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Rodriguez L. Anterior Knee Pain in Adolescents. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Damgacı L, Özer H, Duran S. Patella-patellar tendon angle and lateral patella-tilt angle decrease patients with chondromalacia patella. Knee Surg Sports Traumatol Arthrosc 2020; 28:2715-2721. [PMID: 32451620 DOI: 10.1007/s00167-020-06065-7] [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: 10/10/2019] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on the presence and stage of CP, and identify the differences between sexes. METHODS MRI of 243 patients [146 men (60.1%)] were evaluated retrospectively. Patients were grouped as normal group without chondromalacia, group with mild chondromalacia (grades 1-2) and group with severe chondromalacia (grades 3-4). Sagittal patellofemoral alignment was assessed by the angle between the patella and patellar tendon (P-PTA), and the angle between the quadriceps tendon and patella (Q-PA). Patellar tilt was assessed by lateral patellar tilt angle (LPTA). In addition, patellofemoral joint morphology was evaluated by measuring trochlear depth (TD), trochlear sulcus angle (TSA) and patella angle (PA). RESULTS P-PTA, Q-PA, LPTA and TD values were significantly lower in patients with severe chondromalacia than in patients with both normal and mild chondromalacia (P < 0.001). TSA values were significantly higher in patients with severe chondromalacia than those with both normal and mild chondromalacia (P < 0.001). TSA was higher and TD was lower in women compared to men (P < 0.001). LPTA and P-PTA were lower in women compared to men, and the difference was significant. There was no difference in PA between the two sexes. CONCLUSIONS Patellar cartilage degeneration increases with trochlear dysplasia. There is a strong correlation between patellar malalignment (lateral patellar tilt and sagittal patellar tilt) and chondromalacia patella. Women are more prone to developing CP than men.
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Affiliation(s)
- Lale Damgacı
- Ankara City Hospital, Üniversiteler mh. Bilkent cd. No: 1, 06800, Çankaya/Ankara, Turkey.
| | - Hamza Özer
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Zeynep Kamil mh. Dr. Burhanettin Üstünel Sokağı No: 10, 34668, Üsküdar/İstanbul, Turkey
| | - Semra Duran
- Ankara City Hospital, Üniversiteler mh. Bilkent cd. No: 1, 06800, Çankaya/Ankara, Turkey
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Aysin IK, Askin A, Mete BD, Guvendi E, Aysin M, Kocyigit H. Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment. Eurasian J Med 2018. [PMID: 29531488 DOI: 10.5152/eurasianjmed.2018.17277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective The study aimed to investigate whether there is any association of anterior knee pain and knee function with chondromalacia stage and patellofemoral alignment in patients with anterior knee pain for over a month and with chondromalacia patellae (CMP) detected by magnetic resonance imaging (MRI). Materials and Methods We reviewed the medical records of 38 patients who underwent a knee MRI examination and were diagnosed with chondromalacia based on the MRI. Knee MRI images were evaluated by a radiologist for chondromalacia staging. Patients were divided into two groups as early stage (stage 1-2) and advanced stage (stage 3-4) chondromalacia. Patients' demographical data (age, sex, and occupation), clinical features, physical examination findings and patellofemoral pain severity scale, kujala patellofemoral scoring system, and functional index questionnaire scores were obtained from their medical records. Trochlear sulcus angle, sulcus depth, lateral patellofemoral angle, patellar translation, and Insall-Salvati index were measured using the MRI images. Results The mean patient age was higher in the advanced stage CMP group compared to the early stage CMP group (p=0.038). There was no statistically significant difference regarding other demographical data (p>0.05). MRI measurement parameters did not show difference between the groups (p>0.05). Patients in the advanced stage CMP group had higher patellofemoral pain severity score, lower kujala patellofemoral score, and lower functional index questionnaire score compared to the early stage CMP group. The differences were statistically significant (p=0.008, p=0.012, and p=0.026, respectively). Conclusion As chondromalacia stage advances, the symptom severity worsens and knee functions decline; however, MRI measurements do not show difference between early and advanced stage CMP patients.
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Affiliation(s)
- Idil Kurut Aysin
- Department of Physical Medicine and Rehabilitation, Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ayhan Askin
- Department of Physical Medicine and Rehabilitation, Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Berna Dirim Mete
- Department of Radiology, Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ece Guvendi
- Department of Physical Medicine and Rehabilitation, Dumlupınar University, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Murat Aysin
- Department of Public Health, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hikmet Kocyigit
- Department of Physical Medicine and Rehabilitation, Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
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Leibbrandt D, Louw Q. Kinematic factors associated with anterior knee pain during common aggravating activities: a systematic review. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1283832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dominique Leibbrandt
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Physiotherapy Division/FNB-3D Movement Analysis Laboratory , Tygerberg, South Africa
| | - Quinette Louw
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Physiotherapy Division/FNB-3D Movement Analysis Laboratory , Tygerberg, South Africa
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Abstract
Joint pains are a common reason for children to present to primary care. The differential diagnosis is large including some diseases that do not primarily affect the musculoskeletal system. Although the cause for many patients will be benign and self-resolving, in rare cases the diagnosis is associated with long-term morbidity and mortality if not detected early and appropriately treated. These include primary and secondary malignancies, septic arthritis, osteomyelitis, inflammatory arthritis, slipped upper femoral epiphysis (SUFE) and non-accidental injury. We highlight the importance of a thorough history and directed yet comprehensive examination. A diagnostic algorithm is provided to direct primary care physicians' clinical assessment and investigation with the evidence base where available. In many cases, tests are not required, but if there is suspicion of malignancy, infection or inflammatory conditions, laboratory tests including full blood count, blood film, erythrocyte sedimentation rate, C-reactive protein and lactate dehydrogenase help to support or exclude the diagnosis. Autoimmune tests, such as antinuclear antibodies and rheumatoid factor, have no diagnostic role in juvenile idiopathic arthritis; therefore, we advise against any form of 'rheumatological/autoimmune disease screen' in primary care. Imaging does have a place in the diagnosis of joint pains in children, with plain radiographs being most appropriate for suspected fractures and SUFE, whilst ultrasound is better for the detection of inflammatory or infective effusions. The appropriate referral of children to paediatric rheumatologists, oncologists, orthopaedic surgeons and the emergency department are discussed.
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Affiliation(s)
- E S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - S L N Clarke
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
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Kang S, Park J, Kang SB, Chang CB. MRI findings of young male soldiers with atraumatic anterior knee pain. Scand J Med Sci Sports 2015; 26:572-8. [PMID: 25996828 DOI: 10.1111/sms.12486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 12/11/2022]
Abstract
The purpose of this study is to investigate abnormal magnetic resonance image (MRI) findings of young active males with atraumatic anterior knee pain (AKP). Targeting young male soldiers, we prospectively gathered and analyzed 157 knee MRIs from patients with atraumatic AKP (AKP group) and 53 knee MRIs from patients without knee pain (control group). Abnormalities of the patellofemoral (PF) joint and extensor mechanism on MRI were more common in the AKP group than the control group (48% vs 13%, P < 0.001). The overall prevalence of medial plica (34% vs 13%, P = 0.004) and the prevalence of the thick medial plica (9% vs 0%, P = 0.023) were considerably higher in the AKP group. The cartilaginous sulcus angle in the AKP group without abnormalities on MRI was significantly higher than both the AKP group with abnormalities and the control group (145° vs 141° vs 142°, respectively, P = 0.001). Our results suggest that careful assessment of young, active males with atraumatic AKP is warranted regarding PF joint abnormalities, particularly the presence of medial plica and/or subtle abnormalities of the articular geometry. The results from the present study could be used for the management of patients with AKP.
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Affiliation(s)
- S Kang
- Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.,Department of Orthopaedic Surgery, Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Chungcheongbuk-do, Korea
| | - J Park
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - S-B Kang
- Department of Orthopaedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - C B Chang
- Department of Orthopaedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea
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Freedman SR, Brody LT, Rosenthal M, Wise JC. Short-term effects of patellar kinesio taping on pain and hop function in patients with patellofemoral pain syndrome. Sports Health 2014; 6:294-300. [PMID: 24982700 PMCID: PMC4065564 DOI: 10.1177/1941738114537793] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have become increasingly popular; however, there has been scant research supporting its use on patients with PFPS. Hypothesis: The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-term pain and single-leg hop measures as compared with sham placement of KT. Study Design: Nonrandomized controlled clinical trial with repeated-measures design. Level of Evidence: Level 3. Methods: Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing 4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired t tests to measure improvement on a numeric pain rating scale. A 2-way, 2 × 2 analysis of variance was used to analyze the relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores. Results: Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect for side was not significant. The interaction between taping condition and side was significant. This showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects’ STJT distances were significantly greater for the experimental KT application than the sham application for the involved side. Conclusion: Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg hop function in patients with PFPS when compared with a sham application. However, improvement in STJT scores did not surpass the minimally detectable change value, and therefore, the clinical effectiveness of KT for improving single-leg hop function was not established in the current study. Clinical Relevance: Kinesio Tape provides a viable, short-term method to control pain.
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Affiliation(s)
- Scott R Freedman
- Children's Healthcare of Atlanta, Sports Medicine Program, Atlanta, Georgia ; Rocky Mountain University of Health Professions, Provo, Utah
| | - Lori Thein Brody
- Rocky Mountain University of Health Professions, Provo, Utah ; University of Wisconsin Health Research Park, Madison, Wisconsin
| | - Michael Rosenthal
- Rocky Mountain University of Health Professions, Provo, Utah ; Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, California
| | - Justin C Wise
- Rocky Mountain University of Health Professions, Provo, Utah ; Department of Psychology, Oglethorpe University, Atlanta, Georgia
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MRI of Sports Injuries in Children and Adolescents: What’s Different from Adults. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0045-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Papadopoulos C, Nardi L, Antoniadou M, Stasinopoulos D. Greek adaptation and validation of the Patellofemoral Pain Syndrome Severity Scale. Hong Kong Physiother J 2013. [DOI: 10.1016/j.hkpj.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Simpson M, Smith TO. Quadriceps tendinopathy — a forgotten pathology for physiotherapists? A systematic review of the current evidence-base. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Papadopoulos KD, Noyes J, Barnes M, Jones JG, Thom JM. How do physiotherapists assess and treat patellofemoral pain syndrome in North Wales? A mixed method study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.5.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jane Noyes
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Moyra Barnes
- Physiotherapy Department, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Jeremy G. Jones
- Betsi Cadwaladwr University Health Board, North Wales and an Honorary Research Fellow at the School of Sport, Health and Exercise Sciences, Bangor University, UK, and
| | - Jeanette M. Thom
- Exercise Physiology in the School of Sport Health and Exercise Sciences, Bangor University, UK
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Cook C, Hegedus E, Hawkins R, Scovell F, Wyland D. Diagnostic accuracy and association to disability of clinical test findings associated with patellofemoral pain syndrome. Physiother Can 2010; 62:17-24. [PMID: 21197175 DOI: 10.3138/physio.62.1.17] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the diagnostic accuracy and association to disability of selected functional findings or physical examination tests for patellofemoral pain syndrome (PFPS) in patients with anterior knee pain. METHODS A sample of 76 consecutive patients with anterior knee pain was further subdivided into PFPS and other diagnoses. Routine physical examination tests were examined in a prospective, consecutive-subjects design for a cohort of patients with anterior knee pain. Diagnostic accuracy findings, including sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, and positive (LR+) and negative (LR-) likelihood ratios, were calculated for each test. PPV and NPV reflect the percentage of time of positive or a negative test (respectively) accurately captures the diagnosis of the condition. LR+ and LR- reflect alterations in post-test probability when the test is positive or negative (respectively). Lastly, associations to disability (International Knee Documentation Committee (IKDC) subjective form) were calculated for each clinical finding. RESULTS Diagnostic accuracy analyses of individual functional assessment and situational phenomena suggest that the strongest diagnostic test is pain encountered during resisted muscle contraction of the knee (PPV=82%; LR+=2.2; 95% CI: 0.99-5.2). Clusters of test findings were substantially more diagnostic, with any two of three positive findings of muscle contraction, pain during squatting, and pain during palpation yielding the following values: PPV=89%; LR+=4.0 (95% CI: 1.8-10.3). No individual or clustered test findings were significantly associated with the IKDC score. CONCLUSION Combinations of functional assessment tests and situational phenomena are diagnostic for PFPS and may serve to rule in and rule out the presence of PFPS. Single findings are not related to disability scores (IKDC).
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Affiliation(s)
- Chad Cook
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27708, USA.
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