV. Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial. Clin Rehabil 2012; 27:409-17. [DOI: 10.1177/0269215512459277] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the effectiveness of proprioceptive neuromuscular facilitation combined with exercise, classic stretching physiotherapy intervention, and educational intervention at improving patient function and pain in patients with patellofemoral pain syndrome. Design: Randomized, controlled, blind trial over four months. Setting: Urban population, Spain. Participants: Patients undergoing primary care for retropatellar pain. Intervention: Subjects were allocated on three different treatment options: a proprioceptive neuromuscular facilitation and aerobic exercise group, a classic stretching group, and a control treatment were applied over four months under the supervision of a physiotherapist. Main outcome: Knee Society Score, pain reported (Visual analogue scale) and knee range of motion. Assessments were completed at baseline and after four months. Results: 74 patients were enrolled in the study and distributed between groups. Both the proprioceptive neuromuscular facilitation and classic stretching group showed significant changes in all variables after four months intervention ( p < 0.001). The difference in mean Kujala knee score changes between groups (classic stretching group vs. proprioceptive neuromuscular facilitation group vs. control group) at four months was −24.05 (95% confidence interval (CI) −30.19, −17.90), p ≤ 0.001; vs. −39.03 (95% confidence interval (CI) −42.5, −35.5), p ≤ 0.001; vs. −0.238 (95% confidence interval (CI) −1.2, 0.726), p = 0.621, respectively. Conclusions: A proprioceptive neuromuscular facilitation intervention protocol combined with aerobic exercise showed a better outcome than a classic stretching protocol after four months.
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Affiliation(s)
| | - MC Valenza
- Department of Physiotherapy, University of Granada, Granada, Spain
| | - L Martin Martin
- Department of Physiotherapy, University of Granada, Granada, Spain
| | | | | | - G Valenza Demet
- Department of Physiotherapy, University of Granada, Granada, Spain
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