1
|
Chen Y, Li J, Yang H, Lv F, Sheng B, Lv F. Differences in Patellofemoral Alignment Between Static and Dynamic Extension Positions in Patients With Patellofemoral Pain. Orthop J Sports Med 2024; 12:23259671231225177. [PMID: 38444568 PMCID: PMC10913515 DOI: 10.1177/23259671231225177] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/18/2024] [Indexed: 03/07/2024] Open
Abstract
Background Considering that patellofemoral pain (PFP) is related to dynamic factors, dynamic extension on 4-dimensional computed tomography (4-DCT) may better reflect the influence of muscles and surrounding soft tissue than static extension. Purpose To compare the characteristics of patellofemoral alignment between the static and dynamic knee extension position in patients with PFP and controls via 4-DCT. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were 39 knees (25 patients) with PFP and 37 control knees (24 participants). For each knee, an image of the dynamic extension position (a single frame of the knee in full extension [flexion angle of -5° to 0°] selected from 21 frames of continuous images acquired by 4-DCT during active flexion and extension) and an image of the static extension position (acquired using the same equipment with the knee fully extended and the muscles relaxed) were selected. Patellofemoral alignment was evaluated between the dynamic and static extension positions and between the PFP and control groups with the following parameters: patella-patellar tendon angle (P-PTA), Blackburne-Peel ratio, bisect-offset (BO) index, lateral patellar tilt (LPT), and tibial tuberosity-trochlear groove (TT-TG) distance. Results In both PFP patients and controls, the P-PTA, Blackburne-Peel ratio, and BO index in the static extension position were significantly lower (P < .001 for all), while the LPT and TT-TG distance in the static extension position were significantly higher (P ≤ .034 and P < .001, respectively) compared with values in the dynamic extension position. In the comparison between groups, only P-PTA in the static extension position was significantly different (134.97° ± 4.51° [PFP] vs 137.82° ± 5.63° [control]; P = .027). No difference was found in the rate of change from the static to the dynamic extension position of any parameter between the study groups. Conclusion The study results revealed significant differences in patellofemoral alignment characteristics between the static and dynamic extension positions of PFP patients and controls. Multiplanar measurements may have a role in subsequent patellofemoral alignment evaluation.
Collapse
Affiliation(s)
- Yurou Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Haitao Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| |
Collapse
|
2
|
Sulcus Angle, Trochlear Depth, and Dejour's Classification Can Be Reliably Applied To Evaluate Trochlear Dysplasia: A Systematic Review of Radiological Measurements. Arthroscopy 2023; 39:549-568. [PMID: 36208710 DOI: 10.1016/j.arthro.2022.08.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To summarize data on the reliability of available imaging criteria for the assessment of trochlear dysplasia and to assess the methodological quality of the included studies. METHODS This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Search was performed using major electronic databases from their inception to September 2021. All studies enrolling patients of any age who underwent a radiological exam to rule out features related to trochlear dysplasia were included. After the identification of available imaging criteria, reliability studies were analyzed. Descriptive statistics were used to summarize findings. Methodological quality was assessed using the Quality Appraisal of Reliability studies checklist. RESULTS A total of 2391 articles were identified, and 33 articles comprising 3036 patients with a mean age of 28.6 years were included. Thirty different measurements were extracted. Magnetic resonance imaging (MRI) was the most used imaging modalities (21 studies), followed by computed tomography (10 studies), conventional radiology (8 studies) and ultrasonography (US) (1 study). Sulcus angle, trochlear depth, and Dejour's classification were the most explored measurements. Overall, sulcus angle can be reliably assessed on radiography, CT and MRI, whereas trochlear depth can be reliably measured only with CT and MRI. Reliability of Dejour's classification ranged from poor or fair to very good for all imaging modalities. Methodological quality of included studies varied from 2 to 9 positive items out of 11 possible. Twenty-four studies (72.7%) were considered at high risk of bias. CONCLUSION Trochlear dysplasia can be reliably evaluated at least with 3 measurements: sulcus angle, trochlear depth and Dejour's classification. Methodological quality assessment showed high risk of bias in most included studies. LEVEL OF EVIDENCE Level III, systematic review of Level II-III studies.
Collapse
|
3
|
Su Q, Zhang Y, Zhang Y, Li J, Xue C, Ge H, Cheng B. Multivariate Analysis of Associations between Patellofemoral Instability and Gluteal Muscle Contracture: A Radiological Analysis. J Pers Med 2022; 12:jpm12020242. [PMID: 35207730 PMCID: PMC8877690 DOI: 10.3390/jpm12020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to investigate the associations between gluteal muscle contracture (GMC) severity and patellofemoral instability and evaluate the reliability of novel indicators by multivariate analysis. Clinical and imaging data from 115 patients with GMC were collected for retrospective analysis. Two novel indicators were used to evaluate GMC severity (knee flexion angle and hip flexion angle, feet distance), and two additional novel parameters were used to reflect patellofemoral instability [patellar displacement vector (L, α), patella-femoral trochlear (P-FT) area, and femoral-trochlear-patella (FT-P) area]. In this study, patients with moderate contracture were dominant, and 35.65% also experienced anterior knee pain after physical activity. Ordered logistic regression analysis indicated that a more serious GMC represented a higher risk of lateral tilt and lateral displacement of the patella. Multivariate analysis showed that feet distance was a reliable indicator for evaluating the severity of GMC. The results showed that the more serious the GMC, the more significant the difference between the P-FT area and the FT-P area of the patellofemoral joint space. L, patellar tilt angle, patellar congruency angle, and lateral patellofemoral angle were independent risk factors for this difference. A more serious GMC represents a higher risk of patellar subluxation.
Collapse
Affiliation(s)
- Qihang Su
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Yi Zhang
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Yuanzhen Zhang
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Jie Li
- Department of Orthopedics, Zhabei Central Hospital, No.619 Zhong Hua Xin Road, Jingan District, Shanghai 200070, China;
| | - Chao Xue
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Hengan Ge
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
- Correspondence: ; Tel.: +86-13681973702
| |
Collapse
|
4
|
Burger JA, Kleeblad LJ, Laas N, Pearle AD. The Influence of Preoperative Radiographic Patellofemoral Degenerative Changes and Malalignment on Patellofemoral-Specific Outcome Scores Following Fixed-Bearing Medial Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2019; 101:1662-1669. [PMID: 31567803 DOI: 10.2106/jbjs.18.01385] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is controversy as to whether the presence of degenerative changes and malalignment of the patellofemoral joint is a contraindication to medial unicompartmental knee arthroplasty. Therefore, the aim of the present study was to examine the influence of preoperative radiographic patellofemoral joint osteoarthritis and alignment on intermediate-term knee and patellofemoral joint-specific patient-reported outcomes following fixed-bearing medial unicompartmental knee arthroplasty. METHODS We performed a retrospective review of the records on a consecutive series of patients who had undergone robotic arm-assisted fixed-bearing onlay medial unicompartmental knee arthroplasty and had a minimum duration of follow-up of 2 years. All records were collected from a single surgeon's arthroplasty registry. Patients with severe bone loss or grooving of the lateral patellar facet were excluded. Radiographic assessment was performed with use of the Kellgren-Lawrence and Altman classification systems as well as with patellofemoral joint alignment measurements. The latest follow-up consisted of a patient-reported questionnaire, including the Kujala (Anterior Knee Pain Scale) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Junior (JR), and satisfaction levels. RESULTS A total of 536 patients (639 knees) were included. After a mean duration of follow-up (and standard deviation) of 4.3 ± 1.6 years (range, 2.0 to 9.2 years), good-to-excellent Kujala scores were reported independent of the presence of patellofemoral joint osteoarthritis preoperatively (Kellgren-Lawrence grade 0 compared with ≥1, p = 0.82; grade ≤1 compared with ≥2, p = 0.84). Similar findings were found when osteoarthritis was present in either the medial or lateral side of the patellofemoral joint as defined by an Altman score of ≥2 (medial, p = 0.81; lateral, p = 0.90). KOOS scores and satisfaction also were not affected by degenerative patellofemoral joint changes. Furthermore, neither the patellar tilt angle nor the congruence angle influenced patient-reported outcomes. CONCLUSIONS Preoperative radiographic mild to moderate patellofemoral joint degeneration (Kellgren-Lawrence grades 1 through 3) and/or malalignment did not compromise intermediate-term knee and patellofemoral joint-specific patient-reported outcomes in patients managed with fixed-bearing medial unicompartmental knee arthroplasty. On the basis of the results of the present study, we believe that neither mild to moderate patellofemoral degeneration nor abnormal patellar tilt or congruence should be considered a contraindication to fixed-bearing medial unicompartmental knee arthroplasty. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Niels Laas
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| |
Collapse
|
5
|
Patellar tracking after isolated medial patellofemoral ligament reconstruction: dynamic evaluation using computed tomography. Knee Surg Sports Traumatol Arthrosc 2017; 25:3197-3205. [PMID: 27544273 DOI: 10.1007/s00167-016-4284-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Medial patellofemoral ligament (MPFL) reconstruction offers good clinical results with a very low rate of instability recurrence. However, its in vivo effect on patellar tracking is not clearly known. The aim of this study is to investigate the effects of MPFL reconstruction on patellar tracking using dynamic 320-detector-row CT. METHODS Ten patients with patellofemoral instability referred to isolated MPFL reconstruction surgery were selected and subjected to dynamic CT before and ≥6 months after surgery. Patellar tilt angles and shift distance were analysed using computer software specifically designed for this purpose. Kujala and Tegner scores were applied, and the radiation of the CTs was recorded. Two protocols for imaging acquisition were compared: a tube potential of 80 kV and 50 mA versus a tube potential of 120 kV and 100 mA, both with a slice thickness of 0.5 mm and an acquisition duration of 10 s. RESULTS There were no changes in patellar tracking after MPFL reconstruction. There was no instability relapse. Clinical scores improved from a mean of 51.9 (±15.6)-74.2 (±20.9) on the Kujala scale (p = 0.011) and from a median of 2 (range 0-4) to 4 (range 1-6) on the Tegner scale (p = 0.017). The imaging protocols produced a dose-length product (DLP) of 254 versus 1617 mGycm and a radiation effective estimated dose of 0.2 versus 1.3 mSv, respectively. Both protocols allowed the analysis of the studied parameters without loss of precision. CONCLUSIONS Reconstruction of the MPFL produced no improvement in patellar tilt or shift in the population studied. The low-radiation protocol was equally effective in measuring changes in patellar tracking and is recommended. Although the procedure successfully stabilized the patella, knee surgeons should not expect patellar shift and tilt correction when performing isolated patellofemoral ligament reconstruction in patients with recurrent patellar instability. LEVEL OF EVIDENCE IV.
Collapse
|
6
|
Peng HT, Song CY. Effect of leg press training on patellar realignment in patients with patellofemoral pain. J Phys Ther Sci 2016; 27:3873-8. [PMID: 26834371 PMCID: PMC4713810 DOI: 10.1589/jpts.27.3873] [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: 08/17/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of leg press and leg
press with hip adduction exercise training on patellar alignment and pain in patients with
patellofemoral pain (PFP). [Subjects and Methods] Seventeen patients participated in this
study. Eight weeks of leg press or leg press with hip adduction training, including
progressive lower-limb weight-training and stretching, was given. Patellar alignment (tilt
and displacement) and pain measurements were conducted before and after leg press or leg
press with hip adduction training. Patellar tilt angle and the bisect offset index were
measured on axial computed tomography scans of the fully extended knee position with the
quadriceps relaxed and contracted. Pain was assessed by using a 10-cm visual analog scale.
[Results] No differences were found in patellar tilt and displacement with the quadriceps
either relaxed or contracted after leg press and leg press with hip adduction. However,
significant pain reduction was evident in both leg press and leg press with hip adduction.
[Conclusion] The results indicated that patellar realignment does not appear to mediate
pain alleviation. Furthermore, hip adduction in addition to leg press training had no
additive beneficial effect on patellar realignment or pain reduction.
Collapse
Affiliation(s)
- Hsien-Te Peng
- Department of Physical Education, Chinese Culture University, Taiwan
| | - Chen-Yi Song
- Department of Health Promotion and Gerontological Care, Taipei College of Maritime Technology, Taiwan
| |
Collapse
|
7
|
Drew BT, Redmond AC, Smith TO, Penny F, Conaghan PG. Which patellofemoral joint imaging features are associated with patellofemoral pain? Systematic review and meta-analysis. Osteoarthritis Cartilage 2016; 24:224-36. [PMID: 26471209 DOI: 10.1016/j.joca.2015.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/06/2015] [Accepted: 09/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP). DESIGN A systematic review of the literature from AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro, EMBASE and SPORTDiscus was undertaken from their inception to September 2014. Studies were eligible if they used magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) or X-ray (XR) to compare PFJ features between a PFP group and an asymptomatic control group in people <45 years of age. A pooled meta-analysis was conducted and data was interpreted using a best evidence synthesis. RESULTS Forty studies (all moderate to high quality) describing 1043 people with PFP and 839 controls were included. Two features were deemed to have a large standardised mean difference (SMD) based on meta-analysis: an increased MRI bisect offset at 0° knee flexion under load (0.99; 95% CI: 0.49, 1.49) and an increased CT congruence angle at 15° knee flexion, both under load (1.40 95% CI: 0.04, 2.76) and without load (1.24; 95% CI: 0.37, 2.12). A medium SMD was identified for MRI patella tilt and patellofemoral contact area. Limited evidence was found to support the association of other imaging features with PFP. A sensitivity analysis showed an increase in the SMD for patella bisect offset at 0° knee flexion (1.91; 95% CI: 1.31, 2.52) and patella tilt at 0° knee flexion (0.99; 95% CI: 0.47, 1.52) under full weight bearing. CONCLUSION Certain PFJ imaging features were associated with PFP. Future interventional strategies may be targeted at these features. PROSPERO REGISTRATION NUMBER CRD 42014009503.
Collapse
Affiliation(s)
- B T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - A C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - F Penny
- Physiotherapy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
| |
Collapse
|
8
|
Peng HT, Song CY. Predictors of treatment response to strengthening and stretching exercises for patellofemoral pain: An examination of patellar alignment. Knee 2015; 22:494-8. [PMID: 26254693 DOI: 10.1016/j.knee.2014.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/05/2014] [Accepted: 10/30/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Closed kinetic chain and quadriceps strengthening, combined with flexibility exercises of the lower limb musculature, is a common treatment for patellofemoral pain syndrome (PFPS). The effectiveness has been well documented; however, very little is known about which factors predict treatment success. METHODS A total of 43 female subjects with PFPS participated in an eight-week progressive leg press (LP) strengthening and stretching exercise program. A decrease of 1.5 cm on a 10 cm visual analog scale (VAS) score was used as an indicator for treatment success. The baseline patellar tilt angle difference (PTA-d) due to quadriceps contraction prior to treatment was evaluated as a predictor of treatment success. The logistic regression and receiver operating characteristics (ROC) curve analysis were performed to investigate the predictive value of PTA-d. RESULTS PTA-d could significantly predict the treatment success of LP strengthening and stretching exercises. The odds ratio (OR) for having an unsuccessful outcome was 1.19 (95% confidence interval (CI), 1.03-1.39, P<0.021) per degree increment of PTA-d. The most optimal cut-off value for the clinical discrimination of treatment success after LP strengthening and stretching exercise was -1.5° of PTA-d (sensitivity=0.74, specificity=0.71). The area under the ROC curve was 0.73 (standard error=0.08). CONCLUSIONS Female patients with PFPS whose quadriceps contraction reduced the lateral patellar tilt prior to LP strengthening and stretching exercise treatment are more likely to experience pain relief. It seems clinically important to check dynamic patellar tilt characteristics before treatment to aid in clinical decision making.
Collapse
Affiliation(s)
- Hsien-Te Peng
- Department of Physical Education, Chinese Culture University, No. 55, Hwa-Kang Road, Yang-Ming-Shan, 11114 Taipei, Taiwan
| | - Chen-Yi Song
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Third Floor, No.17, Xuzhou Road, Zhongzheng District, 100 Taipei, Taiwan.
| |
Collapse
|
9
|
Non-anatomical capsular closure of a standard parapatellar knee arthrotomy leads to patellar maltracking and decreased range of motion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 2014; 22:543-9. [PMID: 23334622 DOI: 10.1007/s00167-013-2369-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE A parapatellar approach disrupts the medial soft tissue stabilizers of the patella. We hypothesized that soft tissue realignment during arthrotomy closure of native cadaveric knees influences patellar kinematics leading to decreased range of motion. METHODS Parapatellar arthrotomy was performed in seven native human cadaveric knees that did not contain arthroplasty components. Capsular closure was performed with figure-of-eight sutures in five different positions for each specimen. The capsule was closed anatomically, and then shifted 1.5 or 3 cm distal, or 1.5 or 3 cm proximal relative to surgical markings of the patellar poles. In each closure position, real-time patellar kinematics and range of motion were recorded using a navigation system with patellar tracking function. RESULTS Maximum knee flexion was significantly reduced with closure shifted 3 cm proximal (133° ± 8.2°, p < 0.001) or distal (139° ± 6.4°, p < 0.05) compared to anatomical closure (147° ± 4.1°). All closure positions significantly influenced patellar rotation at 45°, 90°, and 120° of flexion (p < 0.001). Closure 1.5 or 3 cm distal increased lateral patellar shift relative to the mechanical axis (p < 0.01). Patellar tilt was significantly decreased at 90° and 120° by closure 3 cm distal (p < 0.01) and at 120° when closed 1.5 cm distal (p < 0.05). CONCLUSIONS Imprecise arthrotomy closure significantly impacted patellar kinematics and passive range of motion. Therefore, every effort should be made to provide anatomical closure of the extensor mechanism to preserve native patellar movement kinematics. LEVEL OF EVIDENCE V.
Collapse
|
10
|
Freedman BR, Sheehan FT. Predicting three-dimensional patellofemoral kinematics from static imaging-based alignment measures. J Orthop Res 2013; 31:441-7. [PMID: 23097251 PMCID: PMC4447147 DOI: 10.1002/jor.22246] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 09/19/2012] [Indexed: 02/04/2023]
Abstract
Patellofemoral pain syndrome causes significant discomfort and disability among much of the general population. Despite recent breakthroughs in dynamic three-dimensional imaging technologies to assess pathological patellofemoral motion, such tools remain costly for clinical diagnostics applications. Thus, this study investigated whether three-dimensional patellofemoral kinematics could be predicted from routine two-dimensional static measures of patellofemoral joint alignment quantified from magnetic resonance imaging (MRI) data acquired in full knee extension. Twenty-six volunteers clinically diagnosed with patellofemoral pain (19 F/7 M, 25.9 ± 11.1 years) and 26 control subjects (19 F/7 M, 25.3 ± 7.7 years) were included in this IRB-approved study. Static three-dimensional sagittal T1-weighted gradient recall echo and dynamic MRI scans were acquired. For the dynamic image acquisition, subjects cyclically flexed and extended their knee (at 30 cycles/min) while a full cine-phase contrast MRI set (24 time frames of anatomic images and x-, y-, and z-velocity images) was acquired. From these data, static measures of patellofemoral alignment and three-dimensional patellofemoral kinematics were derived. Single and multiple regressions between static and kinematic variables were evaluated. Although shown reliable, the static MRI measures could only partially predict patellofemoral kinematics, with r(2) -values ranging from 16% to 77%. This makes it imperitave that the current precise, accurate, 3D, dynamic imaging techniques be translated into clinical tools.
Collapse
Affiliation(s)
- Benjamin R Freedman
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, CRC Room 1-1469, 10 Center Drive MSC 1604, Bethesda, Maryland 10892-1604, USA
| | | |
Collapse
|
11
|
Abstract
Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in orthopaedic practice. The mission of the second International Patellofemoral Pain Research Retreat was to bring together scientists and clinicians from around the world who are conducting research aimed at understanding the factors that contribute to the development and, consequently, the treatment of PFP. The format of the 2.5-day retreat included 2 keynote presentations, interspersed with 6 podium and 4 poster sessions. An important element of the retreat was the development of consensus statements that summarized the state of the research in each of the 4 presentation categories. In this supplement, you will find the consensus documents from the meeting, as well as the keynote addresses, schedule, and platform and poster presentation abstracts.
Collapse
|
12
|
The role of patellar alignment and tracking in vivo: the potential mechanism of patellofemoral pain syndrome. Phys Ther Sport 2011; 12:140-7. [PMID: 21802041 DOI: 10.1016/j.ptsp.2011.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 02/14/2011] [Accepted: 02/25/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE AND METHOD Lateral patellar malalignment and maltracking are commonly believed to be associated with patellofemoral pain. In the current review, a computerized and manual search of English-language articles was performed using multiple combinations of the following keywords: 'patellofemoral pain syndrome' or 'patellofemoral pain', and 'patellar alignment' or 'patellar tracking'. The role of patellar alignment and tracking in vivo is discussed via a review of papers regarding the differences in asymptomatic and symptomatic patella. An attempt is made to identify the potential mechanism of patellofemoral pain syndrome (PFPS). CONCLUSION Evidence suggests that symptomatic patella do not consistently demonstrate lateral malalignment or tracking in patellar tilt and translation. Abnormal patellar alignment and tracking may be potential risk factors that are associated with patellofemoral pain. Other contributing factors should be considered in dealing with patellofemoral pain syndrome. Further studies are required to determine what normal patella alignment and tracking is before going on to define how these are altered in subjects with patellofemoral pain. Furthermore, prospective studies are needed to identify the alteration of patellofemoral kinematics, if any, and whether these are the causative factor or the consequence of the patellofemoral pain syndrome, as well as to determine the risk of development of patellofemoral pain syndrome in individuals with and without abnormal patellar tracking.
Collapse
|
13
|
Gaudreault N, Mezghani N, Turcot K, Hagemeister N, Boivin K, de Guise JA. Effects of physiotherapy treatment on knee osteoarthritis gait data using principal component analysis. Clin Biomech (Bristol, Avon) 2011; 26:284-91. [PMID: 21071119 DOI: 10.1016/j.clinbiomech.2010.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Interpreting gait data is challenging due to intersubject variability observed in the gait pattern of both normal and pathological populations. The objective of this study was to investigate the impact of using principal component analysis for grouping knee osteoarthritis (OA) patients' gait data in more homogeneous groups when studying the effect of a physiotherapy treatment. METHODS Three-dimensional (3D) knee kinematic and kinetic data were recorded during the gait of 29 participants diagnosed with knee OA before and after they received 12 weeks of physiotherapy treatment. Principal component analysis was applied to extract groups of knee flexion/extension, adduction/abduction and internal/external rotation angle and moment data. The treatment's effect on parameters of interest was assessed using paired t-tests performed before and after grouping the knee kinematic data. FINDINGS Increased quadriceps and hamstring strength was observed following treatment (P<0.05). Except for the knee flexion/extension angle, two different groups (G(1) and G(2)) were extracted from the angle and moment data. When pre- and post-treatment analyses were performed considering the groups, participants exhibiting a G(2) knee moment pattern demonstrated a greater first peak flexion moment, lower adduction moment impulse and smaller rotation angle range post-treatment (P<0.05). When pre- and post-treatment comparisons were performed without grouping, the data showed no treatment effect. INTERPRETATION The results of the present study suggest that the effect of physiotherapy on gait mechanics of knee osteoarthritis patients may be masked or underestimated if kinematic data are not separated into more homogeneous groups when performing pre- and post-treatment comparisons.
Collapse
Affiliation(s)
- Nathaly Gaudreault
- Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Quebec City, Canada.
| | | | | | | | | | | |
Collapse
|
14
|
Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. J Orthop Sports Phys Ther 2010; 40:736-42. [PMID: 21041965 DOI: 10.2519/jospt.2010.3246] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized clinical trial. OBJECTIVE To investigate the influence of strengthening the hip abductor and lateral rotator musculature on pain and function of females with patellofemoral pain syndrome (PFPS). BACKGROUND Hip muscle weakness in women athletes has been the focus of many recent studies and is suggested as an important impairment to address in the conservative treatment of women with PFPS. However, it is still not well established if strengthening these muscles is associated with clinical improvement in pain and function in sedentary females with PFPS. METHODS Seventy females (average±SD age, 25±07 years), with a diagnosis of unilateral PFPS, were distributed randomly into 3 groups: 22 females in the knee exercise group, who received a conventional treatment that emphasized stretching and strengthening of the knee musculature; 23 females in the knee and hip exercise group, who performed exercises to strengthen the hip abductors and external rotators in addition to the same exercises performed by those in the knee exercise group; and of the 25 females who did not receive any treatment. The females of the nontreatment group (control) were instructed to maintain their normal daily activities. An 11-point numerical pain rating scale (NPRS) was used to assess pain during stair ascent and descent. The lower extremity functional scale (LEFS) and the anterior knee pain scale (AKPS) were used to assess function. The single-limb single hop test was also used as a functional outcome to measure preintervention and 4-week postintervention function. RESULTS The 3 groups were homogeneous prior to treatment in respect to demographic, pain, and functional scales data. Both the knee exercise and the knee and hip exercise groups showed significant improvement in the LEFS, the AKPS, and the NPRS, when compared to the control group (P<.05 and P<.001, respectively). But, when we considered minimal clinically important differences, only the knee and hip exercise group demonstrated mean improvements in AKPS and pain scores that were large enough to be clinically meaningful. For the single-limb single hop test, both groups receiving an intervention showed greater improvement than the control group, but there was no difference between the 2 interventions (P>.05). CONCLUSION Rehabilitation programs focusing on knee strengthening exercises and knee strengthening exercises supplemented by hip strengthening exercises were both effective in improving function and reducing pain in sedentary women with PFPS. Improvements of pain and function were greater for the group that performed the hip strengthening exercises, but the difference was significant only for pain rating while descending stairs. LEVEL OF EVIDENCE Therapy, level 1b-.
Collapse
|