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Lally E, Ericksen H, Mach M, Earl-Boehm J. Movement Quality Assessment of Army Reserve Officers' Training Corps Cadets: A Report of Validity and Normative Data. Mil Med 2024:usae266. [PMID: 38829677 DOI: 10.1093/milmed/usae266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/28/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Movement quality screening in early-career military populations, like Army Reserve Officers' Training Corps (AROTC) cadets, could decrease the negative impact of musculoskeletal injury observed within the military. Movement quality screening techniques should be valid before being pursued in the field. Normative data describing movement quality of AROTC cadets are also needed. Therefore, the aims of this study were to determine criterion validity of several movement quality assessments and report normative jump-landing kinematics of AROTC cadets. MATERIALS AND METHODS This cross-sectional research was approved by the Institutional Review Board. As part of a larger study, 20 AROTC cadets (21.3 ± 3.4 years; 1.7 ± 0.1 m; 73.8 ± 14.8 kg) had 3-dimensional (3D) and 2-dimensional (2D) kinematic data collected simultaneously while performing a jump-landing task. Variables of interest were 3D hip and knee sagittal, frontal, and transverse joint angles at maximum knee flexion. An experienced rater calculated sagittal and frontal 2D joint angles at maximum knee flexion. Averages of 2D and 3D angles were calculated to describe normative data and for further data analysis. Bivariate correlations between 3D and 2D variables were used to determine criterion validity. RESULTS Moderate correlations were found between 2D and 3D hip frontal plane angles (P = .05, r =-0.33), 2D and 3D knee sagittal plane angles (P = .04, r = 0.35), and 2D and 3D knee frontal plane angles (P = .03, r = -0.36). Normative values of knee and hip kinematics demonstrated averages of 17.58° of knee adduction, 16.48° of knee external rotation, 11.57° of hip abduction, 10.76° of hip internal rotation, and 103.47° of knee flexion during landings. However, ranges demonstrated that landing patterns vary within AROTC cadets. CONCLUSIONS The normative values of 3D jump-landing kinematic data indicate that movement quality varies greatly within AROTC cadets, and some cadets display potentially injurious movements. Therefore, screening movement quality could be beneficial to determine musculoskeletal injury risk in AROTC cadets. Based on the correlations discovered in this study, we recommend the 2D techniques used in this study be researched further as they may serve as alternatives to expensive, timely 3D techniques that could be better utilized in military environments.
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Affiliation(s)
- Erin Lally
- Department of Health and Human Performance, Jowers Center, Texas State University, San Marcos, TX 78666, USA
| | - Hayley Ericksen
- Department of Kinesiology, McCormick Hall, Illinois State University, Normal, IL 61761, USA
| | - Madison Mach
- Department of Kinesiology, Klotsche Center, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Jennifer Earl-Boehm
- Department of Kinesiology, Klotsche Center, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
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Barton KI, Boldt KR, Sogbein OA, Steiner NJ, Moatshe G, Arendt E, Getgood A. Femoral internal torsion greater than twenty-five degrees and/or external tibial torsion greater than thirty degrees as measured by computed tomography are threshold values for axial alignment correction in patellofemoral instability. J ISAKOS 2024; 9:386-393. [PMID: 38365167 DOI: 10.1016/j.jisako.2024.02.002] [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: 10/05/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Patellofemoral instability (PFI) has multiple predisposing anatomic factors, including ligamentous hyperlaxity, coronal and axial malalignment, patella alta, trochlea dysplasia, excessive lateral patellar tilt, and excessive lateral Q vector. Yet, few studies have analyzed surgical thresholds for performing axial alignment corrective osteotomies in the treatment of PFI and patella maltracking. The objective of this systematic literature review was to determine if there is a threshold for axial plane alignment that triggers surgical correction for the treatment of patellar instability in the published literature. METHODS Using a predetermined search strategy, a systematic literature search of 10 major databases and gray literature resources was completed. Only studies reporting on patellar instability and outcomes were included. Radiologic indications, additional procedures, outcomes, and complications were reported. Titles and abstracts were screened, and full-text manuscripts were then selected and extracted. Variables related to radiographic and clinical parameters, patient demographics, surgery performed, surgical correction, complications, and reoperations were recorded preoperatively and postoperatively. RESULTS A total of 1132 abstracts and titles were screened by two reviewers, yielding 15 eligible studies. The reported threshold identified in our study for axial plane alignment that triggers surgical correction in most of the published literature when discussing PFI was either tibial torsion greater than 30° and/or femoral anteversion greater than 25°. Following rotational osteotomy of one or both long bones, one study (7%) reported improvements in tubercle-sulcus angle, two studies (13%) reported improvements in femoral-tibial angle, and four studies (27%) reported decreases in tibial torsion. For patient-reported outcomes, seven studies (47%) reported improvement in the Kujala score, five studies (33%) reported postoperative improvement in Lysholm, and four studies (27%) reported improvement in the International Knee Documentation Committee (IKDC) score. Nine studies (60%) reported preoperative femoral anteversion; however, only two studies compared pre- and post-operative values (one study reported a decrease in anteversion and another study reported an increase in anteversion). CONCLUSION When treating PFI, the reported threshold for axial plane alignment that triggers surgical correction in most of the published literature was tibial torsion greater than 30° and/or femoral anteversion greater than 25° as measured by CT. However, there is no consensus on the axial alignment measurement technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kristen I Barton
- Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, N6G 2V4, Canada; Orthopaedic Surgery, Schulich School of Dentistry and Medicine, Western University, London, ON, N6A 3K7, Canada; Faculty of Health Sciences, Western University, London, ON, N6A 3K7, Canada.
| | - Kevin R Boldt
- School of Kinesiology, Trent University, Peterborough, ON, K9L 0G2, Canada
| | - Olawale A Sogbein
- Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, N6G 2V4, Canada; Orthopaedic Surgery, Schulich School of Dentistry and Medicine, Western University, London, ON, N6A 3K7, Canada
| | - Nicholas J Steiner
- Faculty of Health Sciences, Western University, London, ON, N6A 3K7, Canada
| | | | | | - Alan Getgood
- Fowler Kennedy Sports Medicine Clinic, Western University, London, ON, N6G 2V4, Canada; Orthopaedic Surgery, Schulich School of Dentistry and Medicine, Western University, London, ON, N6A 3K7, Canada; Faculty of Health Sciences, Western University, London, ON, N6A 3K7, Canada
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Asayama A, Yagi M, Taniguchi M, Hirono T, Kato T, Hayashi R, Ichihashi N. Effect of soft tissue tension around the knee joint on medio-lateral patellar position. J Biomech 2024; 168:112137. [PMID: 38710152 DOI: 10.1016/j.jbiomech.2024.112137] [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: 10/20/2023] [Revised: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Patellofemoral pain (PFP) is one of the most common sports injuries of the knee joint and has a high persistence and recurrence rate. Medio-lateral patellar position in the knee extension position during contraction is associated with PFP. However, soft tissue tension that most influences the medio-lateral patellar position in the knee extension position during contraction in vivo is unclear. We aimed to clarify the relationship between medio-lateral patellar position and soft tissue tension around the knee joint. Twelve patients with PFP and 20 healthy participants were included. Medio-lateral patellar position and tension of the rectus femoris, vastus lateralis (VL), vastus medialis, iliotibial band (ITB), lateral patellofemoral ligament, and medial patellofemoral ligament were measured during contraction and rest. The tensions of the VL and ITB during contraction and the medio-lateral patellar position at rest were significantly associated with medio-lateral patellar position during contraction (β = 0.449, 0.354, and 0.393, respectively). In addition, the tension of ITB was significantly associated with the medio-lateral patellar position at rest (β = 0.646). These relationships were not affected by the presence of PFP. These findings suggest that the patellar position during contraction became more lateral as the tension in the VL and ITB increased, regardless of the presence of PFP. These results may facilitate the prevention and treatment of PFP.
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Affiliation(s)
- Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan; Department of Rehabilitation, Japanese Red Cross Nagahama Hospital, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan.
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan; Research Fellow of the Japan Society for the Promotion of Science Kojimachi Business Center Building, Japan
| | - Takehiro Kato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Remi Hayashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
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Songur A, Demirdel E, Kılıc O, Akin ME, Alkan A, Akkaya M. The effects of different taping methods on patellofemoral alignment, pain and function in individuals with patellofemoral pain: A randomized controlled trial. PM R 2024; 16:474-484. [PMID: 37641891 DOI: 10.1002/pmrj.13067] [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: 10/13/2022] [Revised: 06/20/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Athletic taping has long been a physiotherapeutic application in individuals with patellofemoral pain (PFP). However, the therapeutic effects of local and proximal taping have not been fully determined. OBJECTIVE To evaluate the effects of two different taping techniques applied in addition to exercise on patellofemoral alignment, pain, and function in individuals with PFP. DESIGN Randomized controlled trial. SETTING An outpatient hospital clinic. PARTICIPANTS Individuals with PFP aged 18-50 years (n = 36). INTERVENTIONS Group 1 underwent only the exercise program. Group 2 underwent the exercise plus McConnell patellar taping (MPT), and Group 3 underwent the exercise plus femoral rotational taping (FRT) (6 weeks). MAIN OUTCOME MEASURES Bisect offset index (BOI) and patellar tilt angle (PTA) were measured in relaxed and maximum voluntary contractions of the quadriceps muscle (MVCq) using magnetic resonance imaging. Pain intensity was assessed by the Visual Analog Scale for three conditions: at daytime rest, during activity, and at nighttime. Functional level was assessed by the Kujala Patellofemoral Scoring System. RESULTS Significant improvements in the BOI of Group 2 at rest (p = .015; r = 0.593) and in PTA of Group 3 at MVCq (p = .010; r = 0.613) were found. Improvements in pain under all three conditions were significant within groups (all, p values < .050 and r > 0.5). The change in pain was similar between groups (all, p values > .05). All groups showed significant improvement in functional level (all, p values < .010 and r > 0.5). However, the increase in Group 3 was higher than that in Group 1 (p = .019). CONCLUSION This study shows that MPT and FRT applications increase functionality and can affect patellofemoral alignment in different ways. In the treatment of PFP, more successful results can be obtained with appropriate taping techniques for the local and proximal region.
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Affiliation(s)
- Adil Songur
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ertugrul Demirdel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ozlem Kılıc
- Department of Physical Medicine and Rehabilitation - Rheumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Emre Akin
- Department of Radiology, Ankara Yildirim Beyazit University, Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Carvalho C, Viadanna Serrão F, Felipe Martinez A, Da Silva Serrão PRM. Three-dimensional kinematics of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in subjects with isolated patellofemoral osteoarthritis compared to individually matched controls: Preliminary results. Arch Rheumatol 2024; 39:33-45. [PMID: 38774690 PMCID: PMC11104754 DOI: 10.46497/archrheumatol.2024.9814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/22/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives: This study aimed to compare three-dimensional kinematic of the trunk, pelvis, hip, and knee during the single-leg squat and hip torque in individuals with and without isolated patellofemoral osteoarthritis (PFOA). Patients and methods: This cross-sectional study evaluated trunk, pelvis, hip, and knee kinematics at 30°, 45°, and 60° knee flexion during the single-leg squat using the Vicon motion capture and analysis system, the Nexus System 2.1.1, and 3D Motion Monitor software. Sixteen individuals (8 males, 8 females; mean age: 49.3±6.2 years; range 40 to 61 years) participated in the study, of which eight were PFOA patients and eight were healthy controls. Isometric hip abductor, extensor, and external rotator torques were evaluated using a handheld dynamometer. Results: The PFOA group exhibited greater hip adduction at 30° (p=0.008), 45° (p=0.005), and 60° (p=0.008) knee flexion in the descending phase of the single-leg squat, as well as at 60° (p=0.009) and 45° (p=0.03) knee flexion in the ascending phase. No significant differences were found between groups for other kinematic variables (p>0.05). The PFOA group exhibited lower isometric hip abductor (p=0.02), extensor (p <0.001), and external rotator (p=0.007) torques. Conclusion: Individuals with PFOA exhibited excessive hip adduction that could increase stress on the lateral patellofemoral joint at 30°, 45°, and 60° knee flexion during the single-leg squat and exhibited weakness of the hip abductors, extensors, and external rotators in comparison to healthy controls.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Fábio Viadanna Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Wang B, Mao Z, Guo J, Yang J, Zhang S. The non-invasive evaluation technique of patellofemoral joint stress: a systematic literature review. Front Bioeng Biotechnol 2023; 11:1197014. [PMID: 37456733 PMCID: PMC10343958 DOI: 10.3389/fbioe.2023.1197014] [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: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction: Patellofemoral joint stress (PFJS) is an important parameter for understanding the mechanism of patellofemoral joint pain, preventing patellofemoral joint injury, and evaluating the therapeutic efficacy of PFP rehabilitation programs. The purpose of this systematic review was to identify and categorize the non-invasive technique to evaluate the PFJS. Methods: Literature searches were conducted from January 2000 to October 2022 in electronic databases, namely, PubMed, Web of Science, and EBSCO (Medline, SPORTDiscus). This review includes studies that evaluated the patellofemoral joint reaction force (PJRF) or PFJS, with participants including both healthy individuals and those with patellofemoral joint pain, as well as cadavers with no organic changes. The study design includes cross-sectional studies, case-control studies, and randomized controlled trials. The JBI quality appraisal criteria tool was used to assess the risk of bias in the included studies. Results: In total, 5016 articles were identified in the database research and the citation network, and 69 studies were included in the review. Discussion: Researchers are still working to improve the accuracy of evaluation for PFJS by using a personalized model and optimizing quadriceps muscle strength calculations. In theory, the evaluation method of combining advanced computational and biplane fluoroscopy techniques has high accuracy in evaluating PFJS. The method should be further developed to establish the "gold standard" for PFJS evaluation. In practical applications, selecting appropriate methods and approaches based on theoretical considerations and ecological validity is essential.
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Bolgla LA, Gibson HN, Hannah DC, Curry-McCoy T. Comparison of the Frontal Plane Projection Angle and the Dynamic Valgus Index to Identify Movement Dysfunction in Females with Patellofemoral Pain. Int J Sports Phys Ther 2023; V18:619-625. [PMID: 37425107 PMCID: PMC10324282 DOI: 10.26603/001c.74269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background Clinicians typically measure the knee frontal plane projection angle (FPPA) during a single-leg squat to identify females with patellofemoral pain (PFP). A limitation of this measure is minimal attention to movement of the pelvis on the femur that can create knee valgus loading. The dynamic valgus index (DVI) may be a better assessment. Hypothesis/Purpose The purpose of this study was to compare the knee FPPA and DVI between females with and without PFP and determine if the DVI better identified females with PFP than the knee FPPA. Study Design Case-control. Methods Sixteen females with and 16 without PFP underwent 2-dimensional motion analysis when performing five trials of a single-leg squat. The average peak knee FPPA and peak DVI were analyzed. Independent t-tests determined between-group peak knee FPPA and peak DVI differences. Receiver operating characteristic (ROC) curves determined the area under the curve (AUC) scores for sensitivity and 1 - specificity of each measure. Paired-sample area difference under the ROC curves was conducted to determine differences in the AUC for the knee FPPA and DVI. Positive likelihood ratios were calculated for each measure. The significance level was p < 0.05. Results Females with PFP exhibited a higher knee FPPA (p = 0.001) and DVI (p = 0.015) than controls. AUC scores were .85 (p = 0.001) and .76 (p = 0.012) for the knee FPPA and DVI, respectively. Paired-sample area difference under the ROC curves showed a similar (p = 0.10) AUC for the knee FPPA and DVI. The knee FPPA had 87.5% sensitivity and 68.8% specificity; the DVI had 81.3% sensitivity and 81.0% specificity. Positive likelihood ratios for the knee FPPA and DVI were 2.8 and 4.3, respectively. Conclusion The DVI during a single-leg squat may be another useful tool for discriminating between females with and without PFP. Level of Evidence 3a.
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Hawkins JL, Williams GN, Milner CE. Changes in Walking Biomechanics after a 30-Min Exercise Bout in Sedentary Compared with Active Young Women. Med Sci Sports Exerc 2023; 55:722-726. [PMID: 36374524 DOI: 10.1249/mss.0000000000003083] [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: 11/16/2022]
Abstract
INTRODUCTION Patellofemoral pain (PFP) is a common overuse injury associated with physical activity, including walking. The risk for PFP may increase if walking biomechanics change during a bout of walking. Because walking for exercise is often recommended to previously sedentary adults, this would be a cause for concern. The purpose of this study was to determine any differences in walking biomechanics associated with PFP between sedentary and active young women initially and after 30 min of walking for exercise. METHODS Fifteen sedentary and 15 active young women walked overground for five trials of three-dimensional gait analysis before and after a 30-min treadmill walk. Peak knee flexion angle and extensor moment were compared between groups and before and after the 30-min walk. RESULTS Comparing groups at baseline, peak knee flexion angle and peak knee extensor moment were not statistically significantly different between groups. After the 30-min walk, peak knee flexion angle and extensor moment increased slightly in both groups. CONCLUSIONS Smaller, not larger, peak knee flexion angle and extensor moment during walking have been associated with increased risk of PFP. Therefore, sedentary and active young women can walk for 30 min without further detrimental changes to walking biomechanics that may increase their risk of PFP.
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Affiliation(s)
- Jillian L Hawkins
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA
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Liao TC, Pedoia V, Link TM, Majumdar S, Souza RB. Association of patella alignment with cartilage relaxation times and self-reported symptoms in individuals with patellofemoral degeneration. J Orthop Res 2023; 41:562-569. [PMID: 35598282 PMCID: PMC9679042 DOI: 10.1002/jor.25384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
To determine the cross-sectional and longitudinal associations of patella alignment with cartilage relaxation and patients' self-reported symptoms. Thirty participants with isolated patellofemoral joint (PFJ) degeneration (six males, 53.7 ± 9.3 years) and 24 controls (12 males, 47.6 ± 10.7 years) were included. Magnetic resonance assessment was performed to provide grading of structural abnormalities, cartilage relaxation times, and patella alignment. Self-reported symptoms were assessed using the self-administrated knee injury and osteoarthritis outcome score (KOOS). All participants were examined at baseline and 3 years. Statistical parametric mapping and Pearson partial correlation were used to evaluate the associations between patella alignment with cartilage relaxation times and self-reported symptoms, respectively. The analyses were performed between baseline (cross-sectional) as well as the baseline against 3 years (longitudinal). Results indicated that patella height and patella flexion were associated with T1ρ and T2 relaxation times at baseline (percentages of voxels showing significant correlation [PSV] = 10.1%-24.8%; mean correlations [R] = 0.34-0.36; mean p = 0.015-0.026). Furthermore, greater patella lateral alignment, lateral tilt, and lateral spin were associated with longer T2 times at 3 years (PSV = 11.0%-14.4%, R = 0.39-0.44, p = 0.017-0.028). Last, a higher patella was associated with a lower KOOS at baseline and at 3 years (R = -0.33 to -0.35). The study suggests that patella malalignment is a risk factor for worsening cartilage health, informing clinicians of a better rehabilitation program that targets PFJ degeneration.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Physical Therapy, University of Michigan-Flint, Flint, MI, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA
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Dunning H, van de Groes SAW, Buckens CF, Prokop M, Verdonschot N, Janssen D. Fully automatic extraction of knee kinematics from dynamic CT imaging; normative tibiofemoral and patellofemoral kinematics of 100 healthy volunteers. Knee 2023; 41:9-17. [PMID: 36608361 DOI: 10.1016/j.knee.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/23/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Accurate assessment of knee kinematics is important in the diagnosis and quantification of knee disorders and to determine the effect of orthopaedic interventions. Despite previous studies showing the usefulness of dynamic imaging and providing valuable insights in knee kinematics, dynamic imaging is not widely used in clinics due to a variety of causes. In this study normative knee kinematics of 100 healthy subjects is established using a fully automatic workflow feasible for use in the clinic. METHODS One-hundred volunteers were recruited and a dynamic CT scan was made during a flexion extension movement. Image data was automatically segmented and dynamic and static images were superimposed using image registration. Coordinate systems for the femur, patella and tibia were automatically calculated as well as their dynamic position and orientation. RESULTS Dynamic CT scans weremade withan effective radiation dose of 0.08 mSv. The median tibial internal rotation was 4° and valgus rotation is 5° at full flexion. Femoral rollback of the lateral condyle was 7 mm versus 2 mm of the medial condyle. The median patella flexion reached 65% of tibiofemoral flexion and the median tilt and rotation were 5° and 0° at full flexion, respectively. The median mediolateral translation of the patella was 3 mm (medially) in the first 30° of flexion. CONCLUSION The current study presents TF and PF kinematic data of 97 healthy individuals, providing a unique dataset of normative knee kinematics. The short scanning time, simple motion and, automatic analysis make the methods presented suitable for daily clinical practice.
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Affiliation(s)
- Hans Dunning
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S A W van de Groes
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C F Buckens
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathias Prokop
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; University of Twente, Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, Enschede, the Netherlands
| | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07264-0. [PMID: 36454293 DOI: 10.1007/s00167-022-07264-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE The purpose of this study was to evaluate and compare clinical and radiological outcomes between isolated medial patellofemoral ligament reconstruction (MPFLR) and MPFLR combined with derotational distal femoral osteotomy (DDFO) for patellar dislocation with increased femoral anteversion (FA). METHODS Between 2014 and 2019, 36 patients who underwent isolated MPFLR and 31 patients who underwent MPFLR combined with DDFO were retrospectively included. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Banff Patella Instability Instrument (BPII) scores), activity level (Tegner activity score and return to sports), complications, and patellar re-dislocation rate. Radiological outcomes included patella tilt angle, patellar congruence angle, and patella-trochlear groove distance. RESULTS All clinical outcomes improved significantly in both groups, but the DDFO group had significantly better postoperative scores than the MPFLR group (Kujala: 85.1 ± 7.7 vs. 80.5 ± 8.4, P = 0.023; Lysholm: 86.8 ± 8.2 vs. 81.9 ± 9.1, P = 0.026; IKDC: 86.2 ± 10.0 vs. 81.7 ± 8.1, P = 0.045; and BPII: 68.0 ± 12.5 vs. 62.3 ± 10.0, P = 0.039). Both groups achieved successful return to sports (90.3% vs. 91.7%). No re-dislocation or major complications occurred. Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). The tibial tubercle-trochlear groove distance was only improved after DDFO from 17.0 ± 2.3 mm to 15.1 ± 2.0 mm (P = 0.001). CONCLUSION Both isolated MPFLR and MPFLR combined with DDFO yielded satisfactory clinical and radiological outcomes in the treatment of patellar dislocation with increased FA. However, combined DDFO had better outcomes and should be considered a priority. LEVEL OF EVIDENCE Level III.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the current state of knowledge regarding axial plane deformities in patellofemoral instability, indications and techniques for treatment of those deformities, and outcomes following treatment. RECENT FINDINGS There is opportunity for more information in the literature on all aspects of axial plane deformities in patellofemoral instability. This includes how to assess axial plane deformities on imaging, what is normal and what is an appropriate goal for correction, what techniques are best used depending on the deformity or concomitant pathology, and larger and more discriminating studies on outcomes. Rotational deformity of both the tibia and femur is an important risk factor to consider as a cause of patellar instability. Recent research has shown that surgical correction of these deformities on either the femoral or tibial side can have a positive effect on outcome in terms of patellar instability and knee pain. Further research, however, is warranted to determine what are normal values for femoral version and tibial torsion, and at what values surgical intervention is warranted.
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Lally EM, Thorpe J, Ericksen H, Earl-Boehm J. Reliability and criterion validity of two-dimensional movement assessments in those with patellofemoral pain. Phys Ther Sport 2022; 58:134-140. [DOI: 10.1016/j.ptsp.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 10/31/2022]
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Atkins LT, Reid J, Zink D. The effects of increased forward trunk lean during stair ascent on hip adduction and internal rotation in asymptomatic females. Gait Posture 2022; 97:147-151. [PMID: 35961131 DOI: 10.1016/j.gaitpost.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased hip adduction and internal rotation can lead to excessive patellofemoral joint stress and contribute to patellofemoral pain development. The gluteus maximus acts as a hip extensor, abductor, and external rotator. Improving hip extensor use by increasing one's forward trunk lean in the sagittal plane may improve frontal and transverse plane hip kinematics during stair ascent. RESEARCH QUESTION Does increasing forward trunk lean during stair ascent affect peak hip adduction and internal rotation? METHODS Twenty asymptomatic females performed five stair ascent trials (96 steps/min) on an instrumented stair using their self-selected and forward trunk lean postures. Three-dimensional kinematics (200 Hz) and kinetics (2000 Hz) were recorded during the stance phase of stair ascent. Biomechanical dependent variables were calculated during the stance phase of stair ascent and included peak forward trunk lean, hip flexion, hip adduction, hip internal rotation angles, and the average hip extensor moment. RESULTS During the forward trunk lean condition, decreases were observed for peak hip adduction (MD = 2.8˚; 95% CI = 1.9, 3.8; p < 0.001) and peak hip internal rotation (MD = 1.1˚; 95% CI = 0.1, 2.2; p = 0.04). In contrast, increases were observed during the forward trunk lean condition for the peak forward trunk lean angle (MD = -34.7˚; 95% CI = -39.1, -30.3; p < 0.001), average hip extensor moment (MD = -0.5 N·m/kg; 95% CI = -0.5, -0.4; p < 0.001), and stance time duration (MD = -0.02 s; 95% CI = -0.04, 0.00; p = 0.017). SIGNIFICANCE Increasing forward trunk lean and hip extensor use during stair ascent decreased peak hip adduction and internal rotation in asymptomatic females. Future studies should examine the effects of increasing forward trunk lean on hip kinematics, self-reported pain, and function in individuals with patellofemoral pain.
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Affiliation(s)
- Lee T Atkins
- University of North Texas Health Science Center, Department of Physical Therapy, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
| | - Jacob Reid
- Peterson Regional Medical Center, Ambulatory Care Center, 260 Cully Drive, Kerrville, TX 78028, USA.
| | - Dustin Zink
- Angelo State University, Physical Therapy Department, ASU Station #10923, San Angelo, Texas 76909, USA.
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Carvalho C, de Oliveira MPB, Pisani GK, Marolde IB, Serrão PRMDS. Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies. Clin Biomech (Bristol, Avon) 2022; 98:105721. [PMID: 35868250 DOI: 10.1016/j.clinbiomech.2022.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals. METHODS Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence. FINDINGS Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables. INTERPRETATION The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabela Bianchini Marolde
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
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Peng J, Xiao F, Zhu J, Shen C, Li Y, Han X, Cui Y, Chen X. Characteristics of the patellofemoral joint of patients with DDH and the effects of Bernese periacetabular osteotomy on the patellofemoral joint. BMC Musculoskelet Disord 2022; 23:337. [PMID: 35395939 PMCID: PMC8991590 DOI: 10.1186/s12891-022-05291-z] [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: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some patients with developmental dysplasia of the hip (DDH) complained of anterior knee pain (AKP) before and after Bernese periacetabular osteotomy (PAO) surgery. The purpose of this study was to (1) identify the characteristics of patellofemoral joint (PFJ) deformities in patients with DDH and (2) to determine the effects of PAO on the PFJ. METHODS Seventy patients (86 hips) were included in the DDH group. Thirty-three patients (33 knees) without AKP and hip pain were included in the control group. All patients underwent simultaneous CT scans of the hip and knee joints before PAO and after hardware removal surgery. The distance from the anterior inferior iliac spine to the ilioischial line (DAI), was measured in DDH patients. Imaging parameters of knees, including the sulcus angle (SA), femoral trochlear depth (FTD), patellar width (PW), tibial tuberosity-trochlear groove (TT-TG), patellar tilt angle (PTA) and lateral shift of the patella (LSP) were measured in patients in both the DDH and control group. TT-TG, PTA, and LSP of DDH patients were measured before PAO and after hardware removal. The DAI, PTA, LSP and TT-TG of all DDH patients before and after Bernese PAO were compared using paired t-tests. The FTD, PW, and SA of the DDH patients and the control group were analyzed using independent t-tests. PTA, TT-TG, and LSP between the control group and preoperative DDH patients, between the control group and post PAO patients were compared using independent t-tests. RESULTS The DAI changed from 4.04 ± 0.61 mm before PAO surgery to 5.44 ± 0.63 mm after PAO surgery. The SA of the DDH group (140.69 ± 11.30 degree) was greater than that of the control group (130.82 ± 6.43 degree). The FTD and the PW of the DDH group (5.45 ± 1.59 mm, 4.16 ± 0.36 mm) were smaller than that of the control group (7.39 ± 1.20 mm, 4.24 ± 0.38 mm). The changes in LSP, PTA, and TT-TG before and after surgery were not statistically significant. Both before and after PAO, there was no statistically significant difference in the parameters of LSP, PTA, and TT-TG compared with the control group. CONCLUSION The knee joints of DDH patients presented a certain degree of femur trochlear groove dysplasia and patellofemoral instability. PAO surgery did not change PFJ stability, although the origination point of the rectus femoris muscle moved laterally during PAO surgery.
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Affiliation(s)
- Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Fei Xiao
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiuguo Han
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yimin Cui
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China.
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Theisen BJ, Larson PD, Chambers CC. Optimizing Rehabilitation and Return to Sport in Athletes With Anterior Knee Pain Using a Biomechanical Perspective. Arthrosc Sports Med Rehabil 2022; 4:e199-e207. [PMID: 35141552 PMCID: PMC8811520 DOI: 10.1016/j.asmr.2021.10.028] [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: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
Anterior knee pain represents one of the most common athletic knee conditions and arguably also one of the most complex. The patellofemoral joint is at the center of several forces, and alterations in any of these force vectors due to muscular imbalance, soft-tissue tightness or laxity, and altered functional movement patterns can all combine to create a painful anterior knee. While typically anterior knee pain is not a surgical entity, the orthopaedic surgeon with an understanding of these biomechanical intricacies is best positioned to provide comprehensive evidence-based care for the patient with anterior knee pain. Level of Evidence V, expert opinion.
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18
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Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness. Knee Surg Sports Traumatol Arthrosc 2022; 30:791-799. [PMID: 33496826 PMCID: PMC8901473 DOI: 10.1007/s00167-021-06434-w] [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: 08/11/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthroscopic lateral retinacular release (LRR) has long been considered the gold standard for the treatment for anterior knee pain caused by lateral retinacular tightness (LRT). However, one-third of patients experience continuous pain postoperatively, which is thought to be related to persistent maltracking of the patella and altered femoro-tibial kinematics. Therefore, the aim of the present study was to simultaneously assess femoro-tibial and patello-femoral kinematics and identify the influence of arthroscopic LRR. METHODS Sixteen healthy volunteers and 12 patients with unilateral, isolated LRT were prospectively included. Open MRI scans with and without isometric quadriceps contraction were performed in 0°, 30° and 90° of knee flexion preoperatively and at 12 months after surgery. Patellar shift, tilt angle, patello-femoral contact area and magnitude of femoro-tibial rotation were calculated by digital image processing. RESULTS Postoperatively, patellar shift was significantly reduced at 90° of knee flexion compared to preoperative values. The postoperative patellar tilt angle was found to be significantly smaller at 30° of knee flexion compared to that preoperatively. Isometric muscle contractions did not considerably influence patellar shift or tilt in either group. The patello-femoral contact area increased after LRR over the full range of motion (ROM), with significant changes at 0° and 90°. Regarding femoro-tibial kinematics, significantly increased femoral internal rotation at 0° was observed in the patient group preoperatively, whereas the magnitude of rotation at 90° of knee flexion was comparable to that of healthy individuals. The pathologically increased femoral internal rotation at 30° without muscular activity could be significantly decreased by LRR. With isometric quadriceps contraction no considerable improvement of femoral internal rotation could be achieved by LRR at 30° of knee flexion. CONCLUSIONS Patello-femoral and femoro-tibial joint kinematics could be improved, making LRR a viable surgical option in carefully selected patients with isolated LRT. However, pathologically increased femoral internal rotation during early knee flexion remained unaffected by LRR and thus potentially accounts for persistent pain. LEVEL OF EVIDENCE II.
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19
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Noonan B, Cooper T, Chau M, Albersheim M, Arendt EA, Tompkins M. Rotational Deformity-When and How to Address Femoral Anteversion and Tibial Torsion. Clin Sports Med 2021; 41:27-46. [PMID: 34782074 DOI: 10.1016/j.csm.2021.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Rotational deformity is a less common cause of patellar instability than trochlear dysplasia and patella alta. In some cases, rotational deformity is the primary bony factor producing the instability and should be corrected surgically. More research is needed on what are normal values for femoral version and tibial torsion, as well as when the axial plane alignment needs to be corrected. Many tools can be used to evaluate the axial plane and surgeons should be familiar with each of them. Understanding the advantages and disadvantages of each site for osteotomy will help the surgeon choose the most appropriate osteotomy.
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Affiliation(s)
- Benjamin Noonan
- Sanford Orthopedics & Sports Medicine, 2301 25th Street South, Fargo, ND 58103, USA
| | - Trenton Cooper
- Gillette Children's Specialty Healthcare, 200 University Avenue East, St Paul, MN 55101, USA
| | - Michael Chau
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA
| | - Melissa Albersheim
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, USA.
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20
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Atkins LT, James CR, Yang HS, Sizer PS, Brismée JM, Sawyer SF, Powers CM. Immediate Improvements in Patellofemoral Pain Are Associated With Sagittal Plane Movement Training to Improve Use of Gluteus Maximus Muscle During Single Limb Landing. Phys Ther 2021; 101:6309591. [PMID: 34174077 DOI: 10.1093/ptj/pzab165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/16/2021] [Accepted: 05/15/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The authors sought to examine the immediate effects of movement training aimed at improving use of gluteus maximus (GMAX) in the sagittal plane on hip internal rotation and self-reported patellofemoral pain (PFP) during single-limb landing. METHODS Seventeen females with PFP participated. Lower extremity kinematics and kinetics, GMAX activation, and self-reported PFP were obtained before and after a single-session movement training program aimed at increasing the use of GMAX. Dependent variables of interest included self-reported PFP, average GMAX activation, average hip extensor moment, and peak hip internal rotation. Post-training changes were evaluated using paired t tests and Wilcoxon signed rank tests. RESULTS Following movement training, self-reported PFP decreased significantly (mean [standard deviation]) (3.9 [1.1] vs 0.8 [1.3] on a 0-10 scale). Additionally, significant increases were observed for the average hip extensor moment (0.6 [0.3] vs 1.8 [0.4] Nm/kg) and average GMAX activation (41.0% [18.3] vs 51.6% [25.7] maximum voluntary isometric contraction), whereas peak hip internal rotation decreased significantly (8.5 degrees [5.8] vs 6.0 degrees [5.3]). CONCLUSION Movement training aimed at improving the use of GMAX in the sagittal plane resulted in clinically relevant changes in self-reported pain, GMAX activation, and hip kinetics and kinematics. Improving the use of GMAX during movement merits consideration when designing rehabilitation programs for females with PFP. IMPACT The current study highlights the clinical utility of movement training for persons with PFP and provides a biomechanical rationale for its use as a potential intervention in this population.
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Affiliation(s)
- Lee T Atkins
- Department of Physical Therapy, Angelo State University, San Angelo, Texas, USA
| | - C Roger James
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hyung Suk Yang
- Division of Kinesiology and Sport Management, University of South Dakota, Vermillion, South Dakota, USA
| | - Phillip S Sizer
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Steven F Sawyer
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
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21
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Kinematic and Coordination Variability in Individuals With Acute and Chronic Patellofemoral Pain. J Appl Biomech 2021; 37:463-470. [PMID: 34548419 DOI: 10.1123/jab.2020-0401] [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] [Received: 12/17/2020] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Abstract
Altered gait variability occurs in those with patellofemoral pain and may be relevant to pain progression. We examined gait kinematic and coordination variability between individuals with acute and chronic patellofemoral pain and healthy controls. Eighty-three patellofemoral pain runners (37 men and 46 women) and 142 healthy controls (52 men and 90 women) ran on a treadmill while 3-dimensional lower limb kinematic data were collected. Patellofemoral pain runners were split into acute (n = 22) and chronic (n = 61) subgroups based on pain duration (< and ≥3 mo, respectively). Approximate entropy assessed continuous hip, knee, and ankle kinematic variability. Vector coding calculated coordination variability for select joint couplings. Variability measures were compared between groups using 1-way analysis of variance and post hoc comparisons with Cohen d effect sizes. The chronic patellofemoral pain subgroup displayed higher frontal plane knee kinematic variability compared with controls (P = .0004, d = 0.550). No statistically significant effects for any coordination variability couplings were identified. Minimal differences in gait variability were detected between those with acute and chronic patellofemoral pain and healthy controls.
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22
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Liao TC, Pedoia V, Majumdar S, Souza RB. Longitudinal Changes of Patellar Alignment Before and After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft. Am J Sports Med 2021; 49:2908-2915. [PMID: 34343030 DOI: 10.1177/03635465211028993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evidence has suggested that after anterior cruciate ligament (ACL) reconstruction (ACLR), individuals exhibit patellar malalignment; however, it is unknown if patellar alignment changes over time. PURPOSE To examine the longitudinal changes in patellar alignment before, 6 months after, and 3 years after ACLR and to compare these variations, if present, with patellar alignment in controls. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 35 patients who had ACLR using hamstring autograft (19 male; age, 29.9 ± 7.7 years; body mass index, 23.8 ± 2.5) and 20 controls (13 male; age, 30.4 ± 4.8 years; body mass index, 24.3 ± 2.7) participated. All patients underwent bilateral knee magnetic resonance imaging with the knee in extension and 30° of flexion using sagittal T2-weighted, fat-saturated fast spin-echo images to assess patellar alignment in 6 degrees of freedom: anterior-posterior, medial-lateral, and superior-inferior translations; flexion; tilt; and spin. Patients who had ACLR were assessed before (ACL-deficient state) and 6 months and 3 years after ACLR, while control participants were only assessed once. One-way repeated-measures analysis of variance was used to examine patellar alignment across time in the ACLR group. If changes were present, the independent t test was carried out to examine the differences between ACLR knees and control knees. RESULTS In the knee-extended condition, greater patellar lateral displacement was observed at the ACL-deficient state and 6 months after ACLR compared with 3 years after ACLR within the ACLR group (P < .001 and P = .043, respectively) and compared with the control group (P = .001 and P = .039, respectively). Greater patellar lateral tilt was observed at the ACL-deficient state compared with 3 years after ACLR (P = .003) and compared with the control group (P = .018). In the knee-flexed condition, greater anterior displacement was observed at the ACL-deficient state compared with 3 years after ACLR (P = .001) and compared with the control group (P = .011), and it was also observed at 6 months after ACLR compared with the control group (P = .019). Less lateral spin was observed at the ACL-deficient state (P = .042) and 6 months after ACLR (P = .004) compared with 3 years after ACLR and compared with the control group (P = .004 for both). No patellar alignment measures in the ACLR knees at 3 years were significantly different from those of the controls. CONCLUSION Patellar malalignment in individuals before and after ACLR subjected to longitudinal changes, and the differences in alignment between ACLR and controls diminished over 3 years.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
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Aksu N, Atansay V, Karalök I, Aksu T, Kara AN, Hamzaoglu A. Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper's Knee in Professional Dancers: An MRI Analysis. Orthop J Sports Med 2021; 9:2325967120985229. [PMID: 33796584 PMCID: PMC7970196 DOI: 10.1177/2325967120985229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Jumper’s knee is a type of tendinopathy affecting the distal insertion of the
quadriceps tendon (25% of cases) or the patellar tendon. It has been shown
that frontal-plane measurements, such as genu valgum, genu varum, an
increased quadriceps angle, a protuberant tibial tuberosity, patella alta,
and short hamstring muscles, may be related to jumper’s knee. Purpose: To investigate the effects of tibiofemoral rotational angles and
patellofemoral (PF) angles on the development of jumper’s knee in
professional folk dancers. Study Design: Case-control study; Level of evidence, 3. Methods: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic
resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with
quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were
detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral
PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral
patellar tilt angle, and PF congruence angle) and tibiofemoral rotational
angles (condylar twist angle, posterior condylar angle, femoral Insall
angle, tibial Insall angle, posterior tibiofemoral angle, and angle between
the Whiteside line and posterior femoral condylar line) and noted specifics
such as patella alta, patella baja, and the Wiberg classification of the
patellar shape between the patients with versus without QT and between
patients with versus without PT to understand if there was any relationship
with tendinopathy. Results: No statistically significant difference was observed in age, sex, patella
alta, or the Wiberg classification between the QT groups (with vs without)
and between the PT groups (with vs without) (P > .05).
Having QT was found to be significantly associated with the PF sulcus angle
(P = .009), and having PT was found to be significantly
associated with the femoral Insall angle (P = .029). Conclusion: Jumper’s knee was found to be associated with anatomic variations of the PF
sulcus angle and rotation of the patellar tendon in relation to the femur
(femoral Insall angle) on axial MRI scans in professional dancers. Unlike
those of other athletes, dancers’ knees are exposed more to external
rotation forces because of turnout, and this can be the cause of jumper’s
knee.
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Affiliation(s)
- Neslihan Aksu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Vefa Atansay
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Işık Karalök
- Department of Radiology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Taner Aksu
- Istanbul Neuro-orthopaedics Clinic, Istanbul, Turkey
| | - Ayhan Nedim Kara
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Azmi Hamzaoglu
- Orthopaedic and Spine Center, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Almeida GPL, Rodrigues HLDN, Coelho BAL, Rodrigues CAS, Lima PODP. Anteromedial versus posterolateral hip musculature strengthening with dose-controlled in women with patellofemoral pain: A randomized controlled trial. Phys Ther Sport 2021; 49:149-156. [PMID: 33689989 DOI: 10.1016/j.ptsp.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To compare the effectiveness of adding anteromedial versus posterolateral hip musculature strengthening to knee strengthening in women with patellofemoral pain (PFP). DESIGN Randomized controlled trial. SETTING University physiotherapy clinic. PARTICIPANTS Fifty-two women with PFP were randomized to receive either anteromedial (AMHG) or posterolateral (PLHG) hip musculature strengthening. MAIN OUTCOME MEASURES The primary outcomes were pain intensity by the numeric pain rating scale and function by the Anterior Knee Pain Scale in six weeks. Secondary outcomes were pain and function at six months, global perceived effect at six weeks and six months, pain in step down, isometric torque of abductors, adductors and hip rotators measured with hand-held dynamometer, and dynamic knee valgus by step down in six weeks. RESULTS Both groups showed improvement in primary outcomes; however, no differences were found between groups in pain intensity and function in six weeks and the secondary outcomes. Group x time interaction found superior gains in abductor strength in the PLHG and increase in the strength of the adductors and internal rotators in AMHG. CONCLUSION There was no difference between the addition of anteromedial or posterolateral hip musculature strengthening to knee strengthening in improving pain and function in women with PFP.
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Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | | | - Bruno Augusto Lima Coelho
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Carlos Augusto Silva Rodrigues
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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Grant C, Fick CN, Welsh J, McConnell J, Sheehan FT. A Word of Caution for Future Studies in Patellofemoral Pain: A Systematic Review With Meta-analysis. Am J Sports Med 2021; 49:538-551. [PMID: 32816535 PMCID: PMC9906796 DOI: 10.1177/0363546520926448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar maltracking is widely accepted as an underlying mechanism of patellofemoral pain. However, methodological differences in the literature hinder our ability to generate a universal quantitative definition of pathological patellofemoral kinematics (patellar maltracking) in patellofemoral pain, leaving us unable to determine the cause of patellofemoral pain. PURPOSE To systematically review the literature to provide evidence regarding the influence of confounding variables on patellofemoral kinematics. STUDY DESIGN Systematic review and random effects meta-analysis of control-case studies. METHODS A literature search of case-control studies that evaluated patellofemoral kinematics at or near full extension and were written in English was conducted using Embase, PubMed, Scopus, and Web of Science up to September 2019. Cases were defined as patients with patellofemoral pain. Studies were eliminated if they lacked quantitative findings; had a primary aim to assess therapy efficacy; or included participants with osteoarthritis and/or previous trauma, pathology, or surgery. A quality assessment checklist was employed to evaluate each study. Meta-analyses were conducted to determine the influence of confounding variables on measures of patellofemoral kinematics. RESULTS Forty studies met the selection criteria, with quality scores ranging from 13% to 81%. Patient characteristics, data acquisition, and measurement methods were the primary sources of methodological variability. Active quadriceps significantly increased lateral shift (standardized mean difference [SMD]shift = 0.33; P = .0102) and lateral tilt (SMDtilt = 0.43; P = .006) maltracking. Individuals with pain secondary to dislocation had greater effect sizes for lateral maltracking than had those with isolated patellofemoral pain (ΔSMDshift = 0.71, P = .0071; ΔSMDtilt = 1.38, P = .0055). CONCLUSION This review exposed large methodological variability across the literature, which not only hinders the generalization of results, but ultimately mitigates our understanding of the underlying mechanism of patellofemoral pain. Although our meta-analyses support the diagnostic value of maltracking in patellofemoral pain, the numerous distinct methods for measuring maltracking and the limited control for cofounding variables across the literature prohibit defining a single quantitative profile. Compliance with specific standards for anatomic and outcome measures must be addressed by the scientific and clinical community to establish methodological uniformity in this field.
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Affiliation(s)
- Camila Grant
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Cameron N. Fick
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Judith Welsh
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Jenny McConnell
- Centre for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Frances T. Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA,Address correspondence to Frances T. Sheehan, PhD, Department of Rehabilitation Medicine, National Institutes of Health, 6707 Democracy Blvd, Suite 856. Bethesda, MD 20817, USA ()
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Takabayashi T, Edama M, Inai T, Kubo M. Shank and rearfoot coordination and its variability during running in flatfoot. J Biomech 2020; 115:110119. [PMID: 33385870 DOI: 10.1016/j.jbiomech.2020.110119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
Abstract
Flatfoot is a risk factor for patellofemoral pain syndrome (PFPS), and excessive rearfoot eversion occurring in flatfoot has been associated with the development and progression of PFPS; however, the mechanism remains unclear. This study aimed to investigate transverse shank and frontal rearfoot coordination patterns and variability when running with normal foot and flatfoot. Participants with normal foot (n = 13) and flatfoot (n = 13) were asked to run at their preferred speed. The coupling angle between the shank and rearfoot, representing intersegmental coordination, was calculated using the modified vector coding technique and categorized into four coordination patterns. Standard deviation of the coupling angle was computed as a measure of coordination variability during the stance phase. No differences in the characteristics and spatiotemporal parameters between groups were found, and all participants had rearfoot strike pattern. During midstance, the flatfoot group showed a significantly greater proportion of anti-phase with proximal (shank) dominancy than the normal foot group (p = 0.04, effect size = 0.88 [large]). Furthermore, flatfoot group showed a significantly greater in variability than the normal foot group (p = 0.03, effect size = 0.91 [large]). This study's results may help explain why flatfoot is likely to result in PFPS. However, the occurrence mechanism of running injuries like PFPS is multi- factorial. Since these results alone are not sufficient to explain the cause-effect relationship between flatfoot and injuries like PFPS, a prospective study including other factors such as patellofemoral joint stress would also be needed.
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Affiliation(s)
- Tomoya Takabayashi
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan.
| | - Mutsuaki Edama
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan.
| | - Takuma Inai
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan.
| | - Masayoshi Kubo
- Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan.
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McClinton SM, Cobian DG, Heiderscheit BC. Physical Therapist Management of Anterior Knee Pain. Curr Rev Musculoskelet Med 2020; 13:776-787. [PMID: 33128200 PMCID: PMC7661565 DOI: 10.1007/s12178-020-09678-0] [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] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. RECENT FINDINGS The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.
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Affiliation(s)
- Shane M. McClinton
- Doctor of Physical Therapy Program, Des Moines University, Des Moines, IA USA
| | - Daniel G. Cobian
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI USA
| | - Bryan C. Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA
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Abstract
PURPOSE OF REVIEW The patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. RECENT FINDINGS While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.
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Abstract
Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running). Symptoms can restrict participation in physical activity, sports, and work, as well as recur and persist for years. This clinical practice guideline will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.
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Pizzuto F, de Oliveira CF, Soares TSA, Rago V, Silva G, Oliveira J. Relationship Between Running Economy and Kinematic Parameters in Long-Distance Runners. J Strength Cond Res 2019; 33:1921-1928. [DOI: 10.1519/jsc.0000000000003040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rees D, Younis A, MacRae S. Is there a correlation in frontal plane knee kinematics between running and performing a single leg squat in runners with patellofemoral pain syndrome and asymptomatic runners? Clin Biomech (Bristol, Avon) 2019; 61:227-232. [PMID: 30634094 DOI: 10.1016/j.clinbiomech.2018.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 11/23/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee kinematics when running, specifically knee valgus, have been linked to patellofemoral pain syndrome. Assessing running biomechanics requires skill, equipment and time. Clinically, the single leg squat is used to make inferences about knee kinematics during running. No evidence supports this practice. METHODS Sixteen asymptomatic runners and sixteen runners with patellofemoral pain syndrome were recruited. Asymptomatic runners were sub-divided by dominant and non-dominant leg and runners with patellofemoral pain syndrome by painful and non-painful leg. This gave four groups. Participants were videoed performing single leg squats and running on a treadmill. Frontal plane knee kinematics were calculated using the frontal plane projection angle. Correlation in frontal plane projection angle between running and single leg squat were calculated using Pearson's correlation coefficient. Differences in frontal plane projection angle between groups for running and single leg squat were calculated using multiple independent t-tests with Bonferroni correction. FINDINGS Correlation in frontal plane projection angle between running and the single leg squat was not statistically significant for the painful leg group (p = 0.19) but was for the remaining groups (p < 0.05). There was no statistically significant difference in frontal plane projection angle between the four groups when running. Single leg squat frontal plane projection angle was significantly larger for the painful leg group (10.3°) than the dominant leg (-0.2° (p = 0.003)) and non-dominant leg (-0.4° (p = 0.004)) in the asymptomatic runners group. INTERPRETATION The single leg squat cannot be used to make inferences about frontal plane knee kinematics in running gait in patellofemoral pain syndrome sufferers.
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Affiliation(s)
- David Rees
- School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, a partnership between Kingston University and St George's, University of London, SW17 0RE, United Kingdom.
| | - Ahmed Younis
- School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, a partnership between Kingston University and St George's, University of London, SW17 0RE, United Kingdom.
| | - Siân MacRae
- College of Health and Life Sciences, Brunel University London, Mary Seacole Building, Kingston Lane, Uxbridge UB8 3PH, United Kingdom; Therapy Department, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, London SW10 9NH, United Kingdom.
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van Middelkoop M, Macri EM, Eijkenboom JF, van der Heijden RA, Crossley KM, Bierma-Zeinstra SM, de Kanter JL, Oei EH, Collins NJ. Are Patellofemoral Joint Alignment and Shape Associated With Structural Magnetic Resonance Imaging Abnormalities and Symptoms Among People With Patellofemoral Pain? Am J Sports Med 2018; 46:3217-3226. [PMID: 30321064 PMCID: PMC6236631 DOI: 10.1177/0363546518801314] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral malalignment has been observed among people with patellofemoral pain (PFP) and may be associated with the presence of imaging features of osteoarthritis, symptoms, and function. PURPOSE To determine whether patellofemoral joint alignment and bony shape are associated with (1) cartilage, bone, and soft tissue morphological abnormalities defined on magnetic resonance imaging (MRI) and (2) reported symptoms and function among people with PFP. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants (mean ± SD age, 30.2 ± 9.5 years; range, 14-50 years; 78 females, 58.6%) completed questionnaires regarding demographics, pain, symptoms, and function and underwent a 3-T MRI scan of their more symptomatic eligible knee. Structural MRI abnormalities were scored with the MOAKS (Magnetic Resonance Imaging Osteoarthritis Knee Score), and MRI alignment and shape were measured with standardized methods. Associations among MOAKS features, PFP symptoms, and alignment and shape measures were evaluated with regression analyses (α = .05). RESULTS Minor cartilage defects were present in 22 (16.5%) participants, patellar osteophytes in 83 (62.4%), anterior femur osteophytes in 29 (21.8%), Hoffa synovitis in 81 (60.9%), and prefemoral fat pad synovitis in 49 (36.8%). A larger Insall-Salvati ratio was significantly associated with the presence of patellar osteophytes (odds ratio [OR], 51.82; 95% CI, 4.20-640.01), Hoffa synovitis (OR, 60.37; 95% CI, 4.66-782.61), and prefemoral fat pad synovitis (OR, 43.31; 95% CI, 4.28-438.72) in the patellofemoral joint. A larger patellar tilt angle was significantly associated with the presence of minor cartilage defects (OR, 1.10; 95% CI, 1.00-1.20), the presence of patellar osteophytes (OR 1.12; 95%CI 1.02-1.22), and prefemoral fat pad synovitis (OR, 1.11; 95% CI, 1.03-1.20) in the patellofemoral joint. Finally, a larger bisect offset was significantly associated with the presence of minor cartilage defects (OR, 1.05; 95% CI, 1.00-1.11) and patellar osteophytes (OR, 1.07; 95% CI, 1.01-1.14) in the patellofemoral joint. The majority of patellofemoral alignment measures were not associated with symptoms or function. CONCLUSION For people with PFP, the presence of morphological abnormalities defined on MRI appears to be related to particular patellofemoral alignment measures, including higher Insall-Salvati ratio (indicating patella alta), larger patellar tilt angle (indicating greater lateral tilt), and larger bisect offset (indicating greater lateral displacement). Hardly any associations were found with symptoms or function. So there might be a distinct subgroup of PFP that is more prone to developing patellofemoral osteoarthritis later in life, as particular alignment measures seem to be associated with the presence of patellar osteophytes. Prospective studies are required to investigate the longitudinal relationship between alignment or bony shape and morphological abnormalities defined on MRI in this patient population.
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Affiliation(s)
- Marienke van Middelkoop
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, the Netherlands,Marienke van Middelkoop, PhD, Department of General Practice, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands ()
| | - Erin M. Macri
- Centre for Hip Health and Mobility, Department of Family Practice, University of British, Columbia, Canada
| | - Joost F. Eijkenboom
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, the Netherlands
| | - Rianne A. van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus MC Medical University Center Rotterdam, Rotterdam, the Netherlands
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Sita M.A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, the Netherlands
| | - Janneke L. de Kanter
- Department of Radiology and Nuclear Medicine, Erasmus MC Medical University Center Rotterdam, Rotterdam, the Netherlands
| | - Edwin H. Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC Medical University Center Rotterdam, Rotterdam, the Netherlands
| | - Natalie J. Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Lower-Extremity Muscle Activity, Kinematics, and Dynamic Postural Control in Individuals With Patellofemoral Pain. J Sport Rehabil 2018; 27:505-512. [PMID: 28714838 DOI: 10.1123/jsr.2016-0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered lower-extremity muscle activity has been associated with lower-extremity kinematics in individuals with patellofemoral pain (PFP). However, few studies have examined these relationships, and the results are inconsistent. OBJECTIVE To compare the lower-extremity muscle activity, kinematics, pain level, and reach distance during the anterior reach of the star excursion balance test (SEBT) between participants with PFP and healthy individuals (control [CON] group). DESIGN Case control. SETTING Research laboratory. PARTICIPANTS Twenty-eight (PFP = 14 and CON = 14) participants volunteered. INTERVENTION Each participant performed 3 maximal voluntary isometric contractions of the gluteus maximus, gluteus medius (GMED), adductor longus (AL), and vastus medialis, and 5 anterior reaches of the SEBT. MAIN OUTCOME MEASURES Three-dimensional joint kinematics of the hip and knee at the time of touchdown of the SEBT and integrated electromyography of each muscle were recorded during the descent phase of the SEBT. Coactivation ratios between the GMED and AL were calculated (GMED/AL). Pain level was assessed at the baseline and during performance of the SEBT, using a visual analog scale. RESULTS Participants with PFP demonstrated decreased GMED/AL coactivation ratio (P = .01) and shorter reach distance (P = .01) during anterior reach of the SEBT compared with the CON group. Participants with PFP demonstrated higher pain levels at baseline (P = .03) and during test performance (P < .001) compared with the CON group and increased pain level during the test performance compared with the baseline (P < .001). No other significant differences were observed. CONCLUSIONS There were alterations in muscle activity during SEBT performance, suggesting that overactivity of AL relative to GMED is a unique neural recruitment pattern in those with PFP. However, hip and knee joint kinematics did not seem to contribute to deficits in the anterior reach distance, suggesting a need for continued assessment of these deficiencies.
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Ho KY, French T, Klein B, Lee Y. Patellofemoral joint stress during incline and decline running. Phys Ther Sport 2018; 34:136-140. [PMID: 30296671 DOI: 10.1016/j.ptsp.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare patellofemoral joint (PFJ) stress between level, incline, and decline running. DESIGN Experimental study. SETTING University laboratory. PARTICIPANTS Twenty recreational runners. MAIN OUTCOME MEASURES Kinematics and kinetics of the trunk and lower extremity were obtained under 3 treadmill conditions: level, 6° incline, and 6° decline. PFJ stress, PFJ reaction force, and PFJ contact area were determined using a biomechanical model. One-way ANOVAs with repeated measures and post-hoc analyses were used to compare outcome variables across the 3 conditions. RESULTS Peak PFJ stress and PFJ stress-time integral (cumulative PFJ stress over the stance phase) during decline running were significantly higher than during level and incline running. There was no difference in peak PFJ stress and PFJ stress-time integral between level and incline running. The increased peak PFJ stress during decline running was related to increased PFJ reaction force, resulting from a decrease in trunk flexion angle. CONCLUSIONS Running on a decline treadmill resulted in higher peak PFJ stress and stress-time integral. Peak PFJ stress and PFJ stress-time integral were similar during level and incline running. Results from this study may be used to prevent excessive PFJ stress during decline running, by targeting a postural strategy utilizing increased trunk flexion.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA.
| | - Theresa French
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA
| | - Brooks Klein
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA
| | - Young Lee
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA
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Eijkenboom JFA, Waarsing JH, Oei EHG, Bierma-Zeinstra SMA, van Middelkoop M. Is patellofemoral pain a precursor to osteoarthritis?: Patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res 2018; 7:541-547. [PMID: 30294426 PMCID: PMC6168714 DOI: 10.1302/2046-3758.79.bjr-2018-0112.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives It has been hypothesized that patellofemoral pain, a common knee condition in adolescents and young adults, may be a precursor of degenerative joint changes and may ultimately lead to patellofemoral osteoarthritis. Since both conditions share several mechanical disease characteristics, such as altered contact area between the femur and patella and increased joint stress, we investigated whether these conditions share similar and different shape characteristics of the patella compared with normal controls. Methods This cross-sectional study compared three different study populations: 32 patellofemoral pain subjects (mean age, 32 years (22 to 45); 72% female); 56 isolated radiological patellofemoral osteoarthritis subjects (mean age, 54 years (44 to 58); 89% female); and 80 healthy control subjects (mean age, 52 years (44 to 58); 74% female). Measurements included questionnaires, and lateral and skyline radiographs of the knee. Two separate 30-point 2D statistical shape models of the patella were created from the lateral and skyline radiographs. A general linear model was used to test for differences in standardized shape modes (a specific shape variant of the patella) between patellofemoral osteoarthritis, patellofemoral pain, and controls, using Bonferroni correction and adjustment for body mass index and gender. Results Five shape modes showed statistically significant differences between groups: skyline modes 1 (p < 0.001), 8 (p = 0.004), and 10 (p < 0.001); and lateral modes 5 (p = 0.002) and 7 (p = 0.002). Skyline mode 8 and lateral mode 5 were similar for patellofemoral osteoarthritis and patellofemoral pain populations, while being statistically significant different from the control group. Conclusion Our results indicate that patellofemoral pain and patellofemoral osteoarthritis share similar shape characteristics, which are different from control subjects. These findings support the proposed continuum disease model of patellofemoral pain predisposing to the development of patellofemoral osteoarthritis. Cite this article: J. F. A. Eijkenboom, J. H. Waarsing, E. H. G. Oei, S. M. A. Bierma-Zeinstra, M. van Middelkoop. Is patellofemoral pain a precursor to osteoarthritis? Patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res 2018;7:541–547. DOI: 10.1302/2046-3758.79.BJR-2018-0112.R1.
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Affiliation(s)
- J F A Eijkenboom
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Runners With Patellofemoral Pain Exhibit Greater Peak Patella Cartilage Stress Compared With Pain-Free Runners. J Appl Biomech 2018; 34:298-305. [DOI: 10.1123/jab.2017-0229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The primary purpose of this study is to determine whether recreational runners with patellofemoral pain (PFP) exhibit greater peak patella cartilage stress compared with pain-free runners. A secondary purpose was to determine the kinematic and/or kinetic predictors of peak patella cartilage stress during running. A total of 22 female recreational runners (12 with PFP and 10 pain-free controls) participated in this study. Patella cartilage stress profiles were quantified using subject-specific finite element models simulating the maximum knee flexion angle during the stance phase of running. Input parameters to the finite element model included subject-specific patellofemoral joint geometry, quadriceps muscle forces, and lower-extremity kinematics in the frontal and transverse planes. Tibiofemoral joint kinematics and kinetics were quantified to determine the best predictor of stress using stepwise regression analysis. Compared with the pain-free runners, those with PFP exhibited greater peak hydrostatic pressure (PFP vs control: 21.2 [5.6] MPa vs 16.5 [4.6] MPa) and maximum shear stress (PFP vs control: 11.3 [4.6] MPa vs 8.7 [2.3] MPa). Knee external rotation was the best predictor of peak hydrostatic pressure and peak maximum shear stress (38% and 25% of variances, respectively), followed by the knee extensor moment (21% and 25% of variances, respectively). Runners with PFP exhibit greater peak patella cartilage stress during running compared with pain-free individuals. The combination of knee external rotation and a high knee extensor moment best predicted the elevated peak stress during running.
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Selhorst M, Rice W, Jackowski M, Degenhart T, Coffman S. A sequential cognitive and physical approach (SCOPA) for patellofemoral pain: a randomized controlled trial in adolescent patients. Clin Rehabil 2018; 32:1624-1635. [DOI: 10.1177/0269215518787002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To compare a sequential treatment algorithm considering psychosocial and physical impairments, with a conventional rehabilitation approach considering only physical impairments in adolescents with patellofemoral pain. Design: A randomized, single-blind, controlled study. Participants: Fifty-five adolescents (36 females; mean age 14.3 ± 1.8 years). Interventions: The sequential cognitive and physical approach (SCOPA) group ( n = 28) was treated based on sequential testing and treatment of activity-related fear, flexibility, kinematics, and strength. The comparator group ( n = 27) was treated with a non-sequential physical impairment–based approach. Both groups received treatment two times a week for up to six weeks. Measurements: Function (Anterior Knee Pain Scale), pain (Numeric Pain Rating Scale), and Global Rating of Change were assessed at baseline, three weeks, and six weeks, with a six-month follow-up. Results: Both groups had similar function (73.7 ± 9.6) and pain (6.0 ± 2.3) at baseline. A third of individuals with patellofemoral pain demonstrated elevated activity-related fear at baseline. Patients randomized to the SCOPA group had clinically significant greater improvements at six weeks in function (SCOPA, 95.0 ± 7.4 and comparator, 84.8 ± 10.4; mean difference: 10.2, 95% CI: 5.3, 15.1) and pain (SCOPA, 0.9 ± 1.9 and comparator, 2.7 ± 2.1; mean difference: 1.7, 95% CI: 0.5, 2.9). No differences were noted in Global Rating of Change. No between-group differences were noted in any outcome at six-month follow-up. Conclusion: The sequential cognitive and physical approach resulted in greater improvements in short-term function and pain. By six months, both groups demonstrated similar clinically significant improvements in all outcomes.
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Affiliation(s)
- Mitchell Selhorst
- Sports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| | - William Rice
- Sports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Michael Jackowski
- Sports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Todd Degenhart
- Sports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Shaun Coffman
- Sports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
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Neal BS, Barton CJ, Birn-Jeffrey A, Daley M, Morrissey D. The effects & mechanisms of increasing running step rate: A feasibility study in a mixed-sex group of runners with patellofemoral pain. Phys Ther Sport 2018; 32:244-251. [PMID: 29879639 DOI: 10.1016/j.ptsp.2018.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To explore feasibility of recruitment and retention of runners with patellofemoral pain (PFP), before delivering a step rate intervention. DESIGN Feasibility study. SETTING Human performance laboratory. PARTICIPANTS A mixed-sex sample of runners with PFP (n = 11). MAIN OUTCOME MEASURES Average/worst pain and the Kujala Scale were recorded pre/post intervention, alongside lower limb kinematics and surface electromyography (sEMG), sampled during a 3 KM treadmill run. RESULTS Recruitment and retention of a mixed-sex cohort was successful, losing one participant to public healthcare and with kinematic and sEMG data lost from single participants only. Clinically meaningful reductions in average (MD = 2.1, d = 1.7) and worst pain (MD = 3.9, d = 2.0) were observed. Reductions in both peak knee flexion (MD = 3.7°, d = 0.78) and peak hip internal rotation (MD = 5.1°, d = 0.96) were observed, which may provide some mechanistic explanation for the identified effects. An increase in both mean amplitude (d = 0.53) and integral (d = 0.58) were observed for the Vastus Medialis Obliqus (VMO) muscle only, of questionable clinical relevance. CONCLUSIONS Recruitment and retention of a mixed sex PFP cohort to a step rate intervention involving detailed biomechanical measures is feasible. There are indications of both likely efficacy and associated mechanisms. Future studies comparing the efficacy of different running retraining approaches are warranted.
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Affiliation(s)
- Bradley S Neal
- Sports & Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Christian J Barton
- Sports & Exercise Medicine, Queen Mary University of London, United Kingdom; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia; School of Allied Health, La Trobe University, Melbourne, Victoria, Australia; Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Aleksandra Birn-Jeffrey
- Sports & Exercise Medicine, Queen Mary University of London, United Kingdom; School of Engineering and Materials Science, Queen Mary University of London, United Kingdom
| | - Monica Daley
- Comparative Biomedical Sciences, Royal Vetinary College, United Kingdom
| | - Dylan Morrissey
- Sports & Exercise Medicine, Queen Mary University of London, United Kingdom; Physiotherapy Department, Bart's Health NHS Trust, London, United Kingdom.
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Female PFP patients present alterations in eccentric muscle activity but not the temporal order of activation of the vastus lateralis muscle during the single leg triple hop test. Gait Posture 2018; 62:445-450. [PMID: 29660632 DOI: 10.1016/j.gaitpost.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/04/2017] [Accepted: 04/06/2018] [Indexed: 02/02/2023]
Abstract
This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p < 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.
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Pairot de Fontenay B, Esculier JF, Bouyer L, Roy JS. Hip kinematics during functional tasks in females with patellofemoral pain: Modification following rehabilitation and correlation with clinical improvement. Phys Ther Sport 2018; 32:7-14. [PMID: 29655089 DOI: 10.1016/j.ptsp.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/27/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To compare hip kinematics during two functional tasks in females with and without patellofemoral pain (PFP), and to determine if hip kinematics and, symptoms and functional limitations were improved after a rehabilitation program. DESIGN Cross sectional and longitudinal. PARTICIPANTS Sixteen females with and 15 without PFP. SETTING Laboratory and physical therapy clinic. MAIN OUTCOME MEASURES Hip adduction (HADD) and medial rotation (HMR) peak angles, time integrals and inter-movement variability during step-down and vertical drop jump, symptoms and functional limitations evaluated using the Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS). RESULTS At baseline, no significant differences were found in step-down and vertical drop jump between PFP and controls. Following rehabilitation, significant improvements were reported in KOS-ADLS (p < 0.001). There was a significant decrease in HADD and HMR variability (p < 0.05), a trend for decreased peak HMR (p = 0.06) during step-down, and a significant decrease in HADD variability (p < 0.05) during vertical drop jump. These kinematic changes did not correlate with changes in KOS-ADLS (all p > 0.05). CONCLUSION Females with and without PFP demonstrated no hip kinematic differences during functional tasks. A rehabilitation program improved symptoms and functional status, and modified hip kinematics in females with PFP; however these changes were not correlated.
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Affiliation(s)
- Benoit Pairot de Fontenay
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada
| | - Jean-François Esculier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada
| | - Laurent Bouyer
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, Quebec G1R 1P5, Canada
| | - Jean-Sébastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Universite Laval, Quebec City, Quebec G1R 1P5, Canada.
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Nunes GS, Scattone Silva R, Dos Santos AF, Fernandes RAS, Serrão FV, de Noronha M. Methods to assess patellofemoral joint stress: A systematic review. Gait Posture 2018; 61:188-196. [PMID: 29353744 DOI: 10.1016/j.gaitpost.2017.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 02/02/2023]
Abstract
Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.
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Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil.
| | - Rodrigo Scattone Silva
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Ricardo A S Fernandes
- Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil
| | | | - Marcos de Noronha
- Department of Community and Allied Health, La Trobe University, Bendigo, VIC, Australia
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THE INFLUENCE OF EXTRINSIC FACTORS ON KNEE BIOMECHANICS DURING CYCLING: A SYSTEMATIC REVIEW OF THE LITERATURE. Int J Sports Phys Ther 2017; 12:1023-1033. [PMID: 29234554 DOI: 10.26603/ijspt20171023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The knee is susceptible to injury during cycling due to the repetitive nature of the activity while generating torque on the pedal. Knee pain is the most common overuse related injury reported by cyclists, and intrinsic and extrinsic factors can contribute to the development of knee pain. Purpose Due to the potential for various knee injuries, this purpose of this systematic review of the literature was to determine the association between biomechanical factors and knee injury risk in cyclists. Study Design Systematic review of the literature. Methods Literature searches were performed using CINAHL, Ovid, PubMed, Scopus and SPORTDiscus. Quality of studies was assessed using the Downs and Black Scale for non-randomized trials. Results Fourteen papers were identified that met inclusion and exclusion criteria. Only four studies included cyclists with knee pain. Studies were small with sample sizes ranging from 9-24 participants, and were of low to moderate quality. Biomechanical factors that may impact knee pain include cadence, power output, crank length, saddle fore/aft position, saddle height, and foot position. Changing these factors may lead to differing effects for cyclists who experience knee pain based on specific anatomical location. Conclusion Changes in cycling parameters or positioning on the bicycle can impact movement, forces, and muscle activity around the knee. While studies show differences across some of the extrinsic factors included in this review, there is a lack of direct association between parameters/positioning on the cycle and knee injury risk due to the limited studies examining cyclists with and without pain or injury. The results of this review can provide guidance to professionals treating cyclists with knee pain, but more research is needed. Level of Evidence 3a.
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Fox A, Ferber R, Saunders N, Osis S, Bonacci J. Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain. Med Sci Sports Exerc 2017; 50:502-509. [PMID: 29077638 DOI: 10.1249/mss.0000000000001465] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP) and healthy controls. METHODS Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) subgroups on the basis of whether they had been experiencing pain for less or greater than 3 months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP and chronic PFP and healthy controls. RESULTS Compared with controls, both the acute and chronic PFP subgroups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP subgroup demonstrated greater transverse plane hip motion across stance compared with healthy controls. In contrast, the chronic PFP subgroup demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared with healthy controls. CONCLUSIONS This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared with healthy controls. Certain discriminating characteristics were shared between both the acute and chronic subgroups when compared with healthy controls, whereas others were specific to the duration of PFP.
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Affiliation(s)
- Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Reed Ferber
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Sean Osis
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
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Herrington L, Alarifi S, Jones R. Patellofemoral Joint Loads During Running at the Time of Return to Sport in Elite Athletes With ACL Reconstruction. Am J Sports Med 2017; 45:2812-2816. [PMID: 28749699 DOI: 10.1177/0363546517716632] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint pain and degeneration are common in patients who undergo anterior cruciate ligament reconstruction (ACLR). The presence of patellofemoral joint pain significantly affects the patient's ability to continue sport participation and may even affect participation in activities of daily living. The mechanisms behind patellofemoral joint pain and degeneration are unclear, but previous research has identified altered patellofemoral joint loading in individuals with patellofemoral joint pain when running. It is unclear whether this process occurs after ACLR. PURPOSE To assess the patellofemoral joint stresses during running in ACLR knees and compare the findings to the noninjured knee and matched control knees. STUDY DESIGN Controlled laboratory study. METHODS Thirty-four elite sports practitioners who had undergone ACLR and 34 age- and sex-matched controls participated in the study. The participants' running gait was assessed via 3D motion capture, and knee loads and forces were calculated by use of inverse dynamics. RESULTS A significance difference was found in knee extensor moment, knee flexion angles, patellofemoral contact force (about 23% greater), and patellofemoral contact pressure (about 27% greater) between the ACLR and the noninjured limb ( P ≤ .04) and between the ACLR and the control limb ( P ≤ .04); no significant differences were found between the noninjured and control limbs ( P ≥ .44). CONCLUSION Significantly greater levels of patellofemoral joint stress and load were found in the ACLR knee compared with the noninjured and control knees. CLINICAL RELEVANCE Altered levels of patellofemoral stress in the ACLR knee during running may predispose individuals to patellofemoral joint pain.
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Affiliation(s)
- Lee Herrington
- Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK
| | - Saud Alarifi
- Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK
| | - Richard Jones
- Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK
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Lee DS, Choung SD, Lee SW, Suh HR, Shim JH. The ratio of medial and lateral hamstring muscle thickness does not correlate with the lateral tibial rotation angle in the standing position in healthy young adults. J Phys Ther Sci 2017; 29:618-621. [PMID: 28533596 PMCID: PMC5430259 DOI: 10.1589/jpts.29.618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the relationship between the lateral tibial rotation angle during knee joint flexion and the medial and lateral hamstring muscle thickness ratio during knee joint extension while resting, doing nothing, in upright standing position. The lateral tibial torsion is an important factor of orthopedic knee joint diseases as well as other weight bearing joint diseases such as osteoarthritis, meniscus syndrome, anterior cruciate ligament rupture, etc. [Subjects and Methods] Thirty healthy young adults participated in this study. The thickness of the medial and lateral hamstrings was measured using ultrasonographic imaging technique during knee extension in a resting position. The angle of tibial rotation was measured with 2D motion analysis during knee flexion in a half kneeling position. Pearson's correlation coefficient was used to test the relationship. [Results] There is no significant relationship between the angle of lateral tibial rotation and the ratio of hamstring muscle thickness. [Conclusion] These results demonstrate that lateral tibial rotation is not affected by hamstrings during rest in a standing position.
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Affiliation(s)
- Dong-Soo Lee
- Department of Physical Therapy, Division of Health Science, Baekseok University, Republic of Korea
| | - Sung-Dae Choung
- Department of Physical Therapy, Division of Health Science, Baekseok University, Republic of Korea
| | - Seung-Won Lee
- Department of Social Welfare, Baekseok University, Republic of Korea
| | - Hye Rim Suh
- Department of Medical science, Division of Biomedical Science, Korea University, Republic of Korea
| | - Jae-Hoon Shim
- Department of Physical Therapy, Division of Health Science, Baekseok University, Republic of Korea
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Effects of Patellofemoral Taping on Patellofemoral Joint Alignment and Contact Area During Weight Bearing. J Orthop Sports Phys Ther 2017; 47:115-123. [PMID: 28264631 DOI: 10.2519/jospt.2017.6936] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background Although it has been theorized that patellofemoral joint (PFJ) taping can correct patellar malalignment, the effects of PFJ taping techniques on patellar alignment and contact area have not yet been studied during weight bearing. Objective To examine the effects of 2 taping approaches (Kinesio and McConnell) on PFJ alignment and contact area. Methods Fourteen female subjects with patellofemoral pain and PFJ malalignment participated. Each subject underwent a pretaping magnetic resonance imaging (MRI) scan session and 2 MRI scan sessions after the application of the 2 taping techniques, which aimed to correct lateral patellar displacement. Subjects were asked to report their pain level prior to each scan session. During MRI assessment, subjects were loaded with 25% of body weight on their involved/more symptomatic leg at 0°, 20°, and 40° of knee flexion. The outcome measures included patellar lateral displacement (bisect-offset [BSO] index), mediolateral patellar tilt angle, patellar height (Insall-Salvati ratio), contact area, and pain. Patellofemoral joint alignment and contact area were compared among the 3 conditions (no tape, Kinesio, and McConnell) at 3 knee angles using a 2-factor, repeated-measures analysis of variance. Pain was compared among the 3 conditions using the Friedman test and post hoc Wilcoxon signed-rank tests. Results Our data did not reveal any significant effects of either McConnell or Kinesio taping on the BSO index, patellar tilt angle, Insall-Salvati ratio, or contact area across the 3 knee angles, whereas knee angle had a significant effect on the BSO index and contact area. A reduction in pain was observed after the application of the Kinesio taping technique. Conclusion In a weight-bearing condition, this preliminary study did not support the use of PFJ taping as a medial correction technique to alter the PFJ contact area or alignment of the patella. J Orthop Sports Phys Ther 2017;47(2):115-123. doi:10.2519/jospt.2017.6936.
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Thomson C, Krouwel O, Kuisma R, Hebron C. The outcome of hip exercise in patellofemoral pain: A systematic review. ACTA ACUST UNITED AC 2016; 26:1-30. [DOI: 10.1016/j.math.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/10/2016] [Accepted: 06/06/2016] [Indexed: 12/31/2022]
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Rabin A, Portnoy S, Kozol Z. The Association Between Visual Assessment of Quality of Movement and Three-Dimensional Analysis of Pelvis, Hip, and Knee Kinematics During a Lateral Step Down Test. J Strength Cond Res 2016; 30:3204-3211. [DOI: 10.1519/jsc.0000000000001420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The Association of Ankle Dorsiflexion Range of Motion With Hip and Knee Kinematics During the Lateral Step-down Test. J Orthop Sports Phys Ther 2016; 46:1002-1009. [PMID: 27686412 DOI: 10.2519/jospt.2016.6621] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background Altered hip and knee kinematics have been associated with several knee disorders, including anterior cruciate ligament tear, patellofemoral pain, and iliotibial band syndrome. Limited ankle dorsiflexion (DF) range of motion (ROM), which has been linked with some of these disorders, has also been associated with altered knee kinematics. Objective To explore the association of ankle DF ROM with hip and knee kinematics during a step-down task. Methods Thirty healthy participants underwent a 3-D analysis of hip and knee kinematics during a lateral step-down test, followed by measurement of ankle DF ROM in weight bearing (WB) and non-weight bearing (NWB). Participants were dichotomized using the median values into low- and high-DF subgroups within both WB and NWB. Hip and knee kinematics were compared between the low- and high-DF subgroups. Results Participants in the low-DF subgroups exhibited greater peak hip adduction (WB, P = .02; NWB, P<.01) and greater peak knee external rotation (WB, P = .02; NWB, P<.01) compared with participants in the high-DF subgroups. In addition, participants in the low-DF WB subgroup exhibited decreased peak knee flexion compared with participants in the high-DF WB subgroup (P<.01). Conclusion Individuals with lower ankle DF ROM exhibited hip and knee kinematics previously associated with several knee disorders, suggesting that this impairment may be involved in the pathogenesis of the same disorders. Assessment of ankle DF ROM may be useful as part of a preparticipation screening. Furthermore, deficits in ankle DF ROM may need to be addressed in individuals with altered movement patterns. J Orthop Sports Phys Ther 2016;46(11):-1. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6621.
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Almonroeder TG, Benson LC. Sex differences in lower extremity kinematics and patellofemoral kinetics during running. J Sports Sci 2016; 35:1575-1581. [PMID: 27571504 DOI: 10.1080/02640414.2016.1225972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The incidence of patellofemoral pain (PFP) is 2 times greater in females compared with males of similar activity levels; however, the exact reason for this discrepancy remains unclear. Abnormal mechanics of the hip and knee in the sagittal, frontal, and transverse planes have been associated with an increased risk of PFP. The purpose of this study was to compare the mechanics of the lower extremity in males and females during running in order to better understand the reason(s) behind the sex discrepancy in PFP. Three-dimensional kinematic and kinetic data were collected as male and female participants completed overground running trials at a speed of 4.0 m · s-1 (±5%). Patellofemoral joint stress (PFJS) was estimated using a sagittal plane knee model. The kinematics of the hip and knee in the frontal and transverse planes were also analysed. Male participants demonstrated significantly greater sagittal plane peak PFJS in comparison with the female participants (P < .001, ES = 1.9). However, the female participants demonstrated 3.5° greater peak hip adduction and 3.4° greater peak hip internal rotation (IR). As a result, it appears that the sex discrepancy in PFP is more likely to be related to differences in the kinematics of the hip in the frontal and transverse planes than differences in sagittal plane PFJS.
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Affiliation(s)
- Thomas G Almonroeder
- a Musculoskeletal Injury Biomechanics Laboratory, Department of Kinesiology , University of Wisconsin - Milwaukee , Milwaukee , WI , USA
| | - Lauren C Benson
- a Musculoskeletal Injury Biomechanics Laboratory, Department of Kinesiology , University of Wisconsin - Milwaukee , Milwaukee , WI , USA
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