Patel of emoral Pain An Arthroscopic Perspective

Patellofemorales Schmerzsyndrom

The patellofemoral pain syndrome is of high socioeconomic relevance as it most frequently occurs in young working patients. As its etiology is often unknown there is no standard treatment protocol. Several studies analyzed the different causes of patellofemoral pain and their different therapies. Static problems (pes planovalgus, instabilities, leg length differences) or chronic overuse of the knee extensor mechanism have to be identified and treated. After exclusion of intra-articular pathologies, the treatment of patellofemoral pain syndrome begins with conservative management. Stretching of the flexor and extensor muscles and training of the quadriceps muscle are the main approaches. If conservative treatment fails and patellofemoral pain persists, there are several surgical procedures for realignment of the patella in the trochlear groove and reduction of the patellofemoral pressure. Overweight patients exhibit chronic mechanical overuse of the patellofemoral joint. This leads to a higher rate of cartilage degeneration and problems at the inserting tendons and stabilizing tissues.

Infrapatellar plica as a cause of anterior knee pain

OBJECTIVE

This study seeks to show that in the case of a patient not responding to nonoperative measures for the treatment of anterior knee pain, arthroscopic release of a symptomatic infrapatellar plica can successfully resolve the disability.

DESIGN

We report a retrospective study of 12 cases of anterior knee pain not responding to nonoperative treatment that underwent isolated infrapatellar plica resection without other noted knee pathology.

SETTING

Patients were evaluated and treated in an outpatient orthopedic sports medicine clinic.

PARTICIPANTS

Any patient who presented with anterior knee pain, underwent subsequent arthroscopy, and was treated by isolated resection of the infrapatellar plica was included in the study.

INTERVENTION

The surgical procedure involved arthroscopic division of the infrapatellar plica at its attachment on the superior intercondylar notch of the femur.

MAIN OUTCOME MEASUREMENTS

Patients were reviewed at least 12 months following the date of surgery. Two subjective knee scales were used to assess knee function.

RESULTS

A subjective scale used in prior studies assessing symptomatic medial plica demonstrated 91% percent (11 of 12) excellent (6) or good (5) outcomes at follow-up greater than 1 year. The Knee Injury and Osteoarthritis Outcome Scores of knee function on the subscales of pain, symptoms, activities of daily living, sports activity, and quality of life were 97, 96, 99, 99, and 87, respectively.

CONCLUSIONS

These cases demonstrate a potential role for the infrapatellar plica as a cause of anterior knee pain. A prospective study is warranted to measure causality.

Electromyography of the quadriceps in patellofemoral pain with patellar subluxation

This study compared muscle activity and timing of gait phases during functional activities in 13 subjects with patellofemoral pain associated with lateral subluxation and in 11 subjects with healthy knees. Fine wire electromyography recorded activity in the vastus lateralis and vastus medialis oblique during walking and ascending and descending stairs. Subjects were filmed to divide the activities into phases and determine timing. The vastus medialis oblique and vastus lateralis had similar patterns during all activities. Subjects with patellofemoral pain had significantly increased activity in the vastus medialis oblique and vastus lateralis compared with the healthy subjects during the most demanding phases of the gait cycle, suggesting a generalized quadriceps weakness in the patients with patellofemoral pain. Timing differences were seen in walking and stair ascending with the subjects with patellofemoral pain spending significantly more time in stance compared with the healthy subjects. This may be an attempt to reduce the load on weak quadriceps. These data reflect a generalized quadriceps muscle weakness, rather than the prevailing theory of quadriceps muscle imbalance as an etiology of patellofemoral pain. Therefore, we support the practice of strengthening the entire quadriceps muscle group, rather than attempting to specifically target the vastus medialis oblique.

The effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain

STUDY DESIGN

Pre- and postintervention repeated measures design.

OBJECTIVE

To determine the effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain (PFP).

BACKGROUND

Patellar taping is a common treatment technique for individuals with PFP. Specific data on whether patellar taping improves gait variables, however, are limited.

METHODS AND MEASURES

Ten subjects with a diagnosis of PFP were studied (five men, five women). The subjects' mean age, height, and mass were 36.5 +/- 11.1 years, 173.1 +/- 10.3 cm, and 70.9 +/- 13.3 kg, respectively. Lower extremity kinematics, ground reaction forces, and vastus lateralis EMG were obtained simultaneously while subjects ascended and descended stairs, under taped and untaped conditions. Knee moments were calculated using inverse dynamics equations. Four 2 x 2 (tape condition x stair condition) ANOVAs for repeated measures were generated for cadence and average stance phase knee extensor moment, knee flexion angle, and EMG.

RESULTS

On the average, a 92.6% reduction in pain was observed following the application of tape. Increases in cadence, knee flexion angles, and knee extensor moments were observed under the taped condition for both stair ascent and descent; however, no difference in average vastus lateralis EMG was found.

CONCLUSIONS

Although patellar taping resulted in decreased pain and increased knee extensor moments, knee flexion angles, and cadence during stair ambulation, the vastus lateralis EMG activity level did not change with taping. Based on data from the vastus lateralis, care must be taken if improved gait parameters indicate change in muscle recruitment.

Lower extremity kinetics during stair ambulation in patients with and without patellofemoral pain

OBJECTIVE

To compare lower extremity kinetics during stair ascent and descent in subjects with and without patellofemoral pain.

DESIGN

A cross-sectional study utilizing a control group.

BACKGROUND

The patellofemoral joint reaction force (the resultant force between the quadriceps muscle force and patellar ligament force) increases with quadriceps force and knee flexion angle. Consequently, patients with patellofemoral pain may employ compensatory strategies to minimize pain and reduce patellofemoral joint reaction forces during activity.

METHODS

10 individuals with a diagnosis of patellofemoral pain and 10 individuals without pain participated. Subject groups were matched on sex, age, height, and body mass. Anthropometric data, three dimensional kinematics, and ground reaction forces were used to calculate lower extremity sagittal plane moments (inverse dynamics) while subjects ascended and descended stairs at a self-selected pace. Differences in kinetic variables between groups were assessed using 2x2 (group x stair condition) analysis of variance.

RESULTS

Subjects with patellofemoral pain had decreased peak knee extensor moments during stair ascent and descent. There were no group differences in peak hip, ankle, or support moments, however, subjects with patellofemoral pain had decreased cadence (descent) compared to controls.

CONCLUSION

Subjects with patellofemoral pain had reduced peak knee extensor moments, suggesting that quadriceps avoidance was employed to reduce patellofemoral joint reaction forces. The lack of group differences in peak moments at the hip and ankle suggests that secondary compensation did not occur exclusively at the hip or ankle in this group of subjects with patellofemoral pain. RELEVANCE STATEMENT: Because stair ambulation is often used to evaluate the reproducibility of symptoms and to identify abnormal movement patterns indicative of patellofemoral pain, knowledge of lower extremity mechanics during stair negotiation is necessary to better characterize compensatory behavior in this population.

A comparison of closed kinetic chain and isokinetic joint isolation exercise in patients with patellofemoral dysfunction

Recently, there has been attention to the clinical application of closed kinetic chain and joint isolation exercise. Our purpose was to compare the effect of joint isolation and closed kinetic chain exercise on quadriceps muscle performance and perceived function in patients with patellofemoral pain. Twenty-three patients participated in an 8-week training period and were assigned to either a closed kinetic chain or a joint isolation exercise training group. An 8-inch (20.3 cm) retro step-up test was performed at baseline, 8 weeks, and 1 year. Seated knee extension testing was measured at baseline and at 8 weeks using peak concentric torque on an isokinetic dynamometer at 90 degrees/sec, 180 degrees/sec, and 360 degrees/sec. Perceived functional status was rated as excellent, good, fair, or poor based on questionnaire response. Statistical analysis showed that both groups had significant improvement in peak torque at all speeds, but only the closed kinetic chain group showed significant improvement in closed kinetic chain testing and perceived functional status. We concluded that closed kinetic chain training may be more effective than joint isolation exercise in restoring function in patients with patellofemoral dysfunction.