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Esculier JF, Bouyer LJ, Dubois B, Frémont P, Moore L, Roy JS. Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms. BMC Musculoskelet Disord 2016; 17:5. [PMID: 26738470 PMCID: PMC4702381 DOI: 10.1186/s12891-015-0859-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Patellofemoral pain (PFP) is highly prevalent in runners, and often leads to functional limitations and cessation of running. Training errors as well as decreased lower limb strength and control during running have all been associated with PFP. While strengthening and gait retraining are commonly used by clinicians, no randomised clinical trial has compared these modalities in runners with PFP. The primary objective of this randomised clinical trial will be to compare the effects of three rehabilitation programs targeting different key factors on symptoms and functional limitations of runners with PFP. The secondary objective will be to explore the factors leading to clinical improvement. Methods/design We will conduct a single-blind randomised clinical trial to compare three different 8 week rehabilitation programs: Group 1 will receive education on symptoms management based on training modifications; Group 2 will receive an exercise program targeting lower limb strengthening and control in addition to the education component of Group 1; Group 3 will receive running gait retraining advice as well as the education component of Group 1. Sixty-nine runners with PFP will be recruited and will be seen by independent physiotherapists on five visits through 8 weeks. The primary outcome measure will be symptoms and functional limitations measured by the Knee Outcome Survey – Activities of Daily Living Scale questionnaire at baseline, and at the four, eight and 20 weeks follow-up. Secondary outcomes will include pain level measured using visual analog scales, and running mileage. Lower limb kinematics and kinetics during running, and isometric strength will also be evaluated at baseline and 8 weeks follow-up. The effects of rehabilitation programs on measures of symptoms and functional limitations will be assessed using a 2-way ANOVA (Groups x Time). Regression analyses will be used to identify if changes in running mechanics or strength are determinants of clinical success. Discussion Studies with a high level of evidence are needed to determine the best rehabilitation interventions for runners with PFP. This randomised clinical trial will be the first to compare programs targeting different key factors linked with PFP. Results may guide clinicians and improve their clinical outcomes when treating runners with PFP. Trial Registration ClinicalTrials.gov: NCT02352909. Registered on December 3, 2014.
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Affiliation(s)
- Jean-Francois Esculier
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada. .,The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3B 2J8, Canada.
| | - Laurent J Bouyer
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada.
| | - Blaise Dubois
- The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3B 2J8, Canada.
| | - Pierre Frémont
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
| | - Lynne Moore
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
| | - Jean-Sébastien Roy
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada.
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Howell R, Kumar NS, Patel N, Tom J. Degenerative meniscus: Pathogenesis, diagnosis, and treatment options. World J Orthop 2014; 5:597-602. [PMID: 25405088 PMCID: PMC4133467 DOI: 10.5312/wjo.v5.i5.597] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/06/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.
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Crowell MS, Westrick RB, Fogarty BT. Cysts of the lateral meniscus. Int J Sports Phys Ther 2013; 8:340-348. [PMID: 23772349 PMCID: PMC3679639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
UNLABELLED Accurate diagnosis and management of knee pain with or without mechanical symptoms challenges the physical therapist's clinical reasoning skills. Meniscal cysts are one relatively rare disorder of the knee that can cause both pain and mechanical symptoms and are frequently associated with a meniscal tear. In patients with suspected meniscal cysts, systematic differential diagnosis and sound clinical reasoning encourages appropriate integration of the clinical examination with diagnostic imaging. These case reports describe two different presentations of lateral parameniscal cysts where integration of the clinical examination with appropriate imaging allowed the physical therapist to provide a timely and appropriate intervention. In both cases, the diagnostic process is described along with the subsequent interventions that lead to positive outcomes. LEVEL OF EVIDENCE 5 (Case Report).
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