Hip abductor muscle volumes are smaller in individuals affected by patellofemoral joint osteoarthritis

Hip Abductor Weakness and Its Association With New or Worsened Knee Pain: Data From the Multicenter Osteoarthritis Study

OBJECTIVE

Hip abductors, important for controlling pelvic and femoral orientation during gait, may affect knee pain. Our objective was to evaluate the relation of hip abductor strength to worsened or new-onset frequent knee pain. Given previously noted associations of knee extensor strength with osteoarthritis in women, we performed sex-specific analyses.

METHODS

We used data from the Multicenter Osteoarthritis study. Hip abductor and knee extensor strength was measured. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and a question about frequent knee pain at baseline (144-month visit), and 8, 16, and 24 months thereafter. Knee pain outcomes were worsened knee pain (2-point increase in WOMAC pain) and incident frequent knee pain (answering yes to the frequent knee pain question among those without frequent knee pain at baseline). Leg-specific analyses tested hip abductor strength as a risk factor for worsened and new frequent knee pain, adjusting for potential covariates. Additionally, we stratified by knee extensor strength (high versus low).

RESULTS

Among women, compared to the highest quartile of hip abductor strength, the lowest quartile had 1.7 (95% confidence interval [95% CI] 1.1-2.6) times the odds of worsened knee pain; significant associations were limited to women with high knee extensor strength (odds ratio 2.0 [95% CI 1.1-3.5]). We found no relation of abductor strength to worsening knee pain in men or with incident frequent knee pain in men or women.

CONCLUSION

Hip abductor weakness was associated with worsening knee pain in women with strong knee extensors, but not with incident frequent knee pain in men or women. Knee extensor strength may be necessary, but not sufficient, to prevent pain worsening.

Sex-specific bone and muscular morphological features in ischiofemoral impingement: A three-dimensional study

The study aimed to investigate how hip bone and muscular morphology features differ between ischiofemoral impingement (IFI) patients and healthy subjects among males and females. Three-dimensional models were reconstructed based on magnetic resonance imaging images from IFI patients and healthy subjects of different sexes. Bone morphological parameters and the cross-sectional area of the hip abductors were measured. The diameter and angle of the pelvis were compared between patients and healthy subjects. Bone parameters of the hip and cross-sectional area of the hip abductors were compared between affected and healthy hips. The comparison results of some parameters were significant for females but not males. For females, the comparison results of pelvis parameters showed that the anteroposterior diameter of the pelvic inlet (p = 0.001) and intertuberous distance (p < 0.001) were both larger in IFI patients than in healthy subjects. Additionally, the comparison results of hip parameters showed that the neck shaft angle (p < 0.001) and the cross-sectional area of the gluteus medius (p < 0.001) and gluteus minimus (p = 0.005) were smaller, while the cross-sectional area of the tensor fasciae latae (p < 0.001) was significantly larger in affected hips. Morphological changes in IFI patients demonstrated sexual dimorphism, including bone and muscular morphology. Differences in the anteroposterior diameter of the pelvic inlet, intertuberous distance, neck shaft angle, gluteus medius, and gluteus minimus may explain why females are more susceptible to IFI.

Activation of PDGF Signaling in the Adult Muscle Stem Cell Niche in Patients With Type 2 Diabetes Mellitus

CONTEXT

Type 2 diabetes mellitus (T2D) negatively affects muscle mass and function throughout life. Whether adult muscle stem cells contribute to the decrease in muscle health is not clear and insights into the stem cell niche are difficult to obtain.

OBJECTIVE

To establish the upstream signaling pathway of microRNA (miR)-501, a marker of activated myogenic progenitor cells, and interrogate this pathway in muscle biopsies from patients with T2D.

METHODS

Analysis of primary muscle cell cultures from mice and 4 normoglycemic humans and muscle biopsies from 7 patients with T2D and 7 normoglycemic controls using gene expression, information on histone methylation, peptide screening, and promoter assays.

RESULTS

miR-501 shares the promoter of its host gene, isoform 2 of chloride voltage-gated channel 5 (CLCN5-2), and miR-501 expression increases during muscle cell differentiation. We identify platelet-derived growth factor (PDGF) as an upstream regulator of CLCN5-2 and miR-501 via Janus kinase/signal transducer and activator of transcription. Skeletal muscle biopsies from patients with T2D revealed upregulation of PDGF (1.62-fold, P = .002), CLCN5-2 (2.85-fold, P = .03), and miR-501 (1.73-fold, P = .02) compared with normoglycemic controls. In addition, we observed a positive correlation of PDGF and miR-501 in human skeletal muscle (r = 0.542, P = .045, n = 14).

CONCLUSIONS

We conclude that paracrine signaling in the adult muscle stem cells niche is activated in T2D. Expression analysis of the PDGF-miR-501 signaling pathway could represent a powerful tool to classify patients in clinical trials that aim to improve muscle health and glucose homeostasis in patients with diabetes.

Intrinsic foot muscle size and associations with strength, pain and foot-related disability in people with midfoot osteoarthritis

BACKGROUND

To compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability.

METHODS

Twenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dynamometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index.

FINDINGS

Small and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15-0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12-33% (effect sizes 0.47-1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r < -0.3, p > 0.05).

INTERPRETATION

Despite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.

Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies

BACKGROUND

Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals.

METHODS

Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence.

FINDINGS

Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables.

INTERPRETATION

The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.

Muscle activation, strength, and volume in people with patellofemoral osteoarthritis: a systematic review and meta-analysis

OBJECTIVE

This systematic review investigated whether people with patellofemoral osteoarthritis (PFOA) have muscle strength, volume, and activation around the hip and knee that is different from asymptomatic controls.

METHODS

Searches were carried out in five electronic databases, with terms related to PFOA, including muscle strength, volume and activation. Only studies with at least one group with symptomatic PFOA and one asymptomatic group were included. The methodological quality of the studies was assessed using the Downs and Black checklist. Certainty of evidence was assessed using the GRADE methodology. Using the random effects model, a meta-analysis was performed when there were at least two studies reporting the same domain.

RESULTS

Eight studies (250 participants) met the inclusion criteria. Subjects with PFOA had weaker hip abduction (SMD -0.96; 95%CI = -1.34 to -0.57), hip external rotation (-0.55;-1.07 to -0.03), hip extension (-0.72;-1.16 to -0.28), and knee extension (-0.97;-1.41 to -0.53) when compared to asymptomatic controls. People with PFOA also presented with smaller volumes of the gluteus medius, gluteus minimus, tensor fascia lata, vastus medialis (VM), vastus lateralis (VL) and rectus femoris when compared to asymptomatic controls. Also, people with PFOA presented with changes in muscle activation for the VL, VM and gluteus maximus (GMax) when compared to asymptomatic controls.

CONCLUSION

People with PFOA present with lower strength and volume of the hip and quadriceps muscles and altered muscle activation of the VM, VL and GMax during ascending and descending stairs when compared to asymptomatic controls. However, the certainty of these findings are very low.

TRIAL REGISTRATION NUMBER

PROSPERO systematic review protocol (ID = CRD42020197776).

Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: a scoping review of lateral hip musculature

Background

Measures of hip muscle morphology and composition (e.g., muscle size and fatty infiltration) are possible with magnetic resonance imaging (MRI). Standardised protocols or guidelines do not exist for evaluation of hip muscle characteristics, hindering reliable and valid inter-study analysis. This scoping review aimed to collate and synthesise MRI methods for measuring lateral hip muscle size and fatty infiltration to inform the future development of standardised protocols.

Methods

Five electronic databases (Medline, CINAHL, Embase, SportsDISCUS and AMED) were searched. Healthy or musculoskeletal pain populations that used MRI to assess lateral hip muscle size and fatty infiltration were included. Lateral hip muscles of interest included tensor fascia late (TFL), gluteus maximus, gluteus medius, and gluteus minimus. Data on MRI parameters, axial slice location, muscle size and fatty infiltrate measures were collected and analysed. Cross referencing for anatomical locations were made between MRI axial slice and E-12 anatomical plastinate sections.

Results

From 2684 identified publications, 78 studies contributed data on volume (n = 31), cross sectional area (CSA) (n = 24), and fatty infiltration (n = 40). Heterogeneity was observed for MRI parameters and anatomical boundaries scrutinizing hip muscle size and fatty infiltration. Seven single level axial slices were identified that provided consistent CSA measurement, including three for both gluteus maximus and TFL, and four for both gluteus medius and minimus. For assessment of fatty infiltration, six axial slice locations were identified including two for TFL, and four for each of the gluteal muscles.

Conclusions

Several consistent anatomical levels were identified for single axial MR slice to facilitate muscle size and fatty infiltration muscle measures at the hip, providing the basis for reliable and accurate data synthesis and improvements in the validity of future between studies analyses. This work establishes the platform for standardised methods for the MRI assessment of lateral hip musculature and will aid in the examination of musculoskeletal conditions around the hip joint. Further studies into whole muscle measures are required to further optimise methodological parameters for hip muscle assessment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05439-x.

May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions-a systematic review and meta-analysis

OBJECTIVE

To systematically review and synthesise patellofemoral joint reaction force (PFJRF) in healthy individuals and those with patellofemoral pain and osteoarthritis (OA), during everyday activities, therapeutic exercises and with physical interventions (eg, foot orthotics, footwear, taping, bracing).

DESIGN

A systematic review with meta-analysis.

DATA SOURCES

Medline, Embase, Scopus, CINAHL, SportDiscus and Cochrane Library databases were searched.

ELIGIBILITY CRITERIA

Observational and interventional studies reporting PFJRF during everyday activities, therapeutic exercises, and physical interventions.

RESULTS

In healthy individuals, the weighted average of mean (±SD) peak PFJRF for everyday activities were: walking 0.9±0.4 body weight (BW), stair ascent 3.2±0.7 BW, stair descent 2.8±0.5 BW and running 5.2±1.2 BW. In those with patellofemoral pain, peak PFJRF were: walking 0.8±0.2 BW, stair ascent 2.5±0.5 BW, stair descent 2.6±0.5 BW, running 4.1±0.9 BW. Only single studies reported peak PFJRF during everyday activities in individuals with patellofemoral OA/articular cartilage defects (walking 1.3±0.5 BW, stair ascent 1.6±0.4 BW, stair descent 1.0±0.5 BW). The PFJRF was reported for many different exercises and physical interventions; however, considerable variability precluded any pooled estimates.

SUMMARY

Everyday activities and exercises involving larger knee flexion (eg, squatting) expose the patellofemoral joint to higher PFJRF than those involving smaller knee flexion (eg, walking). There were no discernable differences in peak PFJRF during everyday activities between healthy individuals and those with patellofemoral pain/OA. The information on PFJRF may be used to select appropriate variations of exercises and physical interventions.

Clinical findings in patellofemoral osteoarthritis compared to individually-matched controls: a pilot study

Objective

To explore clinical characteristics in individuals with patellofemoral osteoarthritis (PFOA) compared to individually-matched asymptomatic controls. We also explored associations between functional performance and patient-reported symptoms with patellofemoral alignment.

Methods

We assessed 15 individuals with PFOA and 15 individually-matched asymptomatic controls. In addition to physical examination and patient-reported questionnaires, we evaluated functional performance, lower extremity strength and range of motion, and patellar alignment (using MRI). We analysed group differences with Wilcoxon’s matched-pairs signed rank tests, and within-group associations with Spearman’s rank correlations.

Results

We included 24 (80%) women with median (IQR) age of 56 (9) years and BMI of 22.8 (5.9) kg/m². Individuals with PFOA reported lower quality of life (8/100 points lower EQ-5D-5L, p=0.02), and performed worse on two functional tests: repeated one-leg rises (median 16 fewer rises, p=0.04) and timed stair climb (1.2 s slower, p=0.03). There were no differences in strength tests performed or range of motion. Patellar proximal translation correlated with worse functional performance and worse patient-reported pain, function and self-efficacy, while lateral translation and lateral tilt correlated with worse knee-related quality of life (Spearman’s r ranging from 0.5 to 0.7).

Conclusion

Functional performance was worse in individuals with PFOA, despite those individuals having no significant differences on lower extremity strength testing. Patellofemoral alignment was associated with worse functional performance as well as worse patient-reported outcomes, and it may represent one mechanism underpinning PFOA-related symptoms.

Tensor Fascia Latae Muscle Structure and Activation in Individuals With Lower Limb Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

BACKGROUND

Dysfunction of the tensor fascia latae (TFL) muscle is often clinically implicated in many musculoskeletal disorders.

OBJECTIVE

To systematically review the literature of the TFL muscle to determine whether there are differences in its structure and activation between individuals with and without lower limb musculoskeletal conditions.

DATA SOURCES

A comprehensive search in MEDLINE, EMBASE, CINHAL, and LILACS was undertaken from year of inception to 9 July 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies that directly investigated the structure or activity of the TFL muscle between individuals with a lower limb musculoskeletal condition and a pain-free control group.

RESULTS

Seventeen studies were included (n = 556 participants), eight reporting structure and ten activation of the TFL muscle. Conditions included lateral hip pain, hip joint pathology, ACL injury, iliotibial band syndrome, and patellofemoral joint osteoarthritis. Meta-analysis identified with low confidence (p value = 0.07) a small tendency towards hypertrophy in the affected side of participants with hip joint diseases (SMD 0.37, 95% CI [- 0.02, 0.77]). Moderate effect sizes were found for a higher cross-sectional area of the TFL/sartorius ratio in abductor tendon tear (SMD 0.74; 95% CI [0.05, 1.43, p value = 0.04), and for a smaller body mass normalized TFL volume in patellofemoral joint osteoarthritis (SMD - 0.61; 95% CI [- 1.23, 0.00], p value = 0.05). Normalised electromyography (EMG) amplitude did not differ between groups for any condition, but when EMG was analysed as linear envelopes or synergies, some differences in pattern of TFL activation were observed between individuals with lateral hip pain and controls. Timing of TFL activation did not differ between individuals with knee conditions and controls.

CONCLUSIONS AND IMPLICATIONS

Common clinical assumptions of the role of TFL muscle in lower limb musculoskeletal conditions are not well investigated and poorly supported by current research. There are contradictory findings on the muscle size of TFL. Differing methodology in muscle activation studies precludes a clear interpretation for comparison between groups.

PROSPERO REGISTRATION NUMBER

CRD42017076160.

Concurrent Validation and Reference Values of Gluteus Medius Clinical Test

CONTEXT

The hip abductor muscles, mainly the gluteus medius, are responsible for controlling hip adduction in a closed kinetic chain. Frontal plane knee alignment, assessed during functional activities such squatting, jumping and running, may overload joint structures, like the anterior cruciate ligament and patellofemoral joint. The hand-held dynamometer is reliable and effective for testing the muscular strength of the hip abductors.

OBJECTIVES

1. To assess the concurrent validity between the gluteus medius clinical test and a maximum isometric force test of the hip abductors using the hand-held dynamometer; (2) to determine the intra and inter-examiner reliability for the application of the gluteus medius clinical test; and (3) to describe reference values of gluteus medius clinical test on a population of youth athletes.

DESIGN

Cross-sectional.

METHODS

Thirty healthy individuals were recruited for validity and reliability testing. On the first day, participants performed the maximal isometric test of the hip abductors, measured via hand-held dynamometry. On the following week, the gluteus medius clinical test was performed. Intraclass correlation coefficients (ICC2,2) were computed for the reliability analysis, with a 95% confidence interval. To generate reference values, the gluteus medius clinical test was performed on 273 athletes.

RESULTS

The results of this study indicated a weak positive correlation (r = 0.436, p = 0.001) between tests, which indicates that they examine different domains of gluteus medius muscle function, likely endurance and muscle strength. The magnitude of computed ICCs (>0.95) indicates excellent intra- and inter-examiner reliability.

CONCLUSION

The findings of the current study indicate that the gluteus medius clinical test is reliable and examines a domain of muscular function not fully captured by HHD. The clinical test developed in this study is low-cost and can be included for gluteus medius assessment.

LEVEL OF EVIDENCE

Level 3.

Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review

[Purpose] Gluteus medius syndrome is one of the major causes of back pain or leg pain and is similar to greater trochanteric pain syndrome, which also presents with back pain or leg pain. Greater trochanteric pain syndrome is associated with lumbar degenerative disease and hip osteoarthritis. The objective of this review was to demonstrate gluteus medius syndrome as a disease entity by reviewing relevant articles to elucidate the condition. [Methods] Gluteus medius syndrome was defined as myofascial pain syndrome arising from the gluteus medius. We performed a search of the literature using the following keywords: “back pain”, “leg pain”, “greater trochanteric pain syndrome”, “degenerative lumbar disease”, “hip osteoarthritis”, and “gluteus medius”. We reviewed articles related to gluteus medius syndrome and described the findings in terms of diagnosis and treatment based on the underlying pathology. [Results] A total of 135 articles were included in this review. Gluteus medius syndrome is similar as a disease entity to greater trochanteric pain syndrome, which presents with symptoms of low back pain and leg pain. Gluteus medius syndrome is also related to lumbar degenerative disease, hip osteoarthritis, knee osteoarthritis, and failed back surgery syndrome. [Conclusion] Accurate diagnosis of gluteus medius syndrome and appropriate treatment could possibly improve lumbar degenerative disease and osteoarthritis of the hip and knee, as well as hip-spine syndrome and failed back surgery syndrome.