1
|
Figueroa F, Guiloff R, Bolton S, Figueroa D, Tapasvi S, Stocker E. Specific considerations in female patients with patellar instability: current concepts. J ISAKOS 2024; 9:457-463. [PMID: 38580053 DOI: 10.1016/j.jisako.2024.03.014] [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: 09/24/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Prior literature suggests that patellofemoral instability (PFI) is significantly more prevalent in women than in men. This higher prevalence is commonly attributed to anatomical differences between sexes, particularly with patellofemoral alignment. These differences encompass a higher rate of trochlear dysplasia (TD), patella alta, an increased Q angle, and soft tissue imbalances. In recent years, worse outcomes have been reported in female patients after patellofemoral stabilization surgery using medial patellofemoral ligament reconstruction (MPFLr) alone or in combination with a tibial tubercle osteotomy (TTO), for this reason an "à la carte" plan (addressing the individuals anatomical risk factors) could be more appropriate for female patients.
Collapse
Affiliation(s)
- Francisco Figueroa
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile; Hospital Sotero del Rio, 8207257, Chile.
| | - Rodrigo Guiloff
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile; Hospital Sotero del Rio, 8207257, Chile.
| | - Sarah Bolton
- Fortius Clinic, W1H 6EQ, UK; Chelsea & Westminster Hospital, SW10 9NH, UK.
| | - David Figueroa
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile.
| | | | | |
Collapse
|
2
|
Šarčević Z, Tepavčević A. Iliotibial band tightness and internal rotation of the tibia in the stance phase of running associated with patella instability. J Pediatr Orthop B 2024; 33:83-89. [PMID: 36847190 DOI: 10.1097/bpb.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Management of patellar instability is still a clinical challenge, especially in pediatric and adolescent athletes. The purpose of the study was to check the association between the positive apprehension test (which is a sign of patellar instability) and positive Ober's test [which is a sign of a tight iliotibial band (ITB)] and the lower degree of internal rotation of the tibia in young athletes determined by inertial sensors. The participants of this observational case-control study were 56 young athletes aged 10-15. The moving patellar apprehension test for lateral patellar instability and Ober's test for assessing the flexibility of the ITB were performed on all participants. There were 32 sides with positive apprehension tests (cases) and 80 with negative apprehension tests (controls). The degree of internal rotation of the tibia was determined with an inertial sensor. Internal rotation of the tibia in the stance phase of running was lower in the case group than in the control group. Logistic regression analysis showed that the degree of internal rotation of the tibia in the stance phase of running was a good predictor of patellar instability. Our study illustrates that wearable devices can be valuable in determining possible initial patellar instability. Using inertial sensors, a strong association between patellar instability, ITB tightness, and lower internal rotation of the tibia in the stance phase of running was determined. The significance of this study might be the possibility of preventing damage or dislocations of the patella by improving the elasticity of the ITB, which is particularly relevant since patellar instability is common among adolescents.
Collapse
Affiliation(s)
- Zoran Šarčević
- Faculty of Medicine, University of Novi Sad
- Novi Sad Health Care Centre, Sports Medicine Centre
| | - Andreja Tepavčević
- Faculty of Sciences, University of Novi Sad, Novi Sad
- Mathematical Institute SANU, Belgrade, Serbia
| |
Collapse
|
3
|
Moisan G, Griffiths I, Chicoine D. Flat feet: deformities or healthy anatomical variants? Br J Sports Med 2023; 57:1536-1537. [PMID: 37586781 DOI: 10.1136/bjsports-2023-107183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Gabriel Moisan
- Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Ian Griffiths
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Dominic Chicoine
- Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| |
Collapse
|
4
|
Evans RJ, Moffit TJ, Mitchell PK, Pamukoff DN. Injury and performance related biomechanical differences between recreational and collegiate runners. Front Sports Act Living 2023; 5:1268292. [PMID: 37780121 PMCID: PMC10536965 DOI: 10.3389/fspor.2023.1268292] [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: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Running related injuries (RRI) are common, but factors contributing to running performance and RRIs are not commonly compared between different types of runners. Methods We compared running biomechanics previously linked to RRIs and performance between 27 recreational and 35 collegiate runners. Participants completed 5 overground running trials with their dominant limb striking a force plate, while outfitted with standardised footwear and 3-dimensional motion capture markers. Results Post hoc comparisons revealed recreational runners had a larger vertical loading rate (194.5 vs. 111.5 BW/s, p < 0.001) and shank angle (6.80 vs. 2.09, p < 0.001) compared with the collegiate runners who demonstrated greater vertical impulse (0.349 vs. 0.233 BWs, p < 0.001), negative impulse (-0.022 vs. -0.013 BWs, p < 0.001), positive impulse (0.024 vs. 0.014 BWs, p < 0.001), and propulsive force (0.390 vs. 0.333 BW, p = 0.002). Adjusted for speed, collegiate runners demonstrated greater total support moment (TSM), plantar flexor moment, knee extensor moment, hip extensor moment, and had greater proportional plantar flexor moment contribution and less knee extensor moment contribution to the TSM compared with recreational runners. Unadjusted for speed, collegiate runners compared with recreational had greater TSM and plantar flexor moment but similar joint contributions to the TSM. Discussion Greater ankle joint contribution may be more efficient and allow for greater capacity to increase speed. Improving plantarflexor function during running provides a strategy to improve running speed among recreational runners. Moreover, differences in joint kinetics and ground reaction force characteristics suggests that recreational and collegiate runners may experience different types of RRI.
Collapse
Affiliation(s)
- Ryan J. Evans
- School of Kinesiology, Western University, London ON, Canada
| | - Tyler J. Moffit
- Department of Kinesiology, California State University, Bakersfield, CA, United States
| | - Peter K. Mitchell
- Department of Kinesiology, California State University, Fullerton, CA, United States
| | | |
Collapse
|
5
|
Doyle EW, Doyle TLA, Bonacci J, Beach AJ, Fuller JT. Cumulative patellofemoral force and stress are lower during faster running compared to slower running in recreational runners. Sports Biomech 2023:1-13. [PMID: 37364918 DOI: 10.1080/14763141.2023.2226111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Management strategies for patellofemoral pain often involve modifying running distance or speed. However, the optimal modification strategy to manage patellofemoral joint (PFJ) force and stress accumulated during running warrants further investigation. This study investigated the effect of running speed on peak and cumulative PFJ force and stress in recreational runners. Twenty recreational runners ran on an instrumented treadmill at four speeds (2.5-4.2 m/s). A musculoskeletal model derived peak and cumulative (per 1 km of continuous running) PFJ force and stress for each speed. Cumulative PFJ force and stress decreased with faster speeds (9.3-33.6% reduction for 3.1-4.2 m/s vs. 2.5 m/s). Peak PFJ force and stress significantly increased with faster speeds (9.3-35.6% increase for 3.1-4.2 m/s vs. 2.5 m/s). The largest cumulative PFJ kinetics reductions occurred when speeds increased from 2.5 to 3.1 m/s (13.7-14.2%). Running at faster speeds increases the magnitude of peak PFJ kinetics but conversely results in less accumulated force over a set distance. Selecting moderate running speeds (~3.1 m/s) with reduced training duration or an interval-based approach may be more effective for managing cumulative PFJ kinetics compared to running at slow speeds.
Collapse
Affiliation(s)
- Eoin W Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| | - Tim L A Doyle
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Aaron J Beach
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joel T Fuller
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Biomechanics, Physical Performance, and Exercise Research Group, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Guimaraes Araujo S, Rocha Nascimento L, Ramiro Felício L. Functional tests in women with patellofemoral pain: Which tests make a difference in physical therapy evaluation. Knee 2023; 42:347-356. [PMID: 37148617 DOI: 10.1016/j.knee.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is characterized by anterior knee, which intensifies during functional activities that require the eccentric action of the quadriceps muscle, specially. In ths way, quantitatively measurable functional tests that simulate these activities should be included in the physical therapy evaluation. OBJECTIVE To identify which functional tests are most indicated for the evaluation of women with PFD. METHOD This study evaluated 100 young women (50 with PFP), during the execution of the following functional performance tests: Triple hop, Vertical Jump, Single leg squat, Step Down, YBalance tests, Lunge test and running. Dynamic valgus was also assessed in the tests. The isometric muscle strength of the following muscle groups: hip abductors, extensors and lateral rotators, knee extensors, evertors, and plantar flexors were evaluated. Functional Perception were evaluated by Anterior Knee Pain Scale and Activities of Daily Living Scale. RESULTS PFP group showed lower performance during the Y-Balance, triple hop, vertical jump tests and running. Was observed an increase in dynamic valgus during Triple Hop, Vertical Jump tests and running in PFP group, besides a poorer perception of function. For all lower limb muscle groups, the PFP group showed a reduction in peak isometric force. CONCLUSION The YBalance, triple hop, vertical jump tests, and running should be included in the physical therapy evaluation, in addition to aspects of lower limb muscle strength.
Collapse
Affiliation(s)
- Samara Guimaraes Araujo
- Post Graduation Program in Physical Therapy, Universidade Federal de Uberlândia, Minas Gerais, Brazil
| | | | - Lilian Ramiro Felício
- Post Graduation Program in Physical Therapy, Universidade Federal de Uberlândia, Minas Gerais, Brazil; Physical Therapy Course, Universidade Federal de Uberlândia, Minas Gerais, Brazil.
| |
Collapse
|
7
|
Hébert-Losier K, Dai B, Nunome H, Kong PW, Hobara H, Hsu WC, Bradshaw EJ, Fong DTP, Vanwanseele B. Reporting guidelines for running biomechanics and footwear studies using three-dimensional motion capture. Sports Biomech 2023; 22:473-484. [PMID: 36097884 DOI: 10.1080/14763141.2022.2110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, Tauranga, New Zealand
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Hiroyuki Nunome
- Faculty of Sports and Health Science, Fukuoka University, Jonan-ku, Fukuoka, Japan
| | - Pui Wah Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore
| | - Hiroaki Hobara
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Elizabeth J Bradshaw
- Centre for Sport Research, School of Exercise and Nutrition Science, Deakin University, Melbourne, Australia.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU, Leuven, Belgium
| |
Collapse
|
8
|
Sharma R, Vaibhav V, Meshram R, Singh B, Khorwal G. A Systematic Review on Quadriceps Angle in Relation to Knee Abnormalities. Cureus 2023; 15:e34355. [PMID: 36874732 PMCID: PMC9974941 DOI: 10.7759/cureus.34355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Previous studies on the quadriceps (Q) angle and its relation to knee problems have led to conflicting conclusions. In this comprehensive review, we evaluate recent studies on the Q angle and analyze the changes in Q angles. Specifically, we investigate the variation in Q angles when measured under the following conditions: 1) under various measurement techniques; 2) between symptomatic and non-symptomatic groups; 3) between samples of men and women; 4) unilateral versus bilateral Q angles; 5) Q angle in adolescent boys and girls. It is widely believed that Q angles are more significant in symptomatic patients than in asymptomatic individuals or that the right lower leg and left lower limb are equivalent, which is supported by little scientific data. However, research states that young adult females have higher mean Q angles than males.
Collapse
Affiliation(s)
- Rahul Sharma
- Anatomy, All India Institute of Medical Sciences, Rishikesh, IND
| | - Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Brijendra Singh
- Anatomy, All India Institute of Medical Sciences, Rishikesh, IND
| | | |
Collapse
|
9
|
Van Cant J, Pairot de Fontenay B, Douaihy C, Rambaud A. Characteristics of return to running programs following an anterior cruciate ligament reconstruction: A scoping review of 64 studies with clinical perspectives. Phys Ther Sport 2022; 57:61-70. [PMID: 35921783 DOI: 10.1016/j.ptsp.2022.07.006] [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: 04/03/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To (1) describe return to running (RTR) programs used during rehabilitation after anterior cruciate ligament reconstruction (ACLR); and (2) provide clinical guidelines for RTR program after ACLR. DESIGN Scoping review. LITERATURE SEARCH We searched the MEDLINE (Pubmed), EMBASE, Web of Science and PEDro databases. STUDY SELECTION CRITERIA We included randomized controlled trial (RCT), cases series, meta-analyses, both scoping and systematic reviews including a rehabilitation program after ACLR with a specific RTR program. A "Running program checklist" (RPC) was elaborated based on the Template for Intervention Description and Replication (TIDieR), and on the Consensus on Exercise Reporting Template (CERT) checklist. DATA SYNTHESIS The percentage and number of studies specifying each of the running program checklist items in their RTR program were reported. Number of items reported in each study and specific analysis item-by-item were also proposed. RESULTS The "When (2)" item was the most frequently found (92.19%) and, conversely, the "Who (1)" item appeared only in four studies (6.2%). One-third of the studies presented only one item of the RPC, and 48 of the 64 articles discussed less than three items. Two studies described in detail their RTR program by reporting 8 and 9 items out of the 10, respectively. No study presented 10 of the PRC items. CONCLUSION There is a serious lack of information concerning RTR program following ACLR in the literature and further studies are needed to establish a program based on the best evidence.
Collapse
Affiliation(s)
- Joachim Van Cant
- Faculty of Motors Sciences, Université Libre de Bruxelles, Brussels, Belgium; SFMKS Lab, Pierrefitte-sur-Seine, France; The Running Clinic, Lac Beauport, Canada.
| | - Benoît Pairot de Fontenay
- SFMKS Lab, Pierrefitte-sur-Seine, France; Inter-university Laboratory of Human Movement Science (LIBM EA 7424), Univ Lyon - UJM, Saint Etienne, France; The Running Clinic, Lac Beauport, Canada
| | - Charbel Douaihy
- Faculty of Motors Sciences, Université Catholique de Louvain, Brussels, Belgium
| | - Alexandre Rambaud
- SFMKS Lab, Pierrefitte-sur-Seine, France; Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France; Department of Clinical and Exercise Physiology, Sports Medicine Unity, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
| |
Collapse
|
10
|
de Vasconcelos DP, Aidar FJ, Lima TB, Filho FMDN, Mendonça ILA, Díaz-de-Durana AL, Garrido ND, Santiago MS, Junior WMDS. Assessment of Dynamic Knee Valgus between Lateral Step-Down Test and Running in Female Runners with and without Patellofemoral Pain Using Two-Dimensional Video Analysis. Clin Pract 2022; 12:425-435. [PMID: 35735666 PMCID: PMC9221657 DOI: 10.3390/clinpract12030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Dynamic knee valgus (DKV) is a frontal plane knee kinematic alteration that has been associated with patellofemoral pain (PFP) in female runners. DKV is commonly assessed in clinical practice by measuring frontal plane knee projection angle (FPPA) during squat tests. However, it remains unclear whether the DKV observed in these tests is similar to or correlates with that observed during running in female runners. The aims of this cross-sectional study were to correlate and compare DKV, by measuring FPPA values, in a lateral step-down (LSD) squat test and running in female runners with and without PFP. A two-dimensional (2D) video analysis of the LSD test and running was carried out for 21 asymptomatic female runners and 17 PFP female runners in order to determine FPPA values. A Pearson correlation test and a factorial ANOVA with Bonferroni post hoc correction were used for statistical analysis. The FPPAs recorded in the LSD test were significantly higher than those recorded during running in the asymptomatic (16.32° ± 5.38 vs. 4.02° ± 3.26, p < 0.01) and PFP groups (17.54° ± 7.25 vs. 4.64° ± 3.62, p < 0.01). No significant differences were found in FPPA values between asymptomatic and PFP runners during the LSD test (16.32° ± 5.38 vs. 17.54° ± 7.25, p = 0.55) and running (4.02° ± 3.26 vs. 4.64° ± 3.62, p = 0.58). There was a small (r < 0.3) and non-significant (p > 0.05) correlation in FPPAs between the LSD test and running in both groups. According to our results, DKV was not similar during the LSD test and running, and there was no significant correlation in FPPA values between the LSD test and running in both groups. Therefore, clinicians and therapists should be aware of these findings when using the LSD test in clinical practice to evaluate DKV in female runners with or without PFP.
Collapse
Affiliation(s)
- Diego Protasio de Vasconcelos
- Postgraduate Program of Physical Education, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil;
- Musculoskeletal System Unit, University Hospital, Federal University of Sergipe (UFS), Aracaju 49060-025, Brazil;
- Correspondence: (D.P.d.V.); (F.J.A.)
| | - Felipe J. Aidar
- Postgraduate Program of Physical Education, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil;
- Correspondence: (D.P.d.V.); (F.J.A.)
| | - Tarcisio Brandao Lima
- Postgraduate Program of Health Sciences, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil; (T.B.L.); (F.M.d.N.F.)
| | | | | | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Nuno Domingos Garrido
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal;
| | - Michael Silveira Santiago
- Musculoskeletal System Unit, University Hospital, Federal University of Sergipe (UFS), Aracaju 49060-025, Brazil;
| | - Walderi Monteiro da Silva Junior
- Postgraduate Program of Physical Education, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil;
- Department of Physical Therapy, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil;
| |
Collapse
|
11
|
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.
Collapse
|