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Adel J, Hamoda RE, Mohamed AM, Balbaa AE, Neamat Allah NH, Hamada HA. Is muscle activation diverse in females with isolated patellofemoral osteoarthritis contrasted with age-matched healthy controls during stair descent task? Front Physiol 2024; 15:1286406. [PMID: 38737832 PMCID: PMC11082385 DOI: 10.3389/fphys.2024.1286406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
Background: Patellofemoral osteoarthritis (PF OA) is exceptionally predominant and limiting. However, little is known about the risk factors that contribute to its onset and progression. Purpose: The aim of this study was to decide if women with PF OA descend stairs using different muscular activation strategies compared to similarly aged healthy controls. Methods: Thirty-one women with isolated PF OA and 11 similarly aged healthy women took part in this study. The activation onset and duration of PF OA in vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM), transversus abdominis (TrA), and multifidus muscles were evaluated during the stair descent task using surface electromyography (EMG). Results: There was a non-significant difference between women with PF OA and healthy controls regarding all tested variables, except for the GM activation onset that was significantly delayed in women with PF OA, with the p-value of 0.011. Conclusion: The causes of PF OA differ and might not always be due to a lack of quadriceps strength or VMO activation deficiency, and prospective longitudinal studies are required to confirm this assumption.
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Affiliation(s)
- Jilan Adel
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Reham E. Hamoda
- Department of Physical Therapy for Woman’s Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | - Ayah Mahmoud Mohamed
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Alaa Eldin Balbaa
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Dean of Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
| | - Neama H. Neamat Allah
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hamada Ahmed Hamada
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Carvalho C, Viadanna Serrão F, Felipe Martinez A, Da Silva Serrão PRM. Three-dimensional kinematics of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in subjects with isolated patellofemoral osteoarthritis compared to individually matched controls: Preliminary results. Arch Rheumatol 2024; 39:33-45. [PMID: 38774690 PMCID: PMC11104754 DOI: 10.46497/archrheumatol.2024.9814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/22/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives: This study aimed to compare three-dimensional kinematic of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in individuals with and without isolated patellofemoral osteoarthritis (PFOA). Patients and methods: This cross-sectional study evaluated trunk, pelvis, hip, and knee kinematics at 30°, 45°, and 60° knee flexion during the single-leg squat using the Vicon motion capture and analysis system, the Nexus System 2.1.1, and 3D Motion Monitor software. Sixteen individuals (8 males, 8 females; mean age: 49.3±6.2 years; range 40 to 61 years) participated in the study, of which eight were PFOA patients and eight were healthy controls. Isometric hip abductor, extensor, and external rotator torques were evaluated using a handheld dynamometer. Results: The PFOA group exhibited greater hip adduction at 30° (p=0.008), 45° (p=0.005), and 60° (p=0.008) knee flexion in the descending phase of the single-leg squat, as well as at 60° (p=0.009) and 45° (p=0.03) knee flexion in the ascending phase. No significant differences were found between groups for other kinematic variables (p>0.05). The PFOA group exhibited lower isometric hip abductor (p=0.02), extensor (p <0.001), and external rotator (p=0.007) torques. Conclusion: Individuals with PFOA exhibited excessive hip adduction that could increase stress on the lateral patellofemoral joint at 30°, 45°, and 60° knee flexion during the single-leg squat and exhibited weakness of the hip abductors, extensors, and external rotators in comparison to healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Carvalho C, de Oliveira MPB, Pisani GK, Marolde IB, Serrão PRMDS. Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies. Clin Biomech (Bristol, Avon) 2022; 98:105721. [PMID: 35868250 DOI: 10.1016/j.clinbiomech.2022.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabela Bianchini Marolde
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
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Siqueira MS, Souto LR, Martinez AF, Serrão FV, de Noronha M. Muscle activation, strength, and volume in people with patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:935-944. [PMID: 35257862 DOI: 10.1016/j.joca.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023]
Abstract
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).
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Affiliation(s)
- M S Siqueira
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - L R Souto
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - A F Martinez
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - F V Serrão
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - M de Noronha
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, VIC 3660, Australia.
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Carvalho C, Serrão FV, Pisani GK, Martinez AF, Serrão PRMDS. Frontal plane biomechanics during single-leg squat and hip strength in patients with isolated patellofemoral osteoarthritis compared to matched controls: A cross-sectional study. PLoS One 2022; 17:e0267446. [PMID: 35476842 PMCID: PMC9045627 DOI: 10.1371/journal.pone.0267446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/09/2022] [Indexed: 01/08/2023] Open
Abstract
The patellofemoral compartment of the knee is the most frequently affected by osteoarthritis. However, there is a lack of biomechanics studies on patellofemoral osteoarthritis (PFOA). This study’s purpose was to compare the frontal plane biomechanics of the trunk and lower limb during the single-leg squat and isometric hip abductor torque in individuals with isolated PFOA and controls. Frontal plane kinematics during the single-leg squat were evaluated using a three-dimensional (3-D) motion analysis system. Isometric hip abductor torque was determined using a handheld dynamometer. Twenty individuals participated in the study (10 with PFOA and 10 controls). No significant differences between groups were found regarding age (mean ± SD, PFOA group = 51.8 ± 6.9 versus control group = 47.8 ± 5.5; mean difference = 4, 95% confidence interval [CI] = -1.9 to 9.9, p = 0.20) or body mass index (PFOA group = 27.6 ± 2.2 versus control group = 25.5 ± 2.5; mean difference = 2.1, 95% confidence interval [CI] = -0.1 to 4.3, p = 0.06). Compared to control, the PFOA group presented greater hip adduction in the descending and ascending phases of the single-leg squat at 45° (mean difference [95% CI] = 6.44° [0.39–12.48°], p = 0.04; mean difference [95% CI] = 5.33° [0.24–10.42°], p = 0.045, respectively) and 60° (mean difference [95% CI] = 8.44° [2.15–14.73°], p = 0.01; mean difference [95% CI] = 7.58° [2.1–13.06°], p = 0.009, respectively) of knee flexion. No significant differences between groups were found for the frontal plane kinematics of the trunk, pelvis or knee (p > 0.05). The PFOA group exhibited lower isometric hip abductor torque (mean difference [95% CI] = -0.34 Nm/kg [-0.67 to -0.01 Nm/kg], p = 0.04). The individuals with PFOA presented greater hip adduction than the control group, which could increase lateral patellofemoral joint stress at 45° and 60° of knee flexion in the descending and ascending phases of the single-leg squat. These individuals also exhibited hip abductor weakness in comparison to healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Adalberto Felipe Martinez
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
- * E-mail:
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Macri EM, Crossley KM, Hart HF, d'Entremont AG, Forster BB, Ratzlaff CR, Wilson DR, Khan KM. Clinical findings in patellofemoral osteoarthritis compared to individually-matched controls: a pilot study. BMJ Open Sport Exerc Med 2021; 6:e000877. [PMID: 34422286 PMCID: PMC8323464 DOI: 10.1136/bmjsem-2020-000877] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/28/2020] [Accepted: 11/12/2020] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Erin M Macri
- Department of Family Practice, The University of British Columbia, Vancouver, Canada.,Department of General Practice; Department of Orthopaedics and Sport Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Harvi F Hart
- Department of Physical Therapy, Western University, London, Canada
| | - Agnes G d'Entremont
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada
| | - Bruce B Forster
- Department of Radiology, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Charles R Ratzlaff
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - David R Wilson
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Karim M Khan
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
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Carvalho C, Serrão FV, Mancini L, Serrão PRMDS. Impaired muscle capacity of the hip and knee in individuals with isolated patellofemoral osteoarthritis: a cross-sectional study. Ther Adv Chronic Dis 2021; 12:20406223211028764. [PMID: 34262680 PMCID: PMC8252374 DOI: 10.1177/20406223211028764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/10/2021] [Indexed: 01/25/2023] Open
Abstract
AIMS The aims of this study were to compare the capacity of the knee and hip muscles between individuals with and without isolated patellofemoral osteoarthritis (PFOA) and to evaluate the impact of PFOA on pain, stiffness, and physical function. METHODS This cross-sectional study evaluated muscle capacity of the hip and knee using an isokinetic dynamometer. The isokinetic variables used in the statistical analysis were peak torque, total work, and average power. Pain, stiffness, and physical function were assessed using questionnaires. RESULTS A total of 26 individuals participated in the study (13 with PFOA and 13 controls). The PFOA group exhibited lower peak torque, total work, and average power for knee extension and flexion in the concentric mode (p ⩽ 0.01) as well as lower peak torque and total work for knee extension (p ⩽ 0.005) and lower total work for knee flexion (p = 0.05) in the eccentric mode. The PFOA group exhibited lower peak torque of the extensor, abductor, adductor, and internal rotator muscles of the hip (p ⩽ 0.05), less total work of the abductor and adductor muscles (p ⩽ 0.04), and lower average power of eccentric adduction of the hip (p = 0.01) compared with the healthy controls. Compared with the control group, the PFOA group had a higher level of pain, stiffness, and compromised physical functioning self-reported (p ⩽ 0.005). CONCLUSION Participants with PFOA exhibited impairments regarding muscle capacity of the hip and knee, higher level of pain and stiffness as well as compromised physical functioning in comparison with healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Letícia Mancini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235–SP-310 São Carlos, São Paulo 13.565-905, Brazil
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Sonoo M, Iijima H, Kanemura N. Altered sagittal plane kinematics and kinetics during sit-to-stand in individuals with knee osteoarthritis: A systematic review and meta-analysis. J Biomech 2019; 96:109331. [DOI: 10.1016/j.jbiomech.2019.109331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/13/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
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Abstract
Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running). Symptoms can restrict participation in physical activity, sports, and work, as well as recur and persist for years. This clinical practice guideline will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.
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Macri EM, d'Entremont AG, Crossley KM, Hart HF, Forster BB, Wilson DR, Ratzlaff CR, Goldsmith CH, Khan KM. Alignment differs between patellofemoral osteoarthritis cases and matched controls: An upright 3D MRI study. J Orthop Res 2019; 37:640-648. [PMID: 30690776 PMCID: PMC6593798 DOI: 10.1002/jor.24237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/11/2019] [Indexed: 02/04/2023]
Abstract
Patellofemoral (PF) osteoarthritis (OA) is a prevalent and clinically important knee OA subgroup. Malalignment may be an important risk factor for PF OA. However, little is known about alignment in PF OA, particularly in an upright, weightbearing environment. Using a vertically-oriented open-bore MR scanner, we evaluated 3D knee alignment in 15 PF OA cases and 15 individually matched asymptomatic controls. We imaged one knee per participant while they stood two-legged at four flexion angles (0°, 15°, 30°, 45°), and also while they stood one-legged at 30° knee flexion. We calculated 3D patellofemoral and tibiofemoral alignment. Using mixed effects models, four of the five patellofemoral measures differed by group. For key measures, PF OA patellae were 6.6° [95%CI 5.0, 8.2] more laterally tilted, 2.4 mm [1.3, 3.5] more laterally translated, and at least 3.7 mm [0.2, 7.2] more proximally translated compared to controls (more with knees flexed). Alignment did not differ between two-legged stance and one-legged stance in either group. Statement of Clinical Significance: Our study demonstrated significant and clinically relevant differences in alignment between PF OA cases and controls in upright standing and squatting positions. Our findings were similar to those in previous studies of PF OA using traditional MR scanners in supine positions, supporting the clinical usefulness of existing methods aimed at identifying individuals who may benefit from interventions designed to correct malalignment. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. 9999:1-9, 2019.
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Affiliation(s)
- Erin M. Macri
- Centre for Hip Health and Mobility, Department of Mechanical EngineeringThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Agnes G. d'Entremont
- Centre for Hip Health and Mobility, Department of Mechanical EngineeringThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia
| | - Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia,Department of Physical TherapyWestern UniversityLondonOntarioCanada
| | - Bruce B. Forster
- Centre for Hip Health and Mobility, Department of RadiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Department of OrthopaedicsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Charlie H. Goldsmith
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada,Department of Occupational Science and Occupational TherapyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karim M. Khan
- Centre for Hip Health and Mobility, Department of Family PracticeThe University of British ColumbiaVancouverBritish ColumbiaCanada
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Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med 2018; 46:1797-1808. [PMID: 27142536 DOI: 10.1007/s40279-016-0545-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
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Hoglund LT, Pontiggia L, Kelly JD. A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study. Pilot Feasibility Stud 2018; 4:70. [PMID: 29636983 PMCID: PMC5889597 DOI: 10.1186/s40814-018-0262-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Background Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Methods Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. Results At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention. Conclusions PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise. Trial registration ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).
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Affiliation(s)
- Lisa T Hoglund
- 1Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Laura Pontiggia
- 2Department of Mathematics, Physics and Statistics, University of the Sciences, Philadelphia, PA USA
| | - John D Kelly
- 3Department of Sports Medicine and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
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Hart HF, Barton CJ, Khan KM, Riel H, Crossley KM. Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis. Br J Sports Med 2016; 51:781-790. [DOI: 10.1136/bjsports-2016-096768] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 01/25/2023]
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Samaan MA, Schwaiger BJ, Gallo MC, Link TM, Zhang AL, Majumdar S, Souza RB. Abnormal Joint Moment Distributions and Functional Performance During Sit-to-Stand in Femoroacetabular Impingement Patients. PM R 2016; 9:563-570. [PMID: 27729286 DOI: 10.1016/j.pmrj.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/09/2016] [Accepted: 10/02/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a morphological abnormality of the hip joint that causes pain when performing a mechanically demanding activity of daily living such as the sit-to-stand (STS) task. Previous studies have assessed lower extremity joint mechanics during an STS task in various pathologies, yet the STS task has not been studied in FAI patients. OBJECTIVE The objective of this study was to identify differences in joint kinetics and performance between FAI patients and healthy controls during a STS task. It was hypothesized that FAI patients would exhibit altered time needed to complete the STS task, as well as altered lower extremity biomechanics, when compared to healthy controls. DESIGN This was a cross-sectional cohort study. SETTING The study took place at a motion capture laboratory at an institutional orthopedic facility. PARTICIPANTS Biomechanical analysis was performed in 17 FAI patients and 31 age- and body mass index (BMI)-matched healthy controls during the STS task. METHODS Sagittal plane joint moments, total support moment (TSM), joint contributions to the TSM, and functional measures during the STS task were compared between groups. MAIN OUTCOME MEASUREMENTS Peak joint moments, TSM and joint contributions to the TSM were assessed during the STS task. In addition, the time to and value of the peak vertical ground reaction force (vGRF), limb symmetry index at peak vGRF, loading rate, and total time needed to perform the STS task were determined. RESULTS Compared to the control participants, the FAI patients exhibited worse Hip Disability and Osteoarthritis Outcome Score (HOOS) pain and function subscores. No group differences were observed in peak sagittal joint moments during the STS task. However, when compared to controls, the FAI patients demonstrated reduced knee joint contributions to the TSM. In addition, the FAI patients exhibited increased time needed to perform the STS task, increased time to reach peak vGRF, and reduced lower extremity loading rate during the STS task. CONCLUSIONS FAI patients demonstrated abnormal joint contributions to TSM and altered functional performance during the STS task. These altered movement patterns during the STS task may be compensatory mechanisms used by the FAI patients to reduce pain and to improve function. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107(∗).
| | - Benedikt J Schwaiger
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA(†)
| | - Matthew C Gallo
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA(‡)
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA(§)
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco School of Medicine, San Francisco, CA(‖)
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA(¶)
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA; Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, CA(#)
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Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2606-13. [PMID: 26708412 DOI: 10.1007/s00167-015-3931-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate gait asymmetries and the effect of walking on compliant surfaces in individuals with unilateral total knee arthroplasty (TKA), hypothesizing that asymmetries would increase as an effect of the compliant surface. METHODS Individuals with unilateral TKA ~19 months post-operative (n = 23, median age 59 years) recruited from one orthopaedic clinic and age- and gender-matched healthy individuals without knee complaints (n = 23, median age 56 years) walked at comfortable speed on a hard surface and on a compliant surface. 3D kinematic analyses were made for knee and hip angles in sagittal and frontal planes, stance time, step length, and gait velocity. RESULTS Shorter stance time (p < 0.01) and less peak knee flexion (p < 0.001) at weight bearing acceptance was found in the prosthetic side compared with the contralateral side. Larger knee (p < 0.01) and hip (p < 0.001) adduction was found compared with healthy controls. Neither asymmetries between the prosthetic and the contralateral side nor differences compared with healthy controls were enhanced when walking on compliant surfaces compared with hard surfaces. CONCLUSION The TKA group adapted their gait to compliant surfaces similarly to healthy controls. Gait asymmetries in the TKA group observed on hard surface were not enhanced, and adduction in hip and knee joints did not increase further as an effect of walking on compliant surfaces. Thus, unfavourable knee joint loading did not increase when walking on a compliant surface. This implies that recommendations for walking on soft surfaces to reduce knee joint loading are not counteracted by increased gait asymmetries and unfavourable joint loading configurations. LEVEL OF EVIDENCE III.
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