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Vakili S, Vivacqua T, Getgood A, Willing R. In Vitro Assessment of Knee Joint Biomechanics Using a Virtual Anterior Cruciate Ligament Reconstruction. J Biomech Eng 2024; 146:101006. [PMID: 38683101 DOI: 10.1115/1.4065417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/01/2024]
Abstract
Understanding the biomechanical impact of injuries and reconstruction of the anterior cruciate ligament (ACL) is vital for improving surgical treatments that restore normal knee function. The purpose of this study was to develop a technique that enables parametric analysis of the effect of the ACL reconstruction (ACLR) in cadaver knees, by replacing its contributions with that of a specimen-specific virtual ACLR that can be enabled, disabled, or modified. Twelve ACLR reconstructed knees were mounted onto a motion simulator. In situ ACLR graft forces were measured using superposition, and these data were used to design specimen-specific virtual ACLRs that would yield the same ligament force-elongation behaviors. Tests were then repeated using the virtual ACLR in place of the real ACLR and following that in ACL deficient knee by disabling the virtual ACLR. In comparison to the ACL deficient state, the virtual ACLRs were able to restore knee stability to the same extent as real ACLRs. The average differences between the anterior tibial translation (ATT) of the virtual ACLR versus the real ACLR were +1.6 ± 0.9 mm (p = 0.4), +2.1 ± 0.4 mm (p = 0.4), and +1.0 ± 0.9 mm (p = 0.4) during Anterior drawer, Lachman and Pivot-shift tests, respectively, which is small in comparison to the full ATT range of motion (ROM) of these knees. Therefore, we conclude that a virtual ACLR can be used in place of real ACLR during biomechanical testing of cadaveric knees. This capability opens the door for future studies that can leverage parameterization of the ACLR for surgical design optimization.
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Affiliation(s)
- Samira Vakili
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5B9, Canada
| | - Thiago Vivacqua
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada
- Western University
| | - Alan Getgood
- Department of Orthopaedic Surgery, London Health Sciences Centre University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada;Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
| | - Ryan Willing
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Department of Mechanical & Materials Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
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Smith RDJ, Hanrahan M, Gerber A, Tanaka MJ. Patellofemoral Disorders in Soccer Players. Sports Med Arthrosc Rev 2024; 32:146-155. [PMID: 39087704 DOI: 10.1097/jsa.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Patellofemoral disorders are common in the world of soccer and impact players across all levels and ages of the sport. Patellofemoral disorders encompass a spectrum of conditions, from anterior knee pain to patellar instability, and are often influenced by complex biomechanical factors and anatomic variations that can predispose to these conditions. In recent years, there has been a growing emphasis on injury prevention strategies and data-driven approaches, championed by organizations like the Union of European Football Associations and individual professional clubs. Conservative management remains the initial approach for many players, including physical therapy and supportive devices. However, surgical intervention, particularly in cases of recurrent patellar dislocations, is often necessary. The understanding of patellofemoral biomechanics in soccer continues to evolve and offers opportunities for more effective injury prevention and tailored treatment strategies. Despite the challenges, a comprehensive approach to patellofemoral disorders in soccer is essential to preserve player health, enhance performance, and sustain the sport's vitality.
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Affiliation(s)
- Richard D J Smith
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Shah AK, Uppstrom TJ, Rizy ME, Gomoll AH, Strickland SM. Incidence of Complications After Tibial Tubercle Osteotomy and Tibial Tubercle Osteotomy With Distalization. Am J Sports Med 2024; 52:1274-1281. [PMID: 38516864 DOI: 10.1177/03635465241235883] [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] [Indexed: 03/23/2024]
Abstract
BACKGROUND Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patellofemoral instability and pain. TTO with distalization (TTO-D) is indicated for patients with patellofemoral instability, patellar malalignment, and patella alta. The current literature demonstrates several complications that may be associated with TTO, with reportedly higher rates of complications associated with TTO-D. PURPOSE To analyze and compare complication rates after TTO without distalization (TTO-ND) and TTO-D and assess risk factors associated with complications. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All skeletally mature patients who underwent TTO with or without distalization by a single surgeon between September 2014 and May 2023 with a minimum of 6 months of clinical follow-up were retrospectively reviewed. Patient factors, surgical indications, perioperative data, and complications were collected via a retrospective review of electronic medical records. Concomitant procedures were categorized as intra-articular, extra-articular, and osteotomies. RESULTS A total of 251 TTOs (117 TTO-D, 134 TTO-ND) were included in the study group. Postoperative complications were observed in 15 operations (6%), with arthrofibrosis as the most common complication (10 operations [4%]). TTO-D and TTO-ND had similar rates of complication (5% vs 7%; P = .793). Clinical nonunion was observed in 3 operations (3%) in the TTO-D cohort and 1 operation (1%) in the TTO-ND cohort. In the TTO-D cohort, concomitant intra-articular procedures were significantly associated with an increased likelihood of complications in a univariate model. In the TTO-ND cohort, an increased tourniquet time was significantly associated with an increased likelihood of complications in a univariate model. For all TTOs as well as the TTO-D and TTO-ND cohorts, there were no significant associations between patient or surgical variables in a multivariate model. CONCLUSION TTO with and without distalization is a safe procedure with low rates of complication. TTO-D was not associated with a higher rate of complications compared with TTO-ND. There was no association between complications and surgical variables for TTO procedures.
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Affiliation(s)
- Aakash K Shah
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Tyler J Uppstrom
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Morgan E Rizy
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Andreas H Gomoll
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Sabrina M Strickland
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
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Pence KB, Sen S, Ormeci T, Caliskan M, Sakul BU. Evaluation of femoral condyle volumes in patients with trochlear dysplasia: a pilot study. Clin Radiol 2024; 79:e475-e481. [PMID: 38145924 DOI: 10.1016/j.crad.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 12/27/2023]
Abstract
AIM To examine the volumes of the medial and lateral femoral condyles and the trochlear groove, and to determine their relationship with trochlear dysplasia. MATERIALS AND METHODS Computed tomography images of the knees of 21 patients with trochlear dysplasia and 18 healthy individuals were analysed retrospectively. According to the modified Dejour classification, the degree of trochlear dysplasia was recorded, such as type A trochlea being low-grade dysplasia and types B, C, and D trochlea being high-grade dysplasia. Volume of the trochlear groove and medial and lateral femoral condyles were calculated using the three-dimensional (3D) volume-rendering method. RESULTS The volumes of lateral condyle, medial condyle, and trochlear groove were statistically significantly lower in patients with trochlear dysplasia when compared to healthy participants. When compared according to Dejour types, all parameters were statistically significantly lower in both high- and low-grade dysplasia patients (p<0.05). The correlation between femoral condyle volumes and trochlear groove volume was low in the control group, but there was a moderate positive correlation in the patient group (r=0.50-0.75, p<0.05). CONCLUSION In trochlear dysplasia, the volume of the trochlear groove decreases and hypoplasia may occur in both lateral femoral and medial femoral condyles. Therefore, hypoplasia of only one condyle should not be interpreted as trochlear dysplasia. A holistic approach to patients is required.
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Affiliation(s)
- K B Pence
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey.
| | - S Sen
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey
| | - T Ormeci
- Department of Radiology, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey
| | - M Caliskan
- Department of Orthopedics and Traumatology, Saglik Bilimleri University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh. Turgut Özal Blv. No:46/1 Kucukcekmece, Istanbul, Turkey
| | - B U Sakul
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey
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Bonanzinga T, De Sensi AG, Balzarini B, Doro GL, Bertolino L, Forte L, Kon E. An Innovative Topical Medical Device with Hyaluronic Acid and Polypeptides in Patients with Reduced Knee Function. J Funct Morphol Kinesiol 2024; 9:31. [PMID: 38390931 PMCID: PMC10885074 DOI: 10.3390/jfmk9010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
A topical medical device, AI500®, constituted of a single-chain polypeptide embedded in hyaluronic acid, was tested and evaluated in patients with reduced knee function due to osteoarthritis and other knee conditions. A total of 35 participants with reduced knee function assessed by the WOMAC Physical Function score were recruited. Four study visits were planned, from the first application at V0 to 1 week follow up at V3. Patient symptomatology was evaluated after 24 h (V1) and after 48 h (V2) through phone contact, and after 1 week from V0, on site (V3). The overall duration of the follow up was one week. An amelioration of 40% in WOMAC Physical Functional scores after 1 week of treatment was recorded, thus achieving the primary endpoint of 20%. Furthermore, a reduction of 29% in Physical Functional scores and of 28% in total WOMAC scores between V0-V2 was registered, together with a decrease of 39% between V0 and V3. The NRS scale showed a 29% and 37% reduction in pain between V0-V1 and V0-V2, respectively. Product safety was confirmed by the very low rate of adverse effects, non-device related, observed in only 2 patients out of 35, resolved spontaneously within 24-48 h. No safety concerns or risks associated with the use of the device were highlighted. There are few the studies on the topical use of HA-based gels for the treatment of knee problems. Compared to invasive intra-articular injections and oral pharmacological therapies used in cases of knee pain, the topical application of AI500® is non-invasive, safe, and appreciated by patients. Good results in terms of functional improvement and symptoms resolution were obtained in less than 1 week.
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Affiliation(s)
- Tommaso Bonanzinga
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Alice Giulia De Sensi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Beatrice Balzarini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Gian Luca Doro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Luca Bertolino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Forte
- Contrad Swiss SA, 6900 Lugano, Switzerland
| | - Elizaveta Kon
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
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Buzzatti L, Keelson B, van der Voort JW, Segato L, Scheerlinck T, Héréus S, Van Gompel G, Vandemeulebroucke J, De Mey J, Buls N, Cattrysse E, Serrien B. Dynamic CT scanning of the knee: Combining weight bearing with real-time motion acquisition. Knee 2023; 44:130-141. [PMID: 37597475 DOI: 10.1016/j.knee.2023.07.014] [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: 07/27/2022] [Revised: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Imaging the lower limb during weight-bearing conditions is essential to acquire advanced functional joint information. The horizontal bed position of CT systems however hinders this process. The purpose of this study was to validate and test a device to simulate realistic knee weight-bearing motion in a horizontal position during dynamic CT acquisition and process the acquired images. METHODS "Orthostatic squats" was compared to "Horizontal squats" on a device with loads between 35% and 55% of the body weight (%BW) in 20 healthy volunteers. Intraclass Correlation Coefficient (ICC), and standard error of measurement (SEM), were computed as measures of the reliability of curve kinematic and surface EMG (sEMG) data. Afterwards, the device was tested during dynamic CT acquisitions on three healthy volunteers and three patients with patellofemoral pain syndrome. The respective images were processed to extract Tibial-Tuberosity Trochlear-Groove distance, Bisect Offset and Lateral Patellar Tilt metrics. RESULTS For sEMG, the highest average ICCs (SEM) of 0.80 (6.9), was found for the load corresponding to 42%BW. Kinematic analysis showed ICCs were the highest for loads of 42%BW during the eccentric phase (0.79-0.87) and from maximum flexion back to 20° (0.76). The device proved to be safe and reliable during the acquisition of dynamic CT images and the three metrics were computed, showing preliminary differences between healthy and pathological participants. CONCLUSIONS This device could simulate orthostatic squats in a horizontal position with good reliability. It also successfully provided dynamic CT scan images and kinematic parameters of healthy and pathological knees during weight-bearing movement.
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Affiliation(s)
- Luca Buzzatti
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium; School of Allied Health, Anglia Ruskin University (ARU), Young Street, CB1 1PT Cambridge, UK.
| | - Benyameen Keelson
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Joris Willem van der Voort
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Lorenzo Segato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | - Thierry Scheerlinck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedic Surgery and Traumatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Savanah Héréus
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gert Van Gompel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jef Vandemeulebroucke
- Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Johan De Mey
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Nico Buls
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erik Cattrysse
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ben Serrien
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
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Gencer B, Yiğit A, Çamoğlu C, Çulcu A, Dogan O. Can Anterior Knee Pain Be Explained by Patella Position After Infrapatellar Tibia Intramedullary Nailing? Cureus 2023; 15:e47334. [PMID: 38021528 PMCID: PMC10657199 DOI: 10.7759/cureus.47334] [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] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate the postoperative position of the patella and its relationship with anterior knee pain in patients operated with infrapatellar reamed tibia intramedullary nailing (IMN). MATERIALS AND METHODS Patients who underwent tibia IMN between 2019 and 2022 and who had anterior knee pain in their postoperative follow-up at least two outpatient clinic controls with an interval of at least one month were examined. Patellar height indices (Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Insall-Salvati) and sagittal angulation (patella-patellar tendon angles) were measured on the lateral direct radiographs of the patients in semi-flexion. As a control group, measurements were made on the contralateral intact extremity radiographs of the same patients. RESULTS There was no significant difference in patellar height indices between the fractured and intact sides in any of the patients (p = 0.588; p = 0.747; p = 0.446; p = 0.573, respectively). When the sagittal angulations were analyzed, a significant difference was found between the fractured and intact sides of the patients (p = 0.048), resulting in an approximate three-degree change. CONCLUSION Patellar sagittal balance has been identified as one of the contributing factors to the development of anterior knee pain following reamed tibial IMN. Further biomechanical and comprehensive clinical studies are needed on this subject.
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Affiliation(s)
- Batuhan Gencer
- Department of Orthopaedics and Traumatology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, TUR
| | - Alperen Yiğit
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Can Çamoğlu
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Ahmet Çulcu
- Department of Orthopaedics and Traumatology, Yüksekova State Hospital, Hakkâri, TUR
| | - Ozgur Dogan
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
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Brenneis M, Junker M, Sohn R, Braun S, Ehnert M, Zaucke F, Jenei-Lanzl Z, Meurer A. Patellar malalignment correlates with increased pain and increased synovial stress hormone levels-A cross-sectional study. PLoS One 2023; 18:e0289298. [PMID: 37498905 PMCID: PMC10374142 DOI: 10.1371/journal.pone.0289298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Risk factors for the development of pain in the context of knee osteoarthritis (KOA) remain unclear. Radiological findings often do not correlate with clinical findings, so other pathomechanisms in the development and perception of pain must play a role. The purpose of this study is to investigate the correlation of increased sympathetic nervous system (SNS) activity (measured by subjective and objective chronic stress parameters) with KOA severity, patellofemoral malalignment, and pain. METHODS 47 patients with KOA were assessed. Radiological measurements of tibiofemoral and patellofemoral parameters (Kellgren-Lawrence-score, patellar tilt (PT), Caton-Deschamps-Index and Hepp´s classification) were performed and correlated with knee-specific questionnaires (WOMAC®, KSS©) and chronic stress questionnaires (PSQ-20). Additionally, parameters associated with chronic stress were quantified in synovial fluid and serum samples from patients. RESULTS PT correlated significantly with Caton-Deschamps-Index (r = 0.394,p = 0.006) and with medial patellofemoral joint space (r = 0.516,p<0.001). In addition, asymmetric trochlear groove (Hepp's classification > II) was associated with significantly higher PT values (p = 0.014). A negative correlation between PT and KSS©-symptoms subgroup was found (r = -0.340,p = 0.024). Patients with PT<5° had significantly higher scores in the Knee Society Score©-symptoms subgroup (p = 0.038). A positive and significant correlation between synovial aldosterone levels and PT was observed (r = 0.548,p = 0.042). CONCLUSION The results of this study indicate that patellar malalignment might correlate with increased pain. The previous specification of standard PT values must be reconsidered as even low PT values seem to play a role in the occurrence of patellofemoral osteoarthritis symptoms. Lower PT values might lead to aggravated symptoms in patients with KOA due to a narrow medial patellofemoral joint space. In addition, PT might induce the release of synovial stress biomarkers and thus contribute to the progression of KOA.
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Affiliation(s)
- Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Marius Junker
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
- Department of Orthopedics, Tabea Hospital Hamburg, Hamburg, Germany
| | - Rebecca Sohn
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Markus Ehnert
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Frank Zaucke
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Zsuzsa Jenei-Lanzl
- Department of Orthopedics (Friedrichsheim), Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Andrea Meurer
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
- Medical Park St. Hubertus Klinik, Bad Wiessee, Germany
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Wu CH, Hsu KY, Cheng YH, Yang CP, Sheu H, Chang SS, Chen CY, Chiu CH. Reconstruction of High-Grade Trochlea Dysplasia in a Young Female with Recurrent Patella Dislocation: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050986. [PMID: 37241218 DOI: 10.3390/medicina59050986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
The patellofemoral joint involves a combination of bony structures and soft tissues to maintain stability. Patella instability is a disabling condition, and the cause is multifactorial. The main risk factors include patella alta, trochlea dysplasia, excessive tibial tuberosity to trochlea grove (TT-TG) distance, and excessive lateral patella tilt. In this case report, we highlight the thinking process of diagnosis and method for selecting the optimal treatment in accordance with the guidelines by Dejour et al. when we are presented with a patient with patella instability. A 20-year-old Asian woman without underlying medical conditions, presented with recurrent (>3 episodes) right patella dislocation for 7 years. Investigations revealed a type D trochlea dysplasia, increased TT-TG distance, and excessive lateral tilt angle. She underwent trochlea sulcus deepening, sulcus lateralization and lateral facet elevation, lateral retinacular release, and medial quadriceps tendon-femoral ligament (MQTFL) reconstruction. Due to the complexity behind the anatomy and biomechanics of patella instability, an easy-to-follow treatment algorithm is essential for the treating surgeon to provide effective and efficient treatment. MQTFL reconstruction is recommended for recurrent patella dislocation due to satisfactory clinical and patient reported outcomes and a reduced risk of iatrogenic patella fracture. Controversies for surgical indication in lateral retinacular release, and whether the sulcus angle is an accurate parameter for diagnosis of trochlea dysplasia, remain, and further research is required.
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Affiliation(s)
- Chih-Hsuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shih-Sheng Chang
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Kobayashi T, Tee SM, Morikawa M, Tashiro T, Arima S, Maeda N, Leung AKL. Effect of flexion-resist and extension-assist knee orthosis on electromyographic activities of quadriceps during lateral stepping. Prosthet Orthot Int 2023; 47:168-171. [PMID: 36459507 DOI: 10.1097/pxr.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
Knee orthoses can potentially reduce muscular activities of the quadriceps. The aim of this study was to investigate the effect of a custom flexion-resist and extension-assist knee orthosis on electromyographic activities of quadriceps during lateral stepping (step-up and step-down). Flexion resistance and extension assistance mechanisms were set by a pair of linear springs built into the orthotic knee joints. Electromyography (EMG) signals were collected from rectus femoris (RF), vastus medialis obliquus (VMO), and vastus lateralis (VL) during lateral step-up and lateral step-down activities in 7 healthy young adults. Peak normalized root mean square (RMS) EMG signals of each muscle, as well as VMO:VL ratio, were compared between orthotic and nonorthotic conditions using the Wilcoxon signed-rank test. The knee orthosis significantly reduced the normalized RMS EMG signals of the RF and VL during lateral stepping ( p < 0.05). No significant difference was found in the VMO. The VMO:VL ratio significantly ( p < 0.05) increased under orthotic condition. The experiments demonstrated that the knee orthosis reduces the peak normalized RMS EMG signals of RF and VL, and alter the VMO:VL ratio of quadriceps in healthy young adults. Therefore, this study suggests that the flexion-resist and extension-assist knee orthosis may be effective in reducing muscular activities of RF and VL, which may alleviate patellofemoral loading. Future studies should delve into the effects of the knee orthosis in individuals with patellofemoral pain.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - See Moon Tee
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Prosthetics and Orthotics, Tuen Mun Hospital, Hong Kong, China
| | - Masanori Morikawa
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tsubasa Tashiro
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Arima
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noriaki Maeda
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Aaron K L Leung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Lamplot JD, Jahandar A, Meyers KN, Gomoll AH, Maher SA, Strickland SM. Anteromedialization Tibial Tubercle Osteotomy Improves Patellar Contact Forces: A Cadaveric Model of Patellofemoral Dysplasia. Am J Sports Med 2023; 51:453-460. [PMID: 36453729 DOI: 10.1177/03635465221138287] [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] [Indexed: 12/02/2022]
Abstract
BACKGROUND Patellofemoral (PF) dysplasia is common in patients with recurrent patellar instability. Tibial tubercle osteotomy (TTO) is performed with goals of correcting patellar maltracking and redistributing contact forces across the PF joint. The biomechanical effects of TTO in the setting of PF dysplasia have not been quantified. PURPOSE/HYPOTHESIS To quantify patellar contact mechanics and kinematics after TTO in the setting of PF dysplasia. We hypothesized that a simulated anteromedialization (AMZ) TTO would improve PF contact mechanics as compared with a pure medialization TTO. STUDY DESIGN Controlled laboratory study. METHODS PF dysplasia with Dejour type D classification was simulated in 7 cadaveric knees by replacing the native patellar and trochlear surfaces with synthetic polymeric patellar and trochlear implants. On each specimen, a flat TTO was fixed in 3 distinct positions simulating a pathologic lateralized tubercle (pathologic condition), a medialized tubercle (Elmslie Trillat), and an AMZ tubercle. The sum of forces acting on the medial and lateral patellar facet and patellar kinematics was computed for each knee for each condition from 0° to 70° of flexion at 10° increments. RESULTS Relative to the pathologic condition, AMZ TTO decreased contact forces across the lateral facet (20°-50° and 70° of flexion). Relative to the pathologic condition, Elmslie Trillat TTO had no effect on contact forces on either compartment. Relative to the Elmslie Trillat TTO, the AMZ TTO had significantly decreased contact forces across the medial facet (at 40°, 60°, and 70° of flexion). No significant differences in joint kinematics occurred across any groups. CONCLUSION Of all groups studied, AMZ TTO resulted in significantly decreased patellar contact forces in simulated dysplastic PF joints. AMZ may be considered in certain patients with PF dysplasia to avoid medial compartment PF chondral overload. CLINICAL RELEVANCE PF dysplasia is common in patients with recurrent patellar instability who warrant surgical intervention to prevent subsequent recurrence. Numerous interventions to treat this condition, including various TTOs, have been proposed without a clear consensus. This cadaveric biomechanical study demonstrates that AMZ TTO resulted in more favorable PF contact mechanics than Elmslie Trillat TTO in a model representing PF dysplasia. AMZ TTO may be considered for patients in the setting of recurrent instability with PF dysplasia to avoid cartilage overload on the medial compartment of the PF joint.
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12
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The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:56. [PMID: 36683021 PMCID: PMC9869604 DOI: 10.1186/s12891-022-06100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. METHODS Between 2009 and 2020, 30 knees of 23 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years in the retrospective nature of the study. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR+AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. RESULTS Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR+AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. CONCLUSION Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.
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Sharma R, Vaibhav V, Meshram R, Singh B, Khorwal G. A Systematic Review on Quadriceps Angle in Relation to Knee Abnormalities. Cureus 2023; 15:e34355. [PMID: 36874732 PMCID: PMC9974941 DOI: 10.7759/cureus.34355] [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] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Previous studies on the quadriceps (Q) angle and its relation to knee problems have led to conflicting conclusions. In this comprehensive review, we evaluate recent studies on the Q angle and analyze the changes in Q angles. Specifically, we investigate the variation in Q angles when measured under the following conditions: 1) under various measurement techniques; 2) between symptomatic and non-symptomatic groups; 3) between samples of men and women; 4) unilateral versus bilateral Q angles; 5) Q angle in adolescent boys and girls. It is widely believed that Q angles are more significant in symptomatic patients than in asymptomatic individuals or that the right lower leg and left lower limb are equivalent, which is supported by little scientific data. However, research states that young adult females have higher mean Q angles than males.
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Affiliation(s)
- Rahul Sharma
- Anatomy, All India Institute of Medical Sciences, Rishikesh, IND
| | - Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Brijendra Singh
- Anatomy, All India Institute of Medical Sciences, Rishikesh, IND
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Xie P, István B, Liang M. The Relationship between Patellofemoral Pain Syndrome and Hip Biomechanics: A Systematic Review with Meta-Analysis. Healthcare (Basel) 2022; 11:healthcare11010099. [PMID: 36611559 PMCID: PMC9818693 DOI: 10.3390/healthcare11010099] [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: 11/09/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background and purpose: Muscular control and motor function in a patient with Patellofemoral pain syndrome (PFPS) have not yet been investigated systematically. Therefore, this review synthesis the previous results about the association of PFPS with gluteus muscle activation, hip strength, and kinematic characteristic of the hip and knee joint, to deepen understanding of the PFPS etiology and promote the establishment of an effective treatment strategy. (2) Methods: A literature search was conducted from January 2000 to July 2022 in four electronic databases: Medline, Embase, Google scholar, and Scopus. A total of 846 articles were initially identified, and after the screening process based on the inclusion criteria, 12 articles were eventually included. Means and SDs of gluteus medius (GMed), gluteus maximus (GMax), hip strength, and kinematic variation of hip and knee were retrieved from the present study. (3) Results and conclusion: Regarding kinematic variation, moderate evidence indicates that an increased peak hip adduction was found in PFPS groups during running and single leg (SL) squat activities. There is no difference in the GMed and GMax activation levels between the two groups among the vast majority of functional activities. Most importantly, strong evidence suggests that hip strength is weaker in individuals with PFPS, showing less strength of hip external rotation and hip abduction compared to the control group. However, without prospective studies, it is difficult to determine whether hip strength weakness is a cause or a result of PFPS. Therefore, further research is needed to evaluate the hip strength level in identifying individuals most likely to associated with PFPS development is needed.
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Affiliation(s)
- Pingping Xie
- College of Science and Technology, Ningbo University, Ningbo 315211, China
| | - Bíró István
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
| | - Minjun Liang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Correspondence: ; Tel.: +86-574-87600456
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Aldharman SS, Almuhammadi HH, Madkhali AY, Alnami RA, Alkadi MA, Albalawi DM, Alhamaid YA, Khired ZA. Prevalence of Patellofemoral Pain and Knee Pain in the General Population of Saudi Arabia. Cureus 2022; 14:e30355. [PMID: 36407143 PMCID: PMC9665909 DOI: 10.7759/cureus.30355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background Patellofemoral pain (PFP) is a common cause of knee pain. This condition can restrict daily activities by trying to avoid activities that aggravate their pain. This study aimed to determine the prevalence of PFP and knee pain and its associated factors among Saudi young adults. Methods A descriptive cross-sectional study was conducted in Saudi Arabia. A validated translated Arabic questionnaire was used. Data was collected through an online self-administered questionnaire. Saudi young adults of both genders aged between (18 to 40 years) were included. The mean ±SD was described for continuous variables, whereas categorical variables were reported using frequencies and percentages. The chi-square test was used for descriptive analysis. Results A total of 1558 subjects were enrolled in the current study. About 663 (42.6%) were males and 895 (57.4%) were females. Of the total participants, 718 (46%) were within the age group of 18 to 25. The overall prevalence of PFP among the current study participant was found to be 30.3%. The prevalence of PFP among males was found to be 31.4% and the prevalence of PFP among females was found to be 29.5%. The overall prevalence of knee pain among study participants was found to be 13.2% as 205 of the participants reported knee pain. The prevalence of knee pain among males was found to be 14% and the prevalence of knee pain among females was found to be 12.3%. The multivariate analysis included the following variables: age, gender, and marital status. The following factors predicted higher rate of PFP: being 18 to 25 years old (p-value < 0.001, odds ratio = 1), being 26 to 35 years old (p-value = 0.001, odds ratio = 1.689). Conclusion The prevalence of PFP and knee pains was found to be relatively high in Saudi Arabia. Age less than 40 years old was found to be associated with a higher prevalence of PFP and knee pain when compared to other age groups.
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Development of an Auxiliary Device for Patellar and Femoral Joint Tangential Axial Radiographic Imaging and a Method for Obtaining an Optimal Radiographic Image Using the Development. Appl Bionics Biomech 2022; 2022:5951285. [PMID: 36276581 PMCID: PMC9581617 DOI: 10.1155/2022/5951285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the accuracy of tangential axial radiography of the patellar and femoral joint using an auxiliary device based on three image evaluation criteria, which we named the patellofemoral joint radiography auxiliary device (PJR). To compare the PJR method with conventional radiographic methods, such as Laurin, Merchant, and Settegast, a whole-body phantom (PBU-31) was used and three image evaluation items were set. The radiographic method, the smallest inclination of the patellar and showed the best half lateral image of the patella, is Settegast, and the measurement is 9.40. The second-best PJR measurement is 9.97, and the difference between the two measures is 5.76% (
). The radiographic method showing the image with the largest distance between the patellar and femoral joint space is PJR which a measurement is 12.35. The second best Merchant measure is 10.55, and the difference between the two measures is 14.54% (
). The method in which the two bones were well overlapped (i.e., evaluate the distortion of the image by measured as the distance between the femoral trochlear groove and the tibial tuberosity) is the PJR and the measurement is −0.37. The second-best Merchant measure is 3.93, and the difference between the two measures is 91.4% (
). The Settegast has the image with the smallest inclination of the patella, but the PJR has the image that best describes the patellar–femoral joint and the least distortion of the image. As a result of the comprehensive evaluation, when using PJR, bending the knee by 40° and setting a 140° angle between the long axis of the femur and the long axis of the lower leg were considered to be the most beneficial conditions. Therefore, we propose the use of PJR for tangential axial radiography of the patellar–femoral joint.
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Reduplicated medial parapatellar plica: a case of a medial plica anatomical variation recalcitrant to conservative treatment. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1391-1395. [PMID: 36178525 DOI: 10.1007/s00276-022-03025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The current study aims to report the radiologic and clinical appearance of a rare anatomical variation of the knee medial synovial plica along with its response to conservative and surgical treatment. CASE PRESENTATION This report portrays a 29-year-old male patient with anteromedial gradual onset right knee pain, aggravated when descending stairs or prolonged sitting. Physical examination revealed medial parapatellar local tenderness, a palpable click in this area when the knee was extended, and hamstring tightness. Magnetic resonance imaging showed a duplicated medial plica, characterized by a high-intensity signal of the infrapatellar fat pad medial portion, after which a presumptive diagnosis of medial plica syndrome was proposed. After conservative treatment failure, the patient underwent standard knee arthroscopy that revealed a superior low profile and an inferior high profile medial plica, and hypertrophy of the medial portion of the infrapatellar fat pad. Both plicae and fat pad were resected with a mechanical shaver until no contact between the femoral trochlea and the fat pad was observed during full range of motion. At 4 weeks postoperatively, symptoms completely resolved, and the patient was allowed to return to full activity with no recurrences at 1 year follow-up. CONCLUSIONS The current study presented a rare anatomical variation of the knee medial synovial plica that was symptomatic and recalcitrant to conservative treatment. This case report may be useful for radiologists and orthopaedic surgeons to differentiate this special plica type and consider its response to conservative and surgical treatment during patient management.
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Pompeo KD, da Rocha ES, Morales AB, Klein KD, Vaz MA. Does forward step-down task frontal kinematics differ in women with and without patellofemoral pain? A cross-sectional study. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00869-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pal S, Choi JH, Delp SL, Fredericson M. Botulinum neurotoxin type A improves vasti muscle balance, patellar tracking, and pain in patients with chronic patellofemoral pain. J Orthop Res 2022; 41:962-972. [PMID: 36031589 DOI: 10.1002/jor.25435] [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: 04/20/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine the effects of botulinum neurotoxin type A (BoNT-A) on vastus lateralis:vastus medialis (VL:VM) muscle balance, patellar tracking, and pain in patients with chronic patellofemoral (PF) pain. We recruited 13 participants (9 females, 4 males) with recalcitrant PF pain who underwent ultrasound-guided BoNT-A injections into the distal third of the VL muscle, followed by a 6-week home exercise program to strengthen their VM muscle. We imaged the participants in a C-arm computed tomography (CT) scanner before and after the intervention. We calculated VL:VM ratios from CT images from a supine, nonweight-bearing condition. We obtained patellar tilt and bisect offset values from CT images from an upright, weight-bearing condition. We recorded functional pain scores before, immediately after, and 2-4 years after the intervention. We classified the participants into normal tracking and maltracking groups based on their patellar tilt and bisect offset values. BoNT-A with home exercise reduced VL:VM ratio (18%; p < 0.001), patellar tilt (19%; p = 0.020), and bisect offset (5%; p = 0.025). Four participants classified as maltrackers before the intervention transitioned to normal tracking after the intervention. Functional pain scores improved immediately after the intervention (13%, p < 0.001) and remained improved at 2-year follow-up (12%, p = 0.011). Statement of Clinical Significance: This study provides new evidence in support of BoNT-A for treatment of PF pain. Classification of patients under weight-bearing conditions may identify individuals who will most benefit from a BoNT-A treatment.
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Affiliation(s)
- Saikat Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Jang-Hwan Choi
- Division of Mechanical and Biomedical Engineering, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Patella-patellar tendon angle in relation to the medial patellar plica syndrome, chondromalacia patella, and infrapatellar fat pad syndrome. PLoS One 2022; 17:e0265331. [PMID: 35298516 PMCID: PMC8929550 DOI: 10.1371/journal.pone.0265331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
The patella-patellar tendon angle (PPTA) assessing the sagittal patellar tilt was reported to be related with anterior knee pain. Herein, clinical effect of PPTA in patients with medial patellar plica (MPP) syndrome, chondromalacia patella, and infrapatellar fat pad (IPFP) syndrome, the most common causes of anterior knee pain, was evaluated. In this retrospective study, 156 patients with anterior knee pain who underwent magnetic resonance imaging (MRI) and arthroscopic surgery that confirmed isolated MPP syndrome, chondromalacia patella, or IPFP syndrome from June 2011 to January 2021 were included in the study group and 118 patients without knee pathology on MRI during the same period were included in the control group. The PPTA was measured on knee MRI and compared between the two groups. A receiver operating characteristic (ROC) analysis was used to evaluate the value of PPTA for predicting the risk of patellofemoral joint disorder. The mean PPTA was significantly smaller in study group (138.1 ± 4.2°) than control group (142.1 ± 4.3°) (p < 0.001). However, there was no significant difference in PPTA among the patients with MPP syndrome, chondromalacia patella, and IPFP syndrome. Furthermore, the ROC analysis revealed that the area under curve, sensitivity, and specificity for predicting the risk of patellofemoral joint disorders were 0.696, 70.3% and 57.6%, respectively, at a PPTA cutoff of 138.3°. Therefore, the smaller PPTA may be associated with MPP syndrome, chondromalacia patella, and IPFP syndrome. Furthermore, PPTA could be a predictive factor for the risk of patellofemoral joint disease in patients with anterior knee pain.
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Influence of Articular Geometry and Tibial Tubercle Location on Patellofemoral Kinematics and Contact Mechanics. J Appl Biomech 2022; 38:58-66. [PMID: 35045394 DOI: 10.1123/jab.2021-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/03/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022]
Abstract
Trochlear groove geometry and the location of the tibial tubercle, where the patellar tendon inserts, have both been associated with patellofemoral instability and can be modified surgically. Although their effects on patellofemoral biomechanics have been investigated individually, the interaction between the two is unclear. The authors' aim was to use statistical shape modeling and musculoskeletal simulation to examine the effect of patellofemoral geometry on the relationship between tibial tubercle location and patellofemoral function. A statistical shape model was used to generate new knee geometries with trochlear grooves ranging from shallow to deep. A Monte Carlo approach was used to create 750 knee models by randomly selecting a geometry and randomly translating the tibial tubercle medially/laterally and anteriorly. Each knee model was incorporated into a musculoskeletal model, and an overground walking trial was simulated. Knees with shallow trochlear geometry were more sensitive to tubercle medialization with greater changes in lateral patella position (-3.0 mm/cm medialization shallow vs -0.6 mm/cm deep) and cartilage contact pressure (-0.51 MPa/cm medialization shallow vs 0.04 MPa/cm deep). However, knees with deep trochlear geometry experienced greater increases in medial cartilage contact pressure with medialization. This modeling framework has the potential to aid in surgical decision making.
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22
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Hamawandi SA, Amin HI, Al-Humairi AK. Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial. Arch Orthop Trauma Surg 2022; 142:1-7. [PMID: 33829300 PMCID: PMC9474395 DOI: 10.1007/s00402-021-03878-0] [Citation(s) in RCA: 4] [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: 12/06/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up. MATERIALS AND METHODS 80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery. RESULTS There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release. CONCLUSION Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome. TRIAL REGISTRATION NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.
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Affiliation(s)
- Sherwan A. Hamawandi
- FIBMS Orthopedic Surgery, Head of Orthopaedic Department, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Hazhar I. Amin
- Orthopedic Department, Erbil Teaching Hospital, Erbil, Iraq
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Havey R, Schaver AL, Meyer AM, Duchman KR, Westermann R. Assessment of Femoral Version Should be Assessed Independently of Conventional Measures in Patellofemoral Instability. THE IOWA ORTHOPAEDIC JOURNAL 2021; 41:77-81. [PMID: 34924873 PMCID: PMC8662923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The purpose of the present study is to determine the association between femoral version and traditional pathologic bony factors commonly used to measure and define patellofemoral alignment. METHODS We performed a retrospective review of patients treated for patellofemoral instability (PFI) at a single institution. Patients included underwent magnetic resonance imaging (MRI) of the lower extremity using a rotational protocol prior to medial patellofemoral ligament reconstruction with or without tibial tubercle osteotomy. Those with a history of ipsilateral lower extremity surgery were excluded. Two independent reviewers measured femoral version, tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-posterior cruciate ligament (TT-PCL) distance, and tibial torsion (TT). Pearson correlation coefficients were used to describe the relationships between all radiographic measures. RESULTS A total of 51 knees (43 patients) were included. The average age and body mass index were 23.7 ± 9.33 years and 29.23 ± 8.04 kg/ m2, respectively. The mean femoral version was 15.61 ± 11.57°. The degree of femoral version did not significantly correlate with TT-TG (r=0.103, p=0.474), TT-PCL (-0.086, p=0.550), or TT (r=0.111, p=0.438). Increased TT-TG distance was strongly associated with increased TT-PCL (r=0.470, p=0.001). In females, increased femoral version significantly correlated with increased TT (r=0.381, p=0.029). CONCLUSION Neither increased nor decreased amounts of femoral anteversion significantly correlated with TT-TG, TT-PCL, or TT. Therefore, assessment of femoral version should be measured independently of conventional measures when considering osteotomies to correct PFI.Level of Evidence: IV.
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Affiliation(s)
- Ryan Havey
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew L. Schaver
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Alex M. Meyer
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kyle R. Duchman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Robert Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Shen A, Boden BP, Grant C, Carlson VR, Alter KE, Sheehan FT. Adolescents and adults with patellofemoral pain exhibit distinct patellar maltracking patterns. Clin Biomech (Bristol, Avon) 2021; 90:105481. [PMID: 34562716 DOI: 10.1016/j.clinbiomech.2021.105481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic idiopathic patellofemoral pain is associated with patellar maltracking in both adolescents and adults. To accurately target the underlying, patient-specific etiology, it is crucial we understand if age-of-pain-onset influences maltracking. METHODS Twenty adolescents (13.9 ± 1.4 years) and 20 adults (28.1 ± 4.9 years) female patients with idiopathic patellofemoral pain (age-of-pain-onset: < 14 and > 18 years of age, respectively) formed the patient cohort. Twenty adolescents and 20 adults (matched for gender, age, and body mass index) formed the control cohort. We captured three-dimensional patellofemoral kinematics during knee flexion-extension using dynamic MRI. Patellar maltracking (deviation in patient-specific patellofemoral kinematics, relative to their respective age-controlled mean values) was the primary outcome measure, which was compared between individuals with adolescent-onset and adult-onset patellofemoral pain using ANOVA and discriminant analysis. FINDINGS The female adolescent-onset patellofemoral pain cohort demonstrated increased lateral (P = 0.032), superior (P = 0.007), and posterior (P < 0.001) maltracking, with increased patellar flexion (P < 0.001) and medial spin (P = 0.002), relative to the adult-onset patellofemoral pain cohort. Post-hoc analyses revealed increased lateral shift [mean difference ± 95% confidence interval = -2.9 ± 2.1 mm at 10° knee angle], posterior shift [-2.8 ± 2.1 mm, -3.3 ± 2.3 mm & -3.1 ± 2.4 mm at 10°, 20°& 30°], with greater patellar flexion [3.8 ± 2.6 mm & 5.0 ± 2.8 mm, at 20°& 30°] and medial spin [-2.2 ± 1.7 mm & -3.4 ± 2.3 mm at 20°& 30°]. Axial-plane maltracking accurately differentiated the patient age-of-pain-onset (60-75%, P < 0.001). INTERPRETATION Age-of-pain-onset influences the maltracking patterns seen in patients with patellofemoral pain; with all, but 1, degree of freedom being unique in the adolescent-onset-patellofemoral pain cohort. Clinical awareness of this distinction is crucial for correctly diagnosing a patient's pain etiology and optimizing interventional strategies.
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Affiliation(s)
- Aricia Shen
- Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
| | | | - Camila Grant
- Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA.
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Dandu N, Trasolini NA, DeFroda SF, Darwish RY, Yanke AB. The Lateral Side: When and How to Release, Lengthen, and Reconstruct. Clin Sports Med 2021; 41:171-183. [PMID: 34782073 DOI: 10.1016/j.csm.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability.
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Affiliation(s)
- Navya Dandu
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Nicholas A Trasolini
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Steven F DeFroda
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Reem Y Darwish
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Adam B Yanke
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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SINCLAIR JONATHANKENNETH, BUTTERS BOBBIE. IMMEDIATE EFFECTS OF SEMI-CUSTOM INSOLES AND STRUCTURED KNEE SLEEVES ON LOWER EXTREMITY KINETICS AND KINEMATICS IN RECREATIONAL MALE ATHLETES WITH PATELLOFEMORAL PAIN. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this experiment was to provide insight into the immediate influence of both semi-custom insoles and knee sleeves in recreational male runners/athletes suffering from patellofemoral pain and also to explore the association between the extent of patellofemoral pain and psychological wellbeing. Experiment 1 examined 17 male recreational runners with patellofemoral pain, in semi-custom insole and no-insole conditions. Experiment 2 examined 13 male recreational athletes with patellofemoral pain, undertaking run, [Formula: see text] cut and single-leg hop movements in knee sleeve and no-sleeve conditions. In both experiments, motion capture and ground reaction forces were collected, allowing kinetics and three-dimensional kinematics to be calculated alongside patellofemoral joint loading quantified using musculoskeletal modeling. In both experiments, patellofemoral pain symptoms were examined using the KOOS patellofemoral pain subscale and psychological wellbeing using the COOP-WONCA questionnaire. The findings from both experiments showed that pain symptoms significantly predicted psychological wellbeing ([Formula: see text] in experiment 1 and [Formula: see text] in experiment 2). Experiment 1 showed that orthoses significantly reduced tibial internal rotation range of motion (no-[Formula: see text] and [Formula: see text]) whilst also increasing the peak knee adduction moment (no-[Formula: see text][Formula: see text]N[Formula: see text]m/kg and [Formula: see text][Formula: see text]N[Formula: see text]m/kg). The findings from experiment 2 revealed that the knee sleeve reduced the peak patellofemoral force (no-[Formula: see text][Formula: see text]BW and [Formula: see text][Formula: see text]BW) in the run movement and the patellofemoral load rate in the cut movement (no-[Formula: see text][Formula: see text]BW/s and [Formula: see text][Formula: see text]BW/s). Overall, the findings confirm that pain symptoms are predictive of psychological wellbeing in recreational male athletes with patellofemoral pain. Furthermore, the findings suggest that both insoles and knee sleeves may provide immediate biomechanical benefits in recreationally active individuals with patellofemoral pain, although when wearing insoles this may be at the expense of an increased knee adduction moment during running.
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Affiliation(s)
- JONATHAN KENNETH SINCLAIR
- Research Centre for Applied Sport, Physical Activity and Performance, Faculty of Allied Health and Wellbeing, School of Sport and Health Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK
| | - BOBBIE BUTTERS
- Research Centre for Applied Sport, Physical Activity and Performance, Faculty of Allied Health and Wellbeing, School of Sport and Health Sciences, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK
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Leiprecht J, Mauch F, Huth J, Ambros LP, Best R. Weight-bearing MRI with a knee flexion angle of 20°: a study on additional MRI investigation modalities to support a more accurate understanding of patellofemoral instability. BMC Musculoskelet Disord 2021; 22:902. [PMID: 34696737 PMCID: PMC8546952 DOI: 10.1186/s12891-021-04733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diagnosing patellofemoral instability disorders correctly, weight-bearing MRI (WB-MRI) has become an option. Aiming for a best possible accuracy in displaying potentially underlying causes, the named MRI modalities were sporadically even investigated in different knee flexion angles. However, despite confirmed MRI-outcome-differences between WB-MRI and non-WB-MRI, none of the described MRI modalities have so far established themselves. Mainly this is due to an unfeasibility in daily clinical routine in regard to time and economic aspects. Thus, we intended to evaluate an additional but reduced patellofemoral MR-imaging solely in a relevant 20° of knee flexion under WB- and non-WB-MRI conditions. METHODS Seventy-three subjects with and without patellofemoral instability were investigated under supine as well as under WB-MRI conditions in a 20° of knee flexion angle. Patellofemoral risk indices in the sagittal plane (Insall-Salvati-Index, Caton-Deschamps-Index, Patellotrochlear Index) and the axial plane (Patella tilt of Fulkerson and Sasaki) were detected and compared between the different MRI conditions. Significance, reliability and Cohen's effect size was calculated. RESULTS Nearly all assessed indices showed significant differences between patients and controls in the different MRI positions. Comparing pairwise, all measured indices failed to show significant differences between the two MRI positions. However, patella tilt angles of the patient group showed an elevation from supine to WB-MRI (14.00 ± 7.54° to 15.97 ± 9.10° and 16.34 ± 7.84° to 18.54 ± 9.43°). Here, Cohen's d showed small to medium effects between supine and WB-MRI. CONCLUSION In comparison to standard MRI in supine position, axial risk indices seem to be accentuated under WB-MRI and a knee flexion angle of 20°. In particular, symptomatic cases with inconspicuous conventional MRI imaging, additional MRI imaging only in the axial plane in a 20° of knee flexion could be beneficious and useful in clinical daily routine.
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Affiliation(s)
- J Leiprecht
- Department of Orthopaedics, University of Ulm, Oberer Eselberg 45, 89081, Ulm, Germany
| | - F Mauch
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany
| | - J Huth
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany
| | - L P Ambros
- Department of Surgery and Orthopaedics, St. Vinzenz Hospital, Kirchenweg 15, 87459, Pfronten, Germany
| | - R Best
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany.
- Department of Orthopedic Sports Medicine, University of Tuebingen, Hoppe Seyler Strasse 6, 72076, Tuebingen, Germany.
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Patellofemoral kinematics in patellofemoral pain syndrome: The influence of demographic factors. J Biomech 2021; 130:110819. [PMID: 34749164 DOI: 10.1016/j.jbiomech.2021.110819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022]
Abstract
Due to the multifactorial nature of patellofemoral pain, it is often difficult to identify an individual patient's exact cause of pain. Understanding how demographic variability influences these various factors will support improved consensus in regards to the etiology of PF pain. Thus, in this retrospective study, we tested the hypothesis that sex, height, weight, body mass index (BMI), and age influence the determination of between-groups differences in PF kinematics. We included 41 skeletally mature patients with patellofemoral pain and 79 healthy controls. Three-dimensional patellofemoral kinematics were quantified from dynamic magnet resonance images. We ran multiple regression analyses to determine the influence of demographic covariates (age, sex, height, weight, and BMI) on patellofemoral kinematics. Patellar shift was significantly influenced by weight (p = 0.009) and BMI (p = 0.009). Patellar flexion was influenced by height (p = 0.020) and weight (p = 0.040). Patellar tilt and superior displacement were not influence by demographic variables. Age and sex did not influence kinematics. This study supports the hypothesis that demographic parameters influence PF kinematics. The fact that weight, a modifiable measure, influences both patellar shift and flexion has strong implications for future research and clinical interventions. Clinically, weight loss may have a dual benefit of reducing joint stress and maltracking in patients who are overweight and experiencing patellofemoral pain. The influence of key demographics on patellofemoral kinematics, reinforces the clear need to control for population characteristics in future studies. As such, going forward, improved demographic matching between control and patient cohorts or more advanced statistical techniques that compensate for confounding variables are necessary.
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Doğan A, Şengül İ, Aşkın A, Tosun A. Effect of static knee joint flexion on vastus medialis obliquus fiber angle in patellofemoral pain syndrome: An ultrasonographic study. PM R 2021; 14:802-810. [PMID: 34165244 DOI: 10.1002/pmrj.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/30/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In patients with patellofemoral pain syndrome, the vastus medialis obliquus muscle fiber angle measured by ultrasound at knee extension was found to be different from that in healthy individuals. An important feature of patellofemoral pain syndrome is the increase in pain severity during activities that require knee flexion. OBJECTIVE To investigate whether there was an ultrasonographic change in the vastus medialis obliquus fiber angle by flexing the knee joint in patients with patellofemoral pain syndrome compared to healthy pain-free individuals. DESIGN A cross-sectional clinical study. SETTING An outpatient clinic of a tertiary care hospital. PARTICIPANTS Forty-seven patients with patellofemoral pain syndrome (median age of 40 years) and 43 healthy volunteers (median age of 39 years) were included in the study. INTERVENTIONS No intervention. MAIN OUTCOME MEASURES Vastus medialis obliquus fiber angle measured by ultrasonography at three different positions of knee joint including extension, 30° of flexion, and 45° of flexion. RESULTS There was no significant change in the vastus medialis obliquus fiber angle with knee flexion in both groups (p > .05 for each group). However, the median vastus medialis obliquus fiber angle values in the group with patellofemoral pain syndrome were significantly lower at all knee joint angles than those in the comparison group (p < .05 at all knee joint angles). CONCLUSIONS Although the vastus medialis obliquus fiber angle does not change with static knee flexion, the lower angle of the vastus medialis obliquus fiber in those with patellofemoral pain syndrome implicitly suggests that vastus medialis obliquus dysfunction may exist.
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Affiliation(s)
- Ali Doğan
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - İlker Şengül
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ayhan Aşkın
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Aliye Tosun
- Department of Physical Medicine and Rehabilitation, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
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Song YF, Wang HJ, Yan X, Yuan FZ, Xu BB, Chen YR, Ye J, Fan BS, Yu JK. Tibial Tubercle Osteotomy May Not Provide Additional Benefit in Treating Patellar Dislocation With Increased Tibial Tuberosity-Trochlear Groove Distance: A Systematic Review. Arthroscopy 2021; 37:1670-1679.e1. [PMID: 33359817 DOI: 10.1016/j.arthro.2020.12.210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the indications and outcomes of medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tubercle osteotomy (TTO) in treating recurrent or habitual patellar dislocation with an increased tibial tuberosity-trochlear groove (TT-TG) distance. METHODS We performed a literature search of the established medical databases Cochrane Central, PubMed-MEDLINE, EMBASE, and Web of Science. The inclusion criteria were as follows: skeletally mature patients with recurrent or habitual patellar dislocation and an increased TT-TG distance, treatment with MPFLR combined with a TTO procedure or isolated MPFLR, and reporting of clinical outcomes and complications. Each study was assessed for quality and the level of evidence. The general characteristics, indications, surgical techniques, TT-TG distance, clinical results, imaging evaluation findings, and complications of each study were recorded. RESULTS Nine studies consisting of 288 knees met the inclusion criteria. The average Coleman score was 71.56 (range, 55-83). The threshold for an increased TT-TG distance ranged from 16 to 20 mm in the included studies. Similar good postoperative outcomes were reported in patients with an increased TT-TG distance treated with MPFLR with versus without a TTO procedure. The mean postoperative Lysholm score ranged from 75.0 to 94.7 (I2 = 87.6%) in the isolated MPFLR group and from 85.0 to 87.6 (I2 = 16.3%) in the TTO-with-MPFLR group. Similar postoperative congruence angles were reported in both groups. The postoperative redislocation rate ranged from 0% to 4.2% in the TTO-with-MPFLR group, and no redislocation was found in the isolated MPFLR group. The postoperative apprehension sign was only reported in isolated MPFLR patients. CONCLUSIONS The outcomes of MPFLR with or without TTO to treat recurrent or habitual patellar dislocation with an increased TT-TG distance appeared similar. However, this study was limited by the considerable heterogeneity, variety of techniques, variety of TT-TG distances, and variability in patella alta and trochlear dysplasia among the included studies. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Yi-Fan Song
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Hai-Jun Wang
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xin Yan
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Fu-Zhen Yuan
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Bing-Bing Xu
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - You-Rong Chen
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jing Ye
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Bao-Shi Fan
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jia-Kuo Yu
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
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Tibial tubercle transfer leads to clinically relevant improvement in patients with patellar maltracking without instability: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:1137-1149. [PMID: 32594329 DOI: 10.1007/s00167-020-06114-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the different surgical techniques and their outcomes following tibial tubercle transfer (TTT) in patients with patellar maltracking. METHODS A systematic search of the literature was performed in PubMed, EMBASE and Cochrane Library. Studies reporting patient-reported outcome measures (PROMs) or clinical outcome following: TTT in patients with patellar maltracking were included. Collected PROMs were Lysholm, Kujala, IKDC score, and VAS pain. Clinical outcome included reported clinical success, patient satisfaction, complications and removal of hardware (ROH). Overall pre-, post-operative and change scores were estimated using random-effects meta-analysis models. Results were reported as overall mean and per transfer direction. RESULTS A total of 26 studies and 761 patients (818 knees, mean age 35 years, mean follow-up 5.0 years) were included. In 73% of the studies, surgery was performed after failed conservative treatment. Transfer direction was anteromedial in 76% of all procedures. Overall Lysholm score improved from 61 to 91, Kujala from 52 to 85, IKDC from 53 to 81, and VAS from 6.2 to 2.5, respectively. Clinical success was reported in 79% of patients, and 80% of patients reported to have satisfactory results. Rates of complications and ROH were 13% and 29%, respectively. CONCLUSIONS TTT for management of patellar maltracking can lead to good results with clinically meaningful improvement, an overall clinical success of 79% and overall patient satisfaction of 80% when appreciating the underlying anatomic condition and using appropriate technique. The level of evidence was low, and large-scale prospective, comparative cohort studies with uniform outcome scales are needed to confirm these findings. LEVEL OF EVIDENCE IV.
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Efficacy of Kinesio Taping and McConnell Taping Techniques in the Management of Anterior Knee Pain. J Sport Rehabil 2021; 29:79-86. [PMID: 30526288 DOI: 10.1123/jsr.2017-0369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. OBJECTIVE To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. DESIGN Cross-sectional design. SETTING Clinical biomechanics laboratory. PARTICIPANTS Ten participants (age: 20.3 [1.5] y, height: 169.9 [10.4] cm, and mass: 70.17 [13.1] kg) with anterior knee pain and no history of trauma. INTERVENTION Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. MAIN OUTCOME MEASURES Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges' g), 95% confidence intervals, and repeated-measures analysis of variance (P < .05) compared baseline and taping conditions during exercises for pain Visual Analog Scale and knee flexion in all exercises, hip abduction during step-down and drop jump, frontal plane projection during step-downs, and knee translation in sagittal plane during squats. RESULTS Significant reductions in Visual Analog Scale were recorded during squats between tapes (F2.505,12.867 = 3.407, P = .04, Hedges' g = -0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14 cm, P = .01) and Kinesio taping (mean difference = 1.54 cm, P = .02) compared with baseline during squats. CONCLUSIONS A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.
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Yang YP, Ling YD, Pang CN, Li N, Gong YN, Cui GQ, Gong X, Ao YF. Novel method for diagnosing lateral patellar compression syndrome using X-ray: a retrospective case-control study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:445. [PMID: 33850842 PMCID: PMC8039637 DOI: 10.21037/atm-20-6410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A well-established reference is lacking for diagnosing lateral patellar compression syndrome (LPCS), and this diagnosis currently depends on clinicians' subjective judgment and several examination results. X-rays are primarily used to diagnose LPCS, but they have low detection rates of patellar tilt using the congruence angle (CA) and patellar tilting angle (PTA). Methods We enrolled 87 patients (31 men and 56 women; mean age: 42.11±15.33 years) between 2016 and 2019 and divided them as per diagnosis into three groups of 29 each: LPCS, patellar dislocation (PD, control), and meniscus tear (MT, negative control) groups. A senior radiologist and the chief physician of sports medicine examined their patellar axial radiographs of the knee in 30° flexion using a computer imaging system, measuring LPCA, CA and PTA. Univariate analysis of variance and Kruskal-Wallis H test were used to compare measurement data with normal distribution and non-normal distribution, respectively. Bonferroni correction was used to analyze different indicators for different groups. The area under the curve (AUC) was calculated to verify the value of LPCA in the initial diagnosis of LPCS. Results LPCA (19.88±7.49) was significantly higher in LPCS group than in MT (13.68±4.69) and PD groups (10.16±4.43) (P<0.01) and was also significantly higher on affected side than on healthy side (16.44±5.00) (P=0.04). LPCA >13.9° had sensitivity and specificity of 89.66% and 68.97%, respectively, for LPCS diagnosis (AUC: 0.82, 95% confidence interval: 0.719-0.891, P<0.001). Conclusions We demonstrated that LPCA measured using an axial patellar radiograph of the knee in 30° flexion is high in patients with LPCS, and it may be used for diagnosing LPCS.
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Affiliation(s)
- Yu-Ping Yang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China.,Peking University Third Hospital, Beijing, China
| | - Yu-Dong Ling
- Peking University Health Science Center, Beijing, China
| | - Chao-Nan Pang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yi-Ning Gong
- Peking University Health Science Center, Beijing, China
| | - Guo-Qing Cui
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ying-Fang Ao
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
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Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial. Sports Health 2021; 13:482-489. [PMID: 33615901 DOI: 10.1177/1941738121993777] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Limited data are available on the effect of stretching exercise in patients with patellofemoral pain (PFP) who have inflexible quadriceps, which is one of the various causes of PFP syndrome. This study compares quadriceps flexibility, strength, muscle activation time, and patient-reported outcomes after static and dynamic quadriceps stretching exercises in patients with PFP who had inflexible quadriceps. HYPOTHESIS Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes would improve with dynamic quadriceps stretching as compared with static quadriceps stretching exercises. STUDY DESIGN Randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS Of the 44 patients included in the study, 20 performed static stretching and 24 performed dynamic stretching. Quadriceps flexibility was assessed by measuring the knee flexion angle during knee flexion in the prone position (the Ely test). Muscle strength and muscle activation time were measured using an isokinetic device. The patient-reported outcomes were evaluated using the visual analogue scale for pain and anterior knee pain scale. RESULTS No significant differences in quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in the involved knees were found between the 2 groups (P values > 0.05). CONCLUSION Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in patients with PFP who had inflexible quadriceps showed no significant differences between the static and dynamic quadriceps stretching exercise groups. CLINICAL RELEVANCE Both static and dynamic stretching exercises may be effective for improving pain and function in patients with PFP who have inflexible quadriceps.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea.,Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea.,Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Eunseon Kim
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hye Chang Rhim
- Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea
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Dong C, Li M, Hao K, Zhao C, Piao K, Lin W, Fan C, Niu Y, Fei W. Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome. J Orthop Surg Res 2021; 16:128. [PMID: 33568152 PMCID: PMC7877190 DOI: 10.1186/s13018-021-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background Whether vastus medialis obliquus atrophy exists in patients with patellofemoral pain syndrome and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown. Materials From June 2016 to March 2019, 61 patients with patellofemoral pain syndrome were retrospectively included in the study group, and an age-, sex-, and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group. All enrolled subjects had undergone CT scans in the supine position. The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0, 5, 10, 15, and 20 mm above the upper pole of the patella were measured, and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated. Results In the study group, the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0, 5, 10, 15, and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group (P < 0.05). The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella (the section 0 mm above the upper pole of the patella) than the corresponding ratio in the control group (P < 0.05). No significant difference was noted between the two groups in the sections 5, 10, 15, and 20 mm above the upper pole of the patella (P > 0.05). Conclusion In patients with patellofemoral pain syndrome, vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0–20 mm above the upper pole of the patella, compared with normal controls, and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella. These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation programme for the patients with patellofemoral pain syndrome.
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Affiliation(s)
- Conglei Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ming Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chao Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Kang Piao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wei Lin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chongyi Fan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Wang Fei
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial. BMC Musculoskelet Disord 2021; 22:24. [PMID: 33407337 PMCID: PMC7786499 DOI: 10.1186/s12891-020-03876-0] [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: 06/23/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Degenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. Method Ninety patients age (30–50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intraarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months. Results There was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value< 0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value = 0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value = 0.035). Conclusion Intra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up. Trial registration NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered.
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Identifying Musculoskeletal Pain Generators Using Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Manilov R, Chahla J, Maldonado S, Altintas B, Manilov M, Zampogna B. High tibial derotation osteotomy for distal extensor mechanism alignment in patients with squinting patella due to increased external tibial torsion. Knee 2020; 27:1931-1941. [PMID: 33221691 DOI: 10.1016/j.knee.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The patellofemoral joint is often affected by torsionaldisorders of the lower limb, causing pain, instability and knee degeneration. The aims of this study were to determine functional outcomes of patients who underwent a high tibial derotation osteotomy (HTDO) for symptomatic squinting patella due to increased external tibial torsion. Moreover, factors associated with inferior clinical outcomes were investigated. METHODS Patients with symptomatic squinting patella, increased external tibial torsion (>30°) treated with this technique, and with 2 years of follow up were included. Fulkerson and Kujala patellofemoral joint scores were assessed. Age, body mass index, history of prior surgery, increased femoral anteversion, association of lateral retinaculum release and patellar cartilage lesions were analysed. RESULTS Sixty HTDOs were included in this retrospective study with an average of 66 months of follow up. The mean Kujala score improved from 47.5 preoperatively to 93 postoperatively. The mean Fulkerson score improved from 40.6 to 91.6. Kujala subscores for pain improved from 8.6 to 30.4, for instability improved from 6.4 to 17.9, and their ability to climb stairs increased from 6.9 to 17.9 (all P < 0.0001). Multivariate logistic regression model identified that patient age (P < 0.005) and advanced chondral damage (P < 0.001) were the dominant factors predicting inferior clinical outcomes using Kujala's score. CONCLUSION HTDO provided good results regarding the pain symptoms, instability and the ability to climb stairs. Advanced chondral damage and advanced age had negative effects on outcomes.
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Affiliation(s)
| | - Jorge Chahla
- Cedars Sinai Kerlan Jobe Institute, Santa Monica, CA, USA
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Xue Z, Pei Z, Zhang H, Tang C, Jia J, Zhang K, Zhang K, Guan Z. Development of an innovative measurement method for patellar tracking disorder. Aging (Albany NY) 2020; 13:516-524. [PMID: 33260153 PMCID: PMC7835065 DOI: 10.18632/aging.202161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
In this study, we investigated whether the measurement of patellar tracking can be used as a diagnostic parameter of patellofemoral joint disease. Patellar tracking is defined as the movement of the patella in relation to the femorotibial joint within the full range of flexion and extension of the knee joint. The PubMed, EMBASE, Medline, PsychINFO, and AMED databases were used to find relevant articles. Analyzed were the patellar tracking coordinate system and the measurement objects, precision, methods used in those studies, as well as the results obtained. Origin points for coordinate systems varied across the studies. The research object and methods of patellar tracking varied in the studies. Most studies focused on a static description of the internal and external displacement and the internal and external inclination. The in vivo, noninvasive, and six degrees of freedom evaluation of patellar tracking reflect patellar motion more comprehensively, though each of these methods does so in different ways. Dynamic and quantitative evaluation of patellar tracking is still lacking in clinical work. Accurate and quantitative patellar tracking measurement could provide clinicians with a comprehensive evaluation of the stability of the knee joint.
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Affiliation(s)
- Zhe Xue
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zheng Pei
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Hui Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Chong Tang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Junxiu Jia
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Kun Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Keshi Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zhenpeng Guan
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
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Marques FDS, Barbosa PHB, Alves PR, Zelada S, Nunes RPDS, de Souza MR, Pedro MDAC, Nunes JF, Alves WM, de Campos GC. Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120961082. [PMID: 33195725 PMCID: PMC7605008 DOI: 10.1177/2325967120961082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone-patellar tendon-bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design Case-control study; Level of evidence, 3. Methods We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 (P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain (P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.
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Affiliation(s)
- Fabiano da Silva Marques
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Pedro Henrique Borges Barbosa
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Pedro Rodrigues Alves
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Sandro Zelada
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | | | | | | | | | - Wilson Mello Alves
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,Pontifícia Universidade Católica Hospital of Campinas, Campinas, Brazil
| | - Gustavo Constantino de Campos
- Instituto Wilson Mello, Research and Study Center, Campinas, Brazil.,University of Campinas (UNICAMP), Campinas, Brazil
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Rodrigues R, Souza da Rocha E, Klein KD, Sonda FC, Pompeo KD, Frasson VB, Vaz MA. Proximal and distal muscle thickness is different in women with patellofemoral pain but is not associated with knee frontal plane projection angle. J Bodyw Mov Ther 2020; 25:205-211. [PMID: 33714497 DOI: 10.1016/j.jbmt.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to compare proximal and distal muscle thickness between patellofemoral pain (PFP) and asymptomatic women (CG) and to verify the possible association between morphology and lower limb alignment during single leg-squat. METHODS Thirty women (PFP, n = 15 and CG, n = 15) performed the following evaluations: (i) muscle thickness of external oblique (EO), gluteus medius (GMed), tensor fascia latae (TFL), peroneus (PER) and tibialis anterior (TA); (ii) knee frontal plane projection angle (FPPA) during single-leg squat. RESULTS Compared with the CG, PFP showed: (1) smaller GMed (-10.02%; p = 0.04; effect size = 0.82), greater TFL (+18.44%; p = 0.02; effect size = 0.92) and PER (+14.23%; p = 0.02; effect size = 0.87) muscle thickness and greater knee FPPA during single-leg squat (+31.8%; p = 0.04; effect size = 1.12). No differences were observed in EO (+7.17%; p = 0.37; effect size = 0.34) and TA (-1.35%; p = 0.81; effect size = 0.12) muscle thickness. Additionally, we failed to observe significant associations between muscle morphology and knee FPPA in both groups. CONCLUSION PFP patients showed alterations in proximal and distal muscle thickness, despite the lack of association with poor lower limb alignment. Prospective studies are necessary to determine if differences in muscle morphology are the cause or the consequence of PFP and to confirm the absence of relationship with lower limb alignment.
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Affiliation(s)
- Rodrigo Rodrigues
- Exercise Physiology and Physical Assessment Laboratory, Serra Gaucha University Center, Caxias do Sul, RS, Brazil; Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Emmanuel Souza da Rocha
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kelli Daiana Klein
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Francesca Chaida Sonda
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Klauber Dalcero Pompeo
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marco Aurélio Vaz
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Physique Physiotherapy Centre, Porto Alegre, RS, Brazil
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Lee JH, Jang KM, Kim E, Rhim HC, Kim HD. Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports Health 2020; 13:49-56. [PMID: 32790575 DOI: 10.1177/1941738120932911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings. HYPOTHESIS Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population. STUDY DESIGN Prospective randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS). RESULTS There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups (P > 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS). CONCLUSION In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises. CLINICAL RELEVANCE Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea.,Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eunseon Kim
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Hye Chang Rhim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea
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Prevailing disagreement in the treatment of complex patellar instability cases: an online expert survey of the AGA Knee-Patellofemoral Committee. Knee Surg Sports Traumatol Arthrosc 2020; 28:2697-2705. [PMID: 32185453 DOI: 10.1007/s00167-020-05936-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/28/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the current state of knowledge and potential controversies in the treatment of patellofemoral instability among orthopaedic/trauma surgeons in the German-speaking countries. METHODS An online survey consisting of 32 questions and three fictitious cases was sent to members of the AGA-Society for Arthroscopy and Joint Surgery. Surgeons were defined by our senior authors as high-volume or low-volume surgeons, depending on the number of their cases. The treatment of 25% of patients with patellofemoral instability and/or the performance of 50 patellofemoral instability cases per year distinguishes high- from low-volume surgeons in this study. RESULTS The online questionnaire was completed by 541 experienced knee surgeons from Germany (78%), Austria (10.9%), Switzerland (10.4%) and other countries (0.7%). Most surgeons prefer MPFL reconstruction as surgical intervention in patients with recurrent patellar instability (64-81%). Sixty percent of high-volume surgeons as compared to 21.8% of low-volume surgeons have ever performed a trochleoplasty. Of the overall respondents, 25% would not perform any surgical treatment on adolescents with patellar instability and an open growth plate. Of all responding surgeons, 95% would not treat patellofemoral instability with an isolated lateral release. This corresponds to recent literature showing poor outcome of its strictly isolated application. CONCLUSION This study provides an overview of the current management of acute and recurrent patellofemoral instability in the German-speaking countries. Results show the surgeons' awareness for highly demanding surgical possibilities for complex patellar instability cases. However, disagreement among surgeons still prevails when it comes to selecting individual multimodal treatment options. This highlights the need for treatment guidelines and algorithms for patellofemoral instability. LEVEL OF EVIDENCE V.
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Kim YM, Joo YB, Lee WY, Park IY, Park YC. Patella-patellar tendon angle decreases in patients with infrapatellar fat pad syndrome and medial patellar plica syndrome. Knee Surg Sports Traumatol Arthrosc 2020; 28:2609-2618. [PMID: 32125441 DOI: 10.1007/s00167-020-05892-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Infrapatellar fat pad (IPFP) syndrome and medial patellar plica (MPP) syndrome are two recognized causes of anterior knee pain. However, diagnosing these syndromes is challenging without arthroscopic examination. The aim of this study was to evaluate sagittal patellar tilt in patients with IPFP syndrome or MPP syndrome by measuring the patella-patellar tendon angle (PPTA) in affected patients. METHODS Eighty-three patients with anterior knee pain who underwent diagnostic arthroscopy that confirmed isolated IPFP or MPP syndrome from 2011 to 2016 were included in this retrospective study. Patients were divided into Group A (IPFP syndrome, n = 44) and Group B (MPP syndrome, n = 39). The control group included 78 patients without knee pathology who underwent magnetic resonance imaging (MRI) of the knee during the study period. Radiographic measurements, including PPTA, IPFP area, patellar height, axial patellar alignment, patellar tilt, sulcus angle, and lateral trochlear inclination, were made on MRI images by two experienced sports medicine orthopedists. RESULTS The mean PPTA in each knee-pathology group was significantly smaller than that in the control group (Group A: 137.3° ± 4.9°; Group B: 138.1° ± 3.2°; control group, 141.4° ± 2.9°). There was no significant difference between groups for any other radiographic parameter evaluated. CONCLUSION The PPTA was significantly smaller in patients with IPFP syndrome or MPP syndrome than in healthy controls. Therefore, sagittal patellar tilt should be included in the routine evaluation of patients with anterior knee pain. Evaluation of PPTA may help to diagnose IPFP syndrome or MPP syndrome. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea.
| | - Woo Yong Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Il Young Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
| | - Young Cheol Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Munhwa-dong, Jung-gu, Daejeon, 301-721, South Korea
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Patellofemoral Pain Syndrome and Pain Severity Is Associated With Asymmetry of Gluteus Medius Muscle Activation Measured Via Ultrasound. Am J Phys Med Rehabil 2020; 99:595-601. [DOI: 10.1097/phm.0000000000001367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kölle T, Alt W, Wagner D. Immediate effects of an elastic patellar brace on pain, neuromuscular activity and knee kinematics in subjects with patellofemoral pain. Arch Orthop Trauma Surg 2020; 140:905-912. [PMID: 32108253 DOI: 10.1007/s00402-020-03378-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this randomized controlled trial was to investigate immediate effects of a patellar brace on pain, neuromuscular activity, and knee kinematics in subjects with patellofemoral pain syndrome. MATERIALS AND METHODS Fifty subjects with a diagnosis of patellofemoral pain syndrome completed 6 activities each with and without a patellar brace in a randomized order. The subjects were asked to rate their perceived pain on a Visual Analog Scale after each activity. During the activities, neuromuscular activity of vastus medialis and vastus lateralis, as well as knee angles were measured. RESULTS Subjects showed a statistically significant pain reduction of 33-56% on the Visual Analog Scale during all activities while wearing the brace. Two groups with different onset patterns for vastus medialis and vastus lateralis were identified: one group who activated vastus medialis prior to vastus lateralis, and one who activated vastus medialis after vastus lateralis. In the subgroup of subjects activating vastus lateralis prior to vastus medialis, bracing resulted in a significantly (p = 0.048) earlier onset of vastus medialis by 56 ms. In all but one activity, the vastus medialis/vastus lateralis ratio without the patellar brace was < 1.0 and inverted with the patellar brace > 1.0. Knee angles in the sagittal plane increased significantly with the patellar brace in two activities. CONCLUSION Patellofemoral bracing results in an immediate decrease of pain, an earlier onset of vastus medialis and inverted vastus medialis/vastus lateralis ratio and altered knee kinematics.
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Affiliation(s)
- Theresa Kölle
- Institut für Rehabilitationsmedizinische Forschung an der Universität Ulm, Am Kurpark 1, 88422, Bad Buchau, Germany.
| | - Wilfried Alt
- Institut für Sport- und Bewegungswissenschaft, Universität Stuttgart, Allmandring 28, 70569, Stuttgart, Germany
| | - Daniel Wagner
- Hessingpark Clinic, Hessingstrasse 17, 86199, Augsburg, Germany
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Acute Effects of Open Kinetic Chain Exercise Versus Those of Closed Kinetic Chain Exercise on Quadriceps Muscle Thickness in Healthy Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134669. [PMID: 32610511 PMCID: PMC7369757 DOI: 10.3390/ijerph17134669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to compare immediate changes in the thickness of the rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), and vastus medialis oblique (VMO) muscles after open kinetic chain exercise (OKCE) and closed kinetic chain exercise (CKCE) and identify the effect of both exercise types on each quadricep muscle for early rehabilitation to prevent knee joint injury. Twenty-six healthy participants (13 males and 13 females) were randomly divided into the OKCE (n = 13) and CKCE (n = 13) groups. The thickness of their quadriceps muscles was measured using a portable ultrasonic imaging device before and after exercise in the sequence RF, VI, VL, VM, and VMO. A two-way repeated measures analysis of variance was used to compare the thickness of each component of the quadriceps muscles between the two groups. The thickness of the RF, VL, VM, and VMO muscles increased after OKCE, and the thickness of the VI muscle showed the greatest increase with a medium–large effect size (F = 8.52, p = 0.01, and d = 0.53). The thickness of the VI, VL, VM, and VMO muscles increased after CKCE, and the VMO muscle had the largest effect size (F = 11.71, p = 0.00, and d = 1.02). These results indicate that the thickness of the quadriceps muscles can be selectively improved depending on the type of exercise.
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Comparison of Muscle Activity Using Unstable Devices During a Forward Lunge. J Sport Rehabil 2020; 29:394-399. [PMID: 30860420 DOI: 10.1123/jsr.2018-0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/03/2019] [Accepted: 02/05/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Unstable devices in various forms are used as therapeutic adjuncts for prevention or following an injury. A slip-over-the-shoe design with inflatable domes (STEPRIGHT® Stability Trainer) was developed to improve balance. It is unknown how this unstable device affects muscle activity during a closed-chain exercise such as the forward lunge. OBJECTIVE To compare muscle activity across 3 surfaces (STEPRIGHT®, Both Sides Up [BOSU®] Balance Trainer, and firm) during a forward lunge. DESIGN Within-subject, repeated measures. SETTING University physical therapy research laboratory. PARTICIPANTS A total of 20 healthy, recreationally active subjects (23.4 [1.47] y, 172.7 [14.7] cm, 71.6 [16.8] kg). INTERVENTION Each subject performed 1 set of 10 repetitions of forward lunge exercise in random order with STEPRIGHT®, BOSU®, and firm surface. MAIN OUTCOME MEASURES Surface electromyography data, normalized to maximum voluntary isometric contractions (%MVIC), was used to assess muscle activity on rectus femoris, vastus medialis oblique (VMO), biceps femoris, lateral gastrocnemius, fibularis longus, and tibialis anterior. RESULTS The repeated-measures analysis of variance determined that there was a significant effect for surface type. During the descent of the lunge, the STEPRIGHT® elicited higher rectus femoris (33% [27%] MVIC) compared with BOSU® (22% [14%] MVIC) and VMO (44% [15%] MVIC) on STEPRIGHT® compared with firm (38% [11%] MVIC) (P < .05). During the ascent of the lunge, the rectus femoris (38% [27%] MVIC) using STEPRIGHT® was higher than BOSU® (24% [16%] MVIC), and STEPRIGHT® elicited higher VMO (65% [20%] MVIC) versus BOSU® (56% [19%] MVIC) (P ≤ .01). The STEPRIGHT® for fibularis longus was higher (descent: 51% [20%] MVIC, ascent: 52% [22%] MVIC) than BOSU® (descent: 36% [15%] MVIC, ascent: 33% [16%] MVIC) or firm (descent: 33% [12%] MVIC, ascent: 35% [15%] MVIC) (P < .001). CONCLUSIONS Clinicians may choose to use the STEPRIGHT® for strengthening VMO and fibularis longus muscles, as these were over 41% MVIC or any of the 3 surfaces for endurance training (<25% MVIC) for biceps femoris muscle. This information may be helpful in exercise dosage for forward lunges when using STEPRIGHT®, BOSU®, or a firm surface.
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Rosas A, Losada Agustina B, García-Martínez D, Torres-Tamayo N, García-Tabernero A, Pastor JF, Rasilla MDL, Bastir M. Analyses of the neandertal patellae from El Sidrón (Asturias, Spain) with implications for the evolution of body form in Homo. J Hum Evol 2020; 141:102738. [PMID: 32146203 DOI: 10.1016/j.jhevol.2019.102738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
Abstract
The evolution of the body form in Homo and its potential morphological connection to the arrangement of different skeletal systems is of major interest in human evolution. Patella morphology as part of the knee is potentially influenced by body form. Here, we describe for the first time the patellae remains recovered at El Sidrón Neandertal site and analyze them in a comparative evolutionary framework. We aim to clarify whether morphometric features frequently observed in Neandertal and modern human patellae are retained from a primitive anatomical arrangement or whether they represent derived features (apomorphies). For this purpose, we combine analyses of discrete features, classic anthropological measurements, and 3D geometric morphometrics based on generalized Procrustes analysis, mean size and shape comparisons, and principal components analysis. We found a size increment of the patella in hominin evolution, with large species showing a larger patella. Modern humans and Neandertals exhibit overall larger patellae, with maximum values observed in the latter, likely as a consequence of their broader body shape. Also, some Neandertals display a thicker patella, which has been linked to larger quadriceps muscles. However, Neandertals retain a primitive morphology in their patellar articular surfaces, with similar-sized lateral and medial articular facets, leading to a more symmetrical internal face. This feature is inherited from a primitive Homo ancestor and suggests a different configuration of the knee in Neandertals. Conversely, Homo sapiens exhibits an autoapomorphic patellar anatomy with expanded lateral articular facets. We propose that these distinct configurations of the patella within Homo may be a consequence of different body forms rather than specific functional adaptations of the knee. Thus, the slender body form of modern humans may entail a medial reorientation of the tibial tuberosity (patellar ligament), allowing lateral surface expansion. These anatomical evolutionary variations may involve subtle secondary differences in bipedalism within Homo.
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Affiliation(s)
- Antonio Rosas
- Group of Paleoanthropology MNCN-CSIC, Department of Paleobiology, Museo Nacional de Ciencias Naturales (CSIC), José Gutiérrez Abascal 2, Madrid, Spain.
| | - Beatriz Losada Agustina
- Group of Paleoanthropology MNCN-CSIC, Department of Paleobiology, Museo Nacional de Ciencias Naturales (CSIC), José Gutiérrez Abascal 2, Madrid, Spain
| | - Daniel García-Martínez
- Group of Paleoanthropology MNCN-CSIC, Department of Paleobiology, Museo Nacional de Ciencias Naturales (CSIC), José Gutiérrez Abascal 2, Madrid, Spain; Centro Nacional de Investigación sobre la Evolución Humana, CENIEH, Avenida de La Sierra de Atapuerca 3, 09002, Burgos, Spain
| | - Nicole Torres-Tamayo
- Group of Paleoanthropology MNCN-CSIC, Department of Paleobiology, Museo Nacional de Ciencias Naturales (CSIC), José Gutiérrez Abascal 2, Madrid, Spain
| | - Antonio García-Tabernero
- Group of Paleoanthropology MNCN-CSIC, Department of Paleobiology, Museo Nacional de Ciencias Naturales (CSIC), José Gutiérrez Abascal 2, Madrid, Spain
| | - Juan Francisco Pastor
- Museo Anatómico, Departamento de Anatomía Humana, Universidad de Valladolid, C. Ramón y Cajal 7, 47005, Valladolid, Spain
| | - Marco de la Rasilla
- Área de Prehistoria Departamento de Historia, Universidad de Oviedo, Calle Teniente Alfonso Martínez S/n, 33011, Oviedo, Spain
| | - Markus Bastir
- Group of Paleoanthropology MNCN-CSIC, Department of Paleobiology, Museo Nacional de Ciencias Naturales (CSIC), José Gutiérrez Abascal 2, Madrid, Spain
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Leal A, Andrade R, Flores P, Silva FS, Fulkerson J, Neyret P, Arendt E, Espregueira-Mendes J. Unilateral anterior knee pain is associated with increased patellar lateral position after stressed lateral translation. Knee Surg Sports Traumatol Arthrosc 2020; 28:454-462. [PMID: 31375878 DOI: 10.1007/s00167-019-05652-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/26/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To objectively compare side-to-side patellar position and mobility in patients with idiopathic unilateral anterior knee pain (AKP) using a stress-testing device concomitantly with magnetic resonance imaging. It is hypothesized that the painful knees present greater patellar mobility than the contralateral non-painful knees. METHODS From a total sample of 359 patients, 23 patients with idiopathic unilateral AKP (30.9 years, 23.4 kg/m2, 43% males) were included within the present study. Both knees of all the patients were examined by conventional imaging, including the measurement of trochlear sulcus angle, Caton-Deschamps index, tibial tuberosity to trochlear groove distance, patellar tilt angle and patellar subluxation (both at rest and upon quadriceps contraction). Additionally, the same patients underwent stress testing (Porto Patella Testing Device); these measurements were taken with the patella at rest, after lateral patellar translation and after lateral patellar tilt. Clinical and functional outcomes were obtained using physical examination and the Kujala and Lysholm scores. RESULTS Painful knees showed statistically significant higher patellar lateral position after stressed lateral translation than non-painful knees (p = 0.028), 9.8 ± 3.6 mm and 7.1 ± 6.3 mm, respectively. The adjusted multivariate logistic model identified the patellar position after lateral displacement to be significantly associated with AKP (OR = 1.165) and the model (AUC = 0.807, p < 0.001) showed reasonable sensitivity (67%) and specificity (73%). CONCLUSION Patients with idiopathic unilateral AKP with morphologically equivalent knees showed statistically significant increased patellar lateral position after stressed lateral displacement in their painful knee. The greater lateral patellar mobility quantified by the PPTD testing brings more objectivity to the diagnosis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ana Leal
- Mechanical Engineering Department, CMEMS Center for MicroElectroMechanical Systems, University of Minho, Guimarães, Portugal.,Dom Henrique Research Centre, Porto, Portugal
| | - Renato Andrade
- Dom Henrique Research Centre, Porto, Portugal.,Clínica Do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal.,Faculty of Sports of Porto University, Porto, Portugal
| | - Paulo Flores
- Mechanical Engineering Department, CMEMS Center for MicroElectroMechanical Systems, University of Minho, Guimarães, Portugal
| | - Filipe S Silva
- Mechanical Engineering Department, CMEMS Center for MicroElectroMechanical Systems, University of Minho, Guimarães, Portugal
| | - John Fulkerson
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Philippe Neyret
- Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de La Croix-Rousse, Lyon, France
| | - Elizabeth Arendt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - João Espregueira-Mendes
- Dom Henrique Research Centre, Porto, Portugal. .,Clínica Do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. .,School of Medicine, Minho University, Braga, Portugal.
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