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Andronic O, Suravaram V, Lu V, Wall SJ, Bucher TA, Prosser GH, Yates PJ, Jones CW. What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees. J Arthroplasty 2024; 39:1093-1107.e1. [PMID: 37871862 DOI: 10.1016/j.arth.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
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Affiliation(s)
- Octavian Andronic
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Vishwa Suravaram
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Wall
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Thomas A Bucher
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Gareth H Prosser
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Piers J Yates
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Christopher W Jones
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Curtin University, Perth, Australia
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Waiteman MC, Briani RV, Lopes HS, Ducatti MHM, Silva GGMD, Bazett-Jones DM, Azevedo FMD. People With Patellofemoral Pain Have Bilateral Deficits in Physical Performance Regardless of Pain Laterality. J Athl Train 2024:499457. [PMID: 38477146 DOI: 10.4085/1062-6050-0649.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
CONTEXT People with patellofemoral pain (PFP) may have lower performance during the forward step-down and single-leg hop with their painful (unilateral complaints) or most painful (bilateral complaints) limb when compared to pain-free controls. Yet, no study has investigated the appropriateness of using the pain-free/less painful limb as a reference standard in clinical practice or whether deficits might be present depending on the laterality of pain. OBJECTIVE To compare performance scores and proportion of side-to-side limb symmetry during the forward step-down and single-leg hop tests among people with unilateral and bilateral PFP, and pain-free controls. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Fifty-two young adults (18-35 years old) with unilateral PFP, 72 with bilateral PFP, and 76 controls. MAIN OUTCOME MEASURE(S) Group-by-limb interactions on the performance during the step- down (repetitions) and hop test (distance [cm] normalized by the limb length) were investigated using a repeated-measures analysis of covariance controlling for sex. Pairwise comparisons were interpreted using effect sizes. A Chi-square test was used to compare the proportion of symmetry/asymmetry (cutoff point of ≥ 90% for symmetries indices) across groups and tests. RESULTS Main effects for groups (small-to-medium effects) but not limbs indicated lower performance of both limbs of individuals with unilateral and bilateral PFP compared to controls during forward step-downs and single-leg hop tests. No significant differences for the proportion of symmetry/asymmetry were identified across groups (p ≥ 0.05), which further suggests an impaired physical performance of the contralateral limb. CONCLUSIONS Our results indicate bilateral deficits in the physical performance of people with unilateral and bilateral PFP when compared to pain-free controls during the forward step-down and single-leg hop tests. Limb symmetries indices greater than 90% should be interpreted with caution, as they may overstate the physical performance by not assuming bilateral deficits.
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Affiliation(s)
- Marina C Waiteman
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, SP, Brazil
| | - Ronaldo V Briani
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, SP, Brazil
| | - Helder S Lopes
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, SP, Brazil
| | - Matheus H Maiolini Ducatti
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, SP, Brazil
| | - Gleison G M da Silva
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, SP, Brazil
| | - David M Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH, USA
| | - Fábio M de Azevedo
- School of Science and Technology, Department of Physical Therapy, Sao Paulo State University, Presidente Prudente, SP, Brazil
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Ribeiro R, Gomes E, Ferreira B, Figueiredo I, Valente C, Delgado D, Sánchez M, Andrade R, Espregueira-Mendes J. Derotational distal femoral osteotomy corrects excessive femoral anteversion in patients with patellofemoral instability: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:713-724. [PMID: 38385776 DOI: 10.1002/ksa.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Patellofemoral instability (PFI) is a common condition that can be caused from multiple factors, including lower limb rotational malalignments. Determining precise criteria for performing corrective torsional osteotomy can be a daunting task due to the lack of consensus on normal and excessive values and the limited evidence-based data in the postoperative results. The purpose was to assess the clinical, functional and imaging outcomes following derotational distal femoral osteotomy (DDFO) in patients with PFI and/or anterior knee pain (AKP) associated with lower limb rotational malalignments. METHODS Searches were conducted on PubMed, EMBASE and Web of Science databases up to October 2023. Studies reporting outcomes after DDFO in patients with PFI and/or AKP were eligible for the systematic review. The primary outcome was imaging metrics, especially femoral anteversion. Secondary outcomes included the patient-reported outcome measures (PROMs) (clinical and functional). Quantitative synthesis involved the use of weighted averages to calculate pre- to postoperative mean differences (MD) and compare them against the minimal clinically important difference (MCID). RESULTS Ten studies (309 knees) were included with a mean follow-up of 36.1 ± 11.7 months. Imaging outcomes consistently indicated the correction of femoral anteversion (MD = -19.4 degrees, 95% confidence interval: -20.1 to -18.7) following DDFO. PROMs showed significant improvements in most studies, exceeding the MCID. Patient satisfaction with the DDFO was high (93.3%). CONCLUSIONS The DDFO was an effective treatment option for correcting excessive femoral anteversion in patients with PFI associated with clinically relevant functional and clinical improvement and a high satisfaction rate. LEVEL OF EVIDENCE Level IV, systematic review of level II-IV studies.
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Affiliation(s)
| | - Eluana Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
| | | | | | - Cristina Valente
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Mikel Sánchez
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal
| | - João Espregueira-Mendes
- School of Medicine, Minho University, Braga, Portugal
- Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal
- Dom Henrique Research Centre, Porto, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Braga, Portugal
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Kochar SS, Fating T, Patil S. Efficacy of Isometric Exercises and Somatosensory Training for Pain, Proprioception, and Balance in Runners with Patellofemoral Pain Syndrome. Cureus 2024; 16:e56163. [PMID: 38618329 PMCID: PMC11015899 DOI: 10.7759/cureus.56163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background A significant cause of knee pain is patellofemoral pain syndrome (PFPS). Young adults are the most common population to be impacted, and this condition appears to affect both sexes. Patellofemoral joint (PFJ) compression, which is felt around the patella during any physical or athletic activity, usually causes patients to experience pain in the anterior part of the knee. Physiotherapy is essential for patients suffering from this illness, as it can improve their everyday activities and ability to return to their sport. Methodology The study's main goal was to evaluate the effectiveness of somatosensory training and isometric exercises for pain, proprioception, and balance in runners with PFPS. Before- and after-test approaches were used in the investigation. Eighty-five people made up the study, with the inclusion and exclusion criteria used to determine eligibility. Isometric exercises and somatosensory training were given to every individual; the group was not randomly assigned. The patient's diagnosis was made using the patellar grind test. Participants received 30-45 minutes of isometric exercises and 15 minutes of somatosensory training every four days. The visual analog scale, joint position sense test, and Y-balance test were taken as outcome measures to measure PFPS before and after the intervention. Results The result revealed significant (p=0.0001) improvement in PFPS following the intervention. Both the isometric exercises and somatosensory training were found to be significant in reducing the intensity of the pain and improving the proprioception and balance of the individuals. Conclusion Both treatment approaches were beneficial in lowering pain in the joints, developing balance, and helping the patient perceive the position of the joint. Individuals can use both therapy methods to improve their running abilities, and they should become ingrained in daily practice.
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Affiliation(s)
- Shraddha S Kochar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubhangi Patil
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Barahona M, Guzmán MA, Cartes S, Arancibia AE, Mora JE, Barahona MA, Palma D, Hinzpeter JR, Infante CA, Barrientos CN. Development of a Machine-Learning Model for Anterior Knee Pain After Total Knee Arthroplasty With Patellar Preservation Using Radiological Variables. J Arthroplasty 2024:S0883-5403(24)00105-0. [PMID: 38364878 DOI: 10.1016/j.arth.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Anterior knee pain (AKP) following total knee arthroplasty (TKA) with patellar preservation is a common complication that significantly affects patients' quality of life. This study aimed to develop a machine-learning model to predict the likelihood of developing AKP after TKA using radiological variables. METHODS A cohort of 131 anterior stabilized TKA cases (105 patients) without patellar resurfacing was included. Patients underwent a follow-up evaluation with a minimum 1-year follow-up. The primary outcome was AKP, and radiological measurements were used as predictor variables. There were 2 observers who made the radiological measurement, which included lower limb dysmetria, joint space, and coronal, sagittal, and axial alignment. Machine-learning models were applied to predict AKP. The best-performing model was selected based on accuracy, precision, sensitivity, specificity, and Kappa statistics. Python 3.11 with Pandas and PyCaret libraries were used for analysis. RESULTS A total of 35 TKA had AKP (26.7%). Patient-reported outcomes were significantly better in the patients who did not have AKP. The Gradient Boosting Classifier performed best for both observers, achieving an area under the curve of 0.9261 and 0.9164, respectively. The mechanical tibial slope was the most important variable for predicting AKP. The Shapley test indicated that high/low mechanical tibial slope, a shorter operated leg, a valgus coronal alignment, and excessive patellar tilt increased AKP risk. CONCLUSIONS The results suggest that global alignment, including sagittal, coronal, and axial alignment, is relevant in predicting AKP after TKA. These findings provide valuable insights for optimizing TKA outcomes and reducing the incidence of AKP.
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Affiliation(s)
- Maximiliano Barahona
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Mauricio A Guzmán
- Radiological Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Sebastian Cartes
- Clinical Innovation Department at Clinica Las Condes, Santiago, Chile
| | | | - Javier E Mora
- Clinical Innovation Department at Clinica Las Condes, Santiago, Chile
| | - Macarena A Barahona
- Advanced Clinical Research Department at Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Daniel Palma
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Jaime R Hinzpeter
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Carlos A Infante
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
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Nguyen TT, Le HDT, Hoang NT, Le TB, Ha TH. Morphologic Evaluation of the Patella: The Impact of Gender and Age. Orthop Res Rev 2024; 16:59-66. [PMID: 38375069 PMCID: PMC10875317 DOI: 10.2147/orr.s444533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction The patellofemoral joint is a complex joint that plays a crucial role in knee joint function and stability. This study aims to describe the MRI characteristics of the patellofemoral joint in Vietnamese adults. Subjects and Methodology A cross-sectional study was conducted on 280 patients at Hue UMP Hospital from May 2020 to May 2021. All patients underwent knee MRI using Siemens Magnetom Amira 1.5 Tesla. The evaluation parameters included the morphology of the patella and the femoral trochlea. Results The study found that the morphological parameters of the patellar joint varied significantly between genders and age groups. The mean largest patellar transverse diameter was 4.26 ± 0.37 cm, the average length of the lateral joint facet was 2.5 ± 0.26 cm, and the medial joint facet was 2.0 ± 0.25 cm. The patellar height was 4.07 ± 0.35 cm. The indexes of patellar morphology were higher in men than in women, except for the lateral-medial facet ratio. The most common Wiberg classification was type B (63.9%), followed by type C (25.4%), and type A was the least common (10.7%). There was a statistically significant difference in the patellar measurements between different age groups. There was a weak negative linear correlation between the dimensions of the largest transverse diameter, the length of the articular surface, the patellar articular angle, and the age of the patient. Additionally, there was a moderate inverse linear relationship between patellar height and patient age. Conclusion This study highlights the significant variations in patellar morphology based on gender and age. The findings emphasize the importance of careful assessment and consideration of these variations in the imaging evaluation of the patellofemoral joint.
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Affiliation(s)
- Thanh Thao Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hoang Di Thu Le
- Department of Radiology, Oncology Hospital, Da Nang, Vietnam
| | - Ngoc Thanh Hoang
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Trong Binh Le
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thi Hien Ha
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Kim S, Callahan EG, Malone ZC, Gilgallon TJ, Glaviano NR. Changes in Hip and Knee Strength Are Not Associated With Improved Clinical Outcomes After Rehabilitation in Individuals With Patellofemoral Pain: A Critically Appraised Topic. J Sport Rehabil 2024; 33:140-148. [PMID: 37931619 DOI: 10.1123/jsr.2023-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Abstract
CLINICAL SCENARIO Patellofemoral pain (PFP) is a widespread knee disorder encountered in clinical practice. Clinicians have often focused on strengthening hip and knee musculature to improve pain and disability, which are the ultimate clinical goals of PFP treatment. However, PFP literature has shown improvement in pain and disability without concurrent changes in lower-extremity strength after rehabilitation. Although some researchers have achieved a significant increase in strength after rehabilitation in PFP cohorts, there was no association with improved pain and disability. The inconsistent improvements in strength and the lack of association with clinical outcomes call for a critical appraisal of the available evidence to better understand the association between changes in hip and knee strength and improved clinical outcomes in individuals with PFP. CLINICAL QUESTION Are changes in hip and knee strength associated with improved pain and disability after rehabilitation in individuals with PFP? SUMMARY OF KEY FINDINGS Four studies met the inclusion criteria and were included in the appraisal. Following rehabilitation, one study achieved strength improvements in knee extension. One study achieved strength improvements in knee extension, but not in hip external rotation and hip abduction. Two studies did not achieve strength improvements in hip external rotation, hip abduction, hip extension, or knee extension. All included studies achieved improvements in pain or disability after rehabilitation. None of the studies found a significant association between changes in hip and knee strength (either improved or not) and improved pain and disability. CLINICAL BOTTOM LINE There is consistent evidence that changes in hip and knee strength are not associated with improved clinical outcomes after rehabilitation in adults with PFP. STRENGTH OF RECOMMENDATION Collectively, the body of evidence included is to answer the clinical question aligns with the strength of recommendation of B based on the Strength of Recommendation Taxonomy.
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Affiliation(s)
- Sungwan Kim
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
| | - Evyn G Callahan
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Zachary C Malone
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
| | - Timothy J Gilgallon
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, USA
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Mukherjee K, Ghorai TK, Kumar A, Basak I. Giant Cell Tumor of Patella with Secondary Aneurysmal Bone Cyst-A Rare Case Report of Anterior Knee Pain in Young Adults. J Orthop Case Rep 2024; 14:65-69. [PMID: 38420248 PMCID: PMC10898694 DOI: 10.13107/jocr.2024.v14.i02.4220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Primary bone tumors of the patella are rare, with an incidence as low as 0.12%. The majority are benign, with giant cell tumors (GCT) being the predominant tumor affecting this sesamoid bone. An associated secondary aneurysmal bone cyst (ABC) component with a primary patellar GCT is rarely seen. Case Report We report a case of a 20-year-old male with long-standing anterior knee pain for 9 months. Having visited multiple clinics and found no relief, the patient presented to us at our out-patient department. Clinical examination suggested patellar tenderness, and knee radiographs showed a lytic lesion with cortical erosions. Computed tomography and magnetic resonance imaging were suggestive of GCT. A patellectomy with a good extensor repair was performed. A patellar biopsy revealed a mixed picture of a primary GCT with a secondary ABC. The patient was closely followed up, and at 12 months, he recovered completely and recorded an excellent functional outcome. Conclusion With the incidence of bone tumors on the rise, one should be aware of this relatively rare cause of anterior knee pain. A simple radiograph will help in early diagnosis and will go a long way toward better salvage procedures than more radical procedures like patellectomy.
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Affiliation(s)
- Kaustav Mukherjee
- Department of Orthopaedics, College of Medicine and JNM Hospital, Nadia, West Bengal, India
| | - Tushar Kanti Ghorai
- Department of Orthopaedics, College of Medicine and JNM Hospital, Nadia, West Bengal, India
| | - Ajay Kumar
- Department of Orthopaedics, College of Medicine and JNM Hospital, Nadia, West Bengal, India
| | - Indrakshi Basak
- Department of Pathology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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Ferlito R, De Salvo S, Managò G, Ilardo M, Sapienza M, Caldaci A, Vescio A, Pavone V, Testa G. The Role of Biofeedback in Patellofemoral Pain Conservative Treatment: A Systematic Review. J Funct Morphol Kinesiol 2024; 9:21. [PMID: 38249098 PMCID: PMC10801512 DOI: 10.3390/jfmk9010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
This paper aims to investigate the effectiveness and the outcomes of the association between different types of biofeedback techniques and therapeutic exercises in the conservative treatment of patellar femoral pain (PFP). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines have been used and followed the Cochrane Handbook for Systematic Reviews of Interventions. Between April and June 2023, the following electronic databases were searched: PubMed, ScienceDirect, BIOMED Central, Cochrane Library, and PEDro. Only randomized controlled trials (RCTs) were selected. Following the search, 414 records were found, and after using strict inclusion and exclusion criteria, 12 RCTs were retrieved to include in this systematic review, assessing 513 patients. The association between biofeedback and therapeutic exercise may be beneficial for pain, function (AKPS), extensor muscle strength, reduction of the dynamic knee valgus and vastus medialis (VM) and vastus lateralis (VL) (EMG) optimization. All these results were valued in the short term. Regarding the intervention type, it was possible to correlate the EMG biofeedback with the benefits of the knee extensor strength and the EMG activity of VM and VL. Conversely, using mirror, verbal, and somesthetic (hands and band) feedback seems to be linked to the reduction of the knee dynamic valgus.
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Affiliation(s)
- Rosario Ferlito
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (R.F.); (G.M.)
| | - Sara De Salvo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
| | - Giovanni Managò
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (R.F.); (G.M.)
| | - Martina Ilardo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.S.); (M.I.); (M.S.); (A.C.); (A.V.); (G.T.)
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10
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Gerow DE, Small SR, Lackey WG, Carter JL, Berend ME. What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study. J Arthroplasty 2024; 39:76-80. [PMID: 37454946 DOI: 10.1016/j.arth.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Influences on anterior knee pain, stair climbing limitations, and function such as rising from sitting are poorly understood in unicompartmental knee arthroplasty (UKA). Original indications for UKA excluded patients who had patello-femoral disease, while more recent studies have expanded the indications to include these patients. This study examined the influence of the patello-femoral joint degeneration on patient-reported outcome measures relating to anterior knee pain and function after UKA. METHODS Between October 2017 and August 2021, Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR) patient-reported outcome measures were collected preoperatively and at 12 months of follow-up for 678 medial UKAs. Patello-femoral joint status was visually graded intraoperatively. Radiographic or intraoperative medial patellar facet and trochlear patello-femoral arthritis and preoperative anterior knee pain were not considered contraindications for UKA, while grade IV lateral patello-femoral arthritis was considered a contraindication for UKA. Multivariable ordinal logistic regressions were performed, using the KOOS, JR questionnaire assessing pain during stair climbing, standing upright, and function during rising from sitting. Independent regressions were performed for each targeted KOOS, JR question, with adjustments for age at surgery, sex, and baseline pain and function scores. RESULTS No association was observed between 12-month postoperative anterior knee pain (P = .575) and function (P = .854) with patellar osteoarthritis grading after UKA. When comparing fixed and mobile-bearing UKA designs, no association was observed between bearing type and pain (P = .663) or functional outcomes (P = .758). CONCLUSION Pain and function improved significantly following medial UKA and was independent of medial patellar and trochlear degenerative status.
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Affiliation(s)
- Daniel E Gerow
- Department of Orthopaedic Surgery, University of Michigan Health West, Wyoming, Michigan
| | - Scott R Small
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Gerow DE, Small SR, Lackey WG, Carter JL, Berend ME. Incidence of Anterior Knee Pain and Functional Difficulty in a Prospectively Recruited Cohort Following Total Knee Arthroplasty With Selective Patellar Resurfacing. J Arthroplasty 2024; 39:81-86. [PMID: 37331446 DOI: 10.1016/j.arth.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The influence of patellar resurfacing on anterior knee pain, stair climbing, and functional activity outcomes following total knee arthroplasty (TKA) are incompletely understood. This study examined the influence of patellar resurfacing on patient-reported outcome measures (PROMs) relating to anterior knee pain and function. METHODS The Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR.) patient PROMs were collected preoperatively and at 12 months follow-up for 950 TKAs performed over 5 years. Indications for patellar resurfacing included Grade IV patello-femoral (PFJ) changes or mechanical PFJ findings during patellar trialing. Patellar resurfacing was performed on 393 (41%) of the 950 TKAs performed. Multivariable binomial logistic regressions were performed, using KOOS, JR. questions assessing pain during stair climbing, standing upright, and function during rising from sitting as surrogates for anterior knee pain. Independent regression models were performed for each of the targeted KOOS, JR. questions, with adjustment for age at surgery, sex, and baseline pain and function. RESULTS No association was observed between 12-month postoperative anterior knee pain or function with patellar resurfacing (P = .17, .97). Patients who had moderate or greater preoperative pain on stairs had an increased likelihood of postoperative pain and functional difficulty (odds ratio 2.3, P = .013), while males were 42% less likely to report postoperative anterior knee pain (odds ratio 0.58, P = .002). CONCLUSION Selective patellar resurfacing based on PFJ degeneration and mechanical PFJ symptoms produces similar improvement in PROMs for resurfaced and unresurfaced knees.
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Affiliation(s)
- Daniel E Gerow
- Department of Orthopaedic Surgery, University of Michigan Health West, Wyoming, Michigan
| | - Scott R Small
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Nunes GS, de Oliveira J, Iacob GS, Signori LU, Diel AP, Schreiner R, Solner MW. Effectiveness of Interventions Aimed at Changing Movement Patterns in People With Patellofemoral Pain: A Systematic Review With Network Meta-analysis. J Orthop Sports Phys Ther 2023; 53:1-13. [PMID: 37707784 DOI: 10.2519/jospt.2023.11956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To summarize the effectiveness of interventions for changing movement during weight-bearing functional tasks in people with patellofemoral pain (PFP). DESIGN: Systematic review with network meta-analysis (NMA). LITERATURE SEARCH: Medline, Embase, CINAHL, SPORTDiscus, and Cochrane Library were searched from inception up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials involving people with PFP and nonsurgical, nonpharmacological interventions on task kinematics were included. DATA SYNTHESIS: NMA was conducted for frontal knee movement data, and pairwise meta-analysis was used to pool data when NMA was not possible. Reduced movements were those changes that indicated movements occurring with less amplitude. The GRADE approach was used to grade the certainty of the evidence. RESULTS: Thirty-seven trials were included (n = 1235 participants). Combining knee/hip exercises with internal feedback had the strongest effect on reducing frontal knee movements (standardized mean difference [SMD] from NMA = -2.66; GRADE: moderate evidence). On pairwise comparisons, the same combination of interventions reduced frontal hip movements (SMD = -0.47; GRADE: moderate evidence) and increased sagittal knee movements (SMD = 1.03; GRADE: moderate evidence), with no effects on sagittal hip movements (GRADE: very low evidence), compared to knee/hip exercises alone. There was no effect for single applications of braces on the frontal knee movement (GRADE: very low evidence) and taping on movements of the knee, hip, and ankle (GRADE: very low to low evidence) compared to no intervention. CONCLUSION: Knee/hip exercises combined with internal feedback techniques may change knee and hip movements in people with PFP. The combination of these interventions can reduce frontal knee and hip movements, and can increase sagittal knee movements. J Orthop Sports Phys Ther 2023;53(12):1-13. Epub 14 September 2023. doi:10.2519/jospt.2023.11956.
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Gogia T, Singh N, Dasgupta T, Pramod R, Khera D, Sahu N. A Prospective Comparative Study of the Functional Outcomes of Patellar Resurfacing Versus Non-resurfacing in Patients Undergoing Total Knee Arthroplasty. Cureus 2023; 15:e50380. [PMID: 38213349 PMCID: PMC10782653 DOI: 10.7759/cureus.50380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Background and objective Total knee arthroplasty (TKA) is a highly successful surgical procedure. However, there is a lack of consensus about whether to resurface the patella or not. This study was aimed at evaluating the outcome of patellar resurfacing in terms of a decrease in the incidence of anterior knee pain after TKA and assessing whether patellar resurfacing is beneficial in improving functional outcomes. Materials and methods This prospective comparative study included 100 patients undergoing TKA who were randomly allotted to the patellar resurfacing or non-resurfacing group. Functional evaluation was done based on the Knee Society Score, and the pain was evaluated by the visual analogue scale (VAS) preoperatively and after one year. Results There was a significant improvement in the Knee Society scores as well as the pain scores in both groups postoperatively. The patellar resurfacing group showed statistically significant improvement as compared to the non-resurfacing group in the Knee Society clinical and functional scores as well as the VAS at the end of one year. Conclusion Patellar resurfacing during TKA provides better clinical and functional outcomes as well as more relief from anterior knee pain as compared to non-resurfacing of the patella.
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Affiliation(s)
- Tushar Gogia
- Orthopaedics, Base Hospital Delhi Cantonment, New Delhi, IND
| | - Narender Singh
- Orthopaedics, Base Hospital Delhi Cantonment, New Delhi, IND
| | | | - R Pramod
- Orthopaedics, Military Hospital Pathankot, Pathankot, IND
| | - Dhairya Khera
- Orthopaedics, Base Hospital Delhi Cantonment, New Delhi, IND
| | - Nitin Sahu
- Orthopaedics, Base Hospital Delhi Cantonment, New Delhi, IND
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Kim S, Park J, Boling MC, Glaviano NR. Lower Extremity Muscle Volume in Unilateral and Bilateral Patellofemoral Pain: A Cross-Sectional Exploratory Study Including Superficial and Deep Muscles Authors. J Athl Train 2023:497268. [PMID: 38015817 DOI: 10.4085/1062-6050-0330.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
CONTEXT Existing patellofemoral pain (PFP) literature has primarily focused on quadriceps muscle volume, with limited attention given to the lower limbs deep and superficial muscle volumes in individuals with unilateral and bilateral PFP. This research aims to fill this gap. OBJECTIVE To explore superficial and deep lower extremity muscle volume in women with unilateral and bilateral PFP compared to a normative database of pain-free women. DESIGN Cross-sectional study. SETTING University imaging research center. PATIENTS OR OTHER PARTICIPANTS Twenty women with PFP (10 unilateral and 10 bilateral) and 8 pain-free women. MAIN OUTCOME MEASURE(S) We quantified lower extremity muscle volume via 3.0 Tesla magnetic resonance imaging. Two separate one-way analyses of variance were performed: (1) unilateral PFP (painful vs. non-painful limb) vs. pain-free control and (2) bilateral PFP (more painful vs. less painful limb) vs. pain-free control. RESULTS There were no differences in age and body mass index across groups (P >.05). Compared to pain-free women, both women with unilateral and bilateral PFP had bilaterally smaller volumes of the anterior (iliacus: P ≤ .0004, d = 2.12-2.65), medial (adductor brevis, adductor longus, gracilis, and pectineus: P ≤ .02, d = 1.25-2.24), posterior (obturator externus, obturator internus, and quadratus femoris: P < .05, d = 1.17-4.82), and lateral (gluteus minimus: P ≤ .03, d = 1.16-2.09) hip muscles, and knee extensors (rectus femoris: P ≤.003, d = 1.67-2.16) and flexors (biceps femoris: long and short head: P ≤ .01, d = 1.56-1.93). CONCLUSIONS Both women with unilateral and bilateral PFP 25 displayed decreased volume of multiple superficial and deep muscles of the bilateral hips and knees compared with pain-free women. Interventions should bilaterally target lower limb muscles when treating PFP, and hypertrophy exercises for specific muscles should be explored to enhance interventional choices.
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Affiliation(s)
- Sungwan Kim
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, United States
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, FL, United States
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Sports Medicine, University of Connecticut, Storrs, CT, United States
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Kim S, Glaviano NR, Park J. Sex Differences in Knee Extensor Neuromuscular Function in Individuals With and Without Patellofemoral Pain. Sports Health 2023:19417381231209318. [PMID: 37978417 DOI: 10.1177/19417381231209318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Impaired knee extensor neuromuscular function has been frequently observed in individuals with patellofemoral pain (PFP); however, few researchers have aimed to understand the influence of sex on knee extensor neuromuscular function in this pathological population. The authors aimed to determine whether there are differences in knee extensor neuromuscular function between sexes in individuals with and without PFP. HYPOTHESIS Women with PFP would exhibit greater deficits in knee extensor neuromuscular function than men with PFP, compared with sex-matched individuals without PFP. STUDY DESIGN Cross-sectional, case-control study. LEVEL OF EVIDENCE Level 4. METHODS A total of 110 individuals were classified into 4 groups: women with PFP (n = 25); men with PFP (n = 30); women without PFP (n = 25); and men without PFP (n = 30). Knee extensor strength (isometric peak torque [PT]), activation (central activation ratio), early, late, and total phase rate of torque development (RTD0-100, RTD100-200, and RTD20-80%), and endurance (isokinetic average PT) were assessed using an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFP). RESULTS Both women and men with PFP exhibited lower knee extensor strength, activation, early, late, and total phase RTD, and endurance versus sex-matched individuals without PFP (P < 0.05 for all comparisons). Women with PFP exhibited lower early phase (7.91 ± 2.02 versus 9.78 ± 2.43 N·m/s/kg; P < 0.01; Cohen d = 0.83), late phase (5.34 ± 1.02 versus 7.28±2.28 N·m/s/kg; P < 0.01; Cohen d = 1.37), and total phase (7.40 ± 2.57 versus 8.72 ± 2.57 N·m/s/kg; P = 0.03; Cohen d = 0.51) RTD than men with PFP. CONCLUSION Compared with sex-matched pain-free individuals, women with PFP displayed lower RTD than men with PFP. Clinicians should note that among individuals with PFP, women are more likely to experience a greater impairment in their knee extensor torque-generating capacity than men. CLINICAL RELEVANCE Additional treatment strategies that effectively improve the ability to rapidly generate torque should be developed and implemented, especially when treating women with PFP.
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Affiliation(s)
- Sungwan Kim
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
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Mechlenburg I, Nielsen TG, Kristensen N, Bentzen A, Jørgensen SL. Low-load exercises with concurrent blood flow restriction as rehabilitation for unspecific knee pain to a former American football player: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231203465. [PMID: 37799292 PMCID: PMC10548794 DOI: 10.1177/2050313x231203465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
Former athlete, 30 years of age, suffered several months of moderate anterior knee pain during daily life activities where daily life activities such as negotiating stairs and lifting heavy objects were moderately painful. Magnetic resonance imaging showed normal meniscus and cruciate ligaments and no extra joint fluid. The patient was referred to a physiotherapist who introduced a strengthening program. Low-load resistance training with concurrent blood flow restriction can induce significant gains in maximal muscle strength and mass with minimal exacerbation of knee-joint pain. We describe the outcome of 12 weeks low-load resistance training with concurrent blood flow restriction as a rehabilitation method for anterior knee pain. The patient performed low-load resistance training with concurrent blood flow restriction for the lower limbs (goblet squat, single-leg knee extensions and flexions). After the low-load resistance training with concurrent blood flow restriction, the patient increased isometric knee extensor muscle strength (31%), single-leg hop test performance (23%), obtained clinically relevant improvements in patient-reported outcomes and was able to return to his usual high-loading training regime. Low-load resistance training with concurrent blood flow restriction seems promising to transition patients back to a healthy lifestyle of training and being physically active.
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Affiliation(s)
- Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Public Health, Section of Sports, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Torsten Grønbech Nielsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Occupational and Physical Therapy, Aarhus University Hospital, Aarhus N, Denmark
| | - Nick Kristensen
- Department of Public Health, Section of Sports, Aarhus University, Aarhus, Denmark
| | - Andreas Bentzen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Stian Langgård Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
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AlWadi D, Jweinat M, Almigdad A, AlRousan F, Alawamleh A, Hseinat L. Reduction of Operative Time, Intraoperative Radiographs, and Anterior Knee Pain With the Lateral Parapatellar Approach for Tibial Shaft Fracture Nailing: A Case Series. Cureus 2023; 15:e47309. [PMID: 38021772 PMCID: PMC10657169 DOI: 10.7759/cureus.47309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Tibia fracture is a common indication for operative intervention in orthopedics. Usage of Intramedullary nailing provides a minimally invasive technique with good results. Positioning, operative time, and radiation exposure are major points in such cases. This study described the semi-extended lateral parapatellar intramedullary technique as a technique that helps achieve and maintain reduction, simplifies nail insertion, and decreases fluoroscopy and operative time. Methodology This prospective case series study included nine patients with tibial shaft fractures operated at Royal Rehabilitation Center from April to October 2023 by intramedullary nailing and extra-articular lateral parapatellar insertion technique using the semi-extended knee position. Duration of surgery, intraoperative radiation exposure, and anterior knee pain score were assessed for all patients. Results The average duration of surgery was 63.78 ± 5.3 minutes, and the average intraoperative imaging was 94 (85-103). The average union time was 18 ±2 weeks. The mean Kujala score was 90.9% ± 2.3% six months after the surgery. All patients regained a comparable range of motion in their knees and ankles. One patient reported minimal pain at the pin site but did not require any analgesia. Conclusion The lateral parapatellar approach for tibial shaft fracture nailing has the advantage of reducing operative time, the number of intraoperative radiographs, and lower postoperative anterior knee pain. Additionally, this approach did not cause patellar instability.
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Affiliation(s)
- Deya AlWadi
- Department of Orthopaedics, Jordanian Royal Medical Services, Amman, JOR
| | - Murad Jweinat
- Department of Orthopaedics, Jordanian Royal Medical Services, Amman, JOR
| | - Ahmad Almigdad
- Department of Orthopaedics, Jordanian Royal Medical Services, Amman, JOR
| | - Fadi AlRousan
- Department of Orthopaedics, Jordanian Royal Medical Services, Amman, JOR
| | - Ahmad Alawamleh
- Department of Orthopaedics, Jordanian Royal Medical Services, Amman, JOR
| | - Laith Hseinat
- Department of Orthopaedics, Jordanian Royal Medical Services, Amman, JOR
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Selhorst M, Hoehn J, Schmitt L, Benedict J, Fernandez-Fernandez A. The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:634–642. [PMID: 37706686 DOI: 10.2519/jospt.2023.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.
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Gencer B, Yiğit A, Çamoğlu C, Çulcu A, Dogan O. Can Anterior Knee Pain Be Explained by Patella Position After Infrapatellar Tibia Intramedullary Nailing? Cureus 2023; 15:e47334. [PMID: 38021528 PMCID: PMC10657199 DOI: 10.7759/cureus.47334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate the postoperative position of the patella and its relationship with anterior knee pain in patients operated with infrapatellar reamed tibia intramedullary nailing (IMN). MATERIALS AND METHODS Patients who underwent tibia IMN between 2019 and 2022 and who had anterior knee pain in their postoperative follow-up at least two outpatient clinic controls with an interval of at least one month were examined. Patellar height indices (Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Insall-Salvati) and sagittal angulation (patella-patellar tendon angles) were measured on the lateral direct radiographs of the patients in semi-flexion. As a control group, measurements were made on the contralateral intact extremity radiographs of the same patients. RESULTS There was no significant difference in patellar height indices between the fractured and intact sides in any of the patients (p = 0.588; p = 0.747; p = 0.446; p = 0.573, respectively). When the sagittal angulations were analyzed, a significant difference was found between the fractured and intact sides of the patients (p = 0.048), resulting in an approximate three-degree change. CONCLUSION Patellar sagittal balance has been identified as one of the contributing factors to the development of anterior knee pain following reamed tibial IMN. Further biomechanical and comprehensive clinical studies are needed on this subject.
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Affiliation(s)
- Batuhan Gencer
- Department of Orthopaedics and Traumatology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, TUR
| | - Alperen Yiğit
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Can Çamoğlu
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Ahmet Çulcu
- Department of Orthopaedics and Traumatology, Yüksekova State Hospital, Hakkâri, TUR
| | - Ozgur Dogan
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
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Cepni SK, Kemah B, Karataş ME, Oruç MM, Batar S, Söylemez MS. Comparison of clinical and radiological results after a minimum one-year follow-up of tibial fractures operated via suprapatellar or infrapatellar intramedullary nailing: A retrospective study. Jt Dis Relat Surg 2023; 34:679-686. [PMID: 37750273 PMCID: PMC10546852 DOI: 10.52312/jdrs.2023.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES In this study, we aimed to evaluate the clinical and radiological results after a minimum one-year follow-up of suprapatellar (SP) and infrapatellar (IP) nail applications for the treatment of tibial fractures. PATIENTS AND METHODS Between September 2019 and September 2021, a total of 80 patients treated for tibial fractures were retrospectively analyzed. The patients were divided into two equal groups including 40 patients in each group. The first group (32 males, 8 females; mean age: 36.4±13.2 years; range, 19 to 64 years) consisted of those who were operated using intramedullary nailing (IMN) through the SP approach (SP group). The second group (25 males, 15 females; mean age: 34.4±13.6 years; range, 15 to 64 years) consisted of patients operated with IMN using an IP approach (IP group). Data including the location of the fracture, duration of surgery, need for additional interventions for fracture reduction, union time, duration of follow-up, delayed union, nonunion, malunion, and infection rates were recorded. During the final follow-up, we evaluated the results for range of motion (ROM), Visual Analog Scale (VAS), score, Lysholm score, and Knee Society Score (KSS) postoperative functional outcome measure. RESULTS The mean duration of follow-up in the SP and IP groups were 17.6±2.3 (range, 13 to 21) and 19.9±1.3 (range, 15 to 41) months, respectively (p=0.236). The mean duration of surgery was significantly shorter in the SP group than in the IP group (73.2±19.9 [45 to 160] min in the SP group and 152.0±28.5 [100 to 240] min in the IP group) (p=0.0001). There was no significant difference between the groups regarding duration of postoperative hospital stay, union time, and decrease in hemoglobin levels. There was no significant difference between the groups regarding Lysholm scores, KSS functional outcome scores, VAS, ROM, and thigh and calf diameter difference measured at the final follow-up. A Poller screw or provisional Kirschner wire was used for 14 (35%) of 16 diametaphyseal fractures in the IP group. No additional technique was used for any patient in SP group (p=0.001). CONCLUSION The SP application of an IMN for diaphyseal tibial fractures yields an easy and practical application, having easy reduction with shorter operative time and no need for additional techniques to achieve reduction. However, the clinical and radiological outcomes of both techniques are similar after a one-year follow-up.
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Affiliation(s)
| | | | - Muhammed Enes Karataş
- Ümraniye Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 34764 Ümraniye, İstanbul, Türkiye.
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Samih M, Fadili H, Chagou A, Jaafar A, Zryouil B. Resurfacing Versus Non-resurfacing Patella in Total Knee Replacement: When and What to Choose. Cureus 2023; 15:e44276. [PMID: 37772249 PMCID: PMC10523826 DOI: 10.7759/cureus.44276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION The opinion on the necessity of patella resurfacing has been deeply divided in the scientific community. There are three approaches to the management of the patella in total knee arthroplasty (TKA). The first method involves always resurfacing the patella, the second method involves never resurfacing it, and the third method involves resurfacing the patella only under specific circumstances. Different data support each of these strategies, but no consensus on the best management has been reached. METHODS This is a retrospective study of 106 cases of TKA (including 29 resurfaced patellas and 77 non-resurfaced patellas), over 5 years, at the Trauma-Orthopedics Department of the Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco. Our objective is to conduct a comparative study between TKA with patella resurfacing and those without resurfacing, by analyzing the functional and radiological results obtained after the operation, to show each technique's advantages and disadvantages. RESULTS The average age of our patients was 65 years with extremes ranging from 46 to 80 years. There was a clear female predominance with a sex ratio of 0.2. The left side was predominantly affected. Primary gonarthrosis was the main diagnosis. Our results showed no significant difference between the two groups in terms of patient satisfaction and Knee Society Score (KSS). Nevertheless, complications generated by resurfacing, such as infection, anterior pain, stiffness, and loosening of the patellar component, as well as additional costs and increased operative time, were observed. In the majority of meta-analyses, there was no discernible difference in clinical and functional results between the resurfaced and non-resurfaced groups, suggesting that patellar resurfacing is not beneficial and, therefore, unnecessary. CONCLUSION It appears that regular resurfacing is not necessary. However, there is agreement that resurfacing the patella is the best course of action for patients with inflammatory arthropathy, considerable patella malalignment, and severe patellofemoral osteoarthritis. There are arguments in favor of each of the patella resurfacing techniques, but none of them are particularly compelling, each of these strategies has its advantages and should not be considered bad. The final decision, therefore, rests on each surgeon's practice, training, and experience.
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Affiliation(s)
- Mohamed Samih
- Orthopedics and Traumatology, Cheikh Khalifa Bin Zayed Al Nahyan Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Hajar Fadili
- Neurology, Cheikh Khalifa Bin Zayed Al Nahyan Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Aniss Chagou
- Orthopedics and Traumatology, Cheikh Khalifa Bin Zayed Al Nahyan Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Abdeloaihab Jaafar
- Orthopedics and Traumatology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Bouchaib Zryouil
- Orthopedics and Traumatology, Cheikh Khalifa Bin Zayed Al Nahyan Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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Song K, Scattone Silva R, Hullfish TJ, Silbernagel KG, Baxter JR. Patellofemoral Joint Loading Progression Across 35 Weightbearing Rehabilitation Exercises and Activities of Daily Living. Am J Sports Med 2023; 51:2110-2119. [PMID: 37272685 PMCID: PMC10315869 DOI: 10.1177/03635465231175160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Exercises that provide progressive therapeutic loading are a central component of patellofemoral pain rehabilitation, but quantitative evidence on patellofemoral joint loading is scarce for a majority of common weightbearing rehabilitation exercises. PURPOSE To define a loading index to quantify, compare, rank, and categorize overall loading levels in the patellofemoral joint across 35 types of weightbearing rehabilitation exercises and activities of daily living. STUDY DESIGN Descriptive laboratory study. METHODS Model-estimated knee flexion angles and extension moments based on motion capture and ground-reaction force data were used to quantify patellofemoral joint loading in 20 healthy participants who performed each exercise. A loading index was computed via a weighted sum of loading peak and cumulative loading impulse for each exercise. The 35 rehabilitation exercises and daily living activities were then ranked and categorized into low, moderate, and high "loading tiers" according to the loading index. RESULTS Overall patellofemoral loading levels varied substantially across the exercises and activities, with loading peak ranging from 0.6 times body weight during walking to 8.2 times body weight during single-leg decline squat. Most rehabilitation exercises generated a moderate level of patellofemoral joint loading. Few weightbearing exercises provided low-level loading that resembled walking or high-level loading with both high magnitude and duration. Exercises with high knee flexion tended to generate higher patellofemoral joint loading compared with high-intensity exercises. CONCLUSION This study quantified patellofemoral joint loading across a large collection of weightbearing exercises in the same cohort. CLINICAL RELEVANCE The visualized loading index ranks and modifiable worksheet may assist clinicians in planning patient-specific exercise programs for patellofemoral pain rehabilitation.
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Affiliation(s)
- Ke Song
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rodrigo Scattone Silva
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Todd J. Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Josh R. Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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23
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Spencer SJ, Jamal B, Abram SGF, Kane N, Mohammed A. Patella Denervation With Circumferential Electrocautery in Primary Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2023; 38:1057-1062. [PMID: 36858129 DOI: 10.1016/j.arth.2023.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical effectiveness of patella rim electrocautery "denervation" versus no denervation in patients undergoing total knee arthroplasty (TKA). METHODS We conducted a single-center, double-blind randomized controlled trial. Patients aged 40 years or older, due to undergo a TKA who did not have patella resurfacing (usual care) were randomized with or without circumferential patella electrocautery. This was undertaken according to a randomly generated sequence of treatment allocation that was placed into numbered, sealed opaque envelopes. Participants were blinded to treatment allocation. There was no crossover. The primary outcome was Oxford Knee Score at 1 year postoperatively. Secondary outcomes were Bartlett Patella Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-Item Short Form Survey. Linear regression analyses were performed with adjustments by age, sex, and baseline (preoperative) scores. There were 142 participants recruited, of which 49 (35%) were allocated to the denervation intervention. Recruitment was stopped early when interim statistical analyses confirmed adequate numbers in both groups despite an imbalance in early treatment allocation rates due to the randomization method. The mean patient age was 71 years (range, 50 to 85) and 51% (n = 74) were women. RESULTS No difference in Oxford Knee Score was detected at 1 year (mean difference [MD] 1.87; 95% confidence interval [CI] -1.28 to 5.03). No difference was detected in Bartlett Patella Score (MD 0.490; 95% CI -1.61 to 2.59) or 12-Item Short Form Survey (MD 0.196; 95% CI -2.54 to 2.93). A statistically significant difference in WOMAC was detected, but at a level less than the minimal clinically important difference for WOMAC (MD 4.79; 95% CI 1.05 to 8.52). CONCLUSION No clinically relevant benefit was detected from patella rim electrocautery in patients undergoing TKA who did not have patella resurfacing (including no benefit in terms of anterior knee pain). This treatment is therefore not recommended for clinical practice. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Simon J Spencer
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Bilal Jamal
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Simon G F Abram
- Queen Elizabeth University Hospital, Glasgow, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Nicholas Kane
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Aslam Mohammed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Kim S, Roh Y, Glaviano NR, Park J. Quadriceps Neuromuscular Function During and After Exercise-Induced Fatigue in Patients With Patellofemoral Pain. J Athl Train 2023; 58:554-562. [PMID: 36395370 PMCID: PMC10496447 DOI: 10.4085/1062-6050-0348.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
CONTEXT Exercise-induced fatigue reduces muscle force production and motoneuron pool excitability. However, it is unclear if patients with patellofemoral pain (PFP) experience further loss in quadriceps neuromuscular function due to fatigue during exercise and postexercise. OBJECTIVE To observe how quadriceps maximal strength, activation, and force-generating capacity change during and after repetitive bouts of isokinetic knee-extension exercise in patients with PFP. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-two patients with PFP (visual analog scale mean pain severity = 4.2 of 10 cm, mean symptom duration = 38.6 months) and 19 healthy control individuals matched on age and body mass index. MAIN OUTCOME MEASURE(S) Quadriceps peak torque (PT), central activation ratio (CAR), and rate of torque development (RTD) were assessed at baseline and immediately after every 5 sets of knee-extension exercise (times 1-5). Participants continued knee-extension exercises until the baseline quadriceps PT dropped below 50% for 3 consecutive contractions. RESULTS No group-by-time interaction was observed for quadriceps PT (F5,195 = 1.03, P = .40). However, group-by-time interactions were detected for quadriceps CAR (F5,195 = 2.63, P= .03) and RTD (F5,195 = 3.85, P = .002). Quadriceps CAR (-3.6%, P = .04, Cohen d = 0.53) and RTD (-18.9%, P = .0008, Cohen d = 1.02) decreased between baseline and time 1 in patients with PFP but not in their healthy counterparts (CAR -1.9%, P = .86; RTD -9.8%, P = .22). Quadriceps RTD also decreased between times 4 and 5 in patients with PFP (-24.9%, P = .002, Cohen d = 0.89) but not in the healthy group (-0.9%, P = .99). CONCLUSIONS Patients with PFP appeared to experience an additional reduction in quadriceps activation, force-generating capacity, or both during the early and late stages of exercise compared with healthy individuals. Clinicians should be aware of such possible acute changes during exercise and postexercise and use fatigue-resistant rehabilitation programs for patients with PFP.
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Affiliation(s)
| | | | | | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Korea
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Abstract
The anterior part (third space) of the knee appears important in the soft tissue functional outcome following knee replacement surgery. Native patellofemoral kinematics are complex and variable, and further understanding has led to prosthetic redesign. Attention to soft tissue tension anteriorly (balancing the third space) during knee replacement may maximise post-operative function and avoid issues with understuffing and overstuffing. Patellofemoral compression forces may now be measured dynamically during knee replacement, allowing an objective approach to balancing the third space.
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Affiliation(s)
- David Barrett
- School of Engineering Science, University of Southampton, United Kingdom
- Instituto Clinico Citta Studi, Milan, Italy
| | - Angela Brivio
- Instituto Clinico Citta Studi, Milan, Italy
- King Edward VII Hospital, London, UK
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Díaz-Allende P, Osorio-Riquelme V, Colmenares-Sandoval O, Partarrieu-Stegmeier R, Guillén-Vicente I, Guillén-García P. [ Anterior knee pain: a simplified assessment and management algorithm]. Acta Ortop Mex 2023; 37:126-136. [PMID: 38052432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Anterior knee pain is a common condition that affects adolescent and young adult patients, being one of the most challenging consultations for a knee surgeon. The large number of distinct diagnoses makes it a peculiar syndrome, the only similarities being the presence of retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. From a pathophysiological perspective, an overuse injury should be considered, where the structural unit of the tissue is damaged or its capacity for reparative response is exceeded. The diagnosis is clinical. Images should be reserved for a particular group of patients. Early intervention is essential to achieve favorable results. Conservative treatment is the gold standard and it is based on multimodal management validated by international consensus. Based on a categorization by clinic and images, we can have a guide to those etiologies that are susceptible to surgical management. The goal of the intervention is to reduce joint stress. The present review defines a simplified algorithm for the study and management of anterior knee pain.
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27
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Takagi S, Blaha JD, Mochizuki T. Medial-pivot design improved knee symptoms from anteroposterior instability in early-range flexion and resolved anterior knee pain in revision total knee arthroplasty. J Arthroplasty 2023; 38:S284-S289. [PMID: 36958715 DOI: 10.1016/j.arth.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Instability can lead to poor functional results after tricompartmental total knee arthroplasty (TKA). We identified a group of patients who appeared to have antero-posterior (AP) instability in early-range flexion (i.e., 20 to 30° range) associated with anterior knee pain and feelings of instability. The purpose of this study was to assess the clinical results in terms of stability and anterior knee pain after revision TKA with a medial-pivot implant and to assess the effect of the implant positioning used in the revision technique. METHODS There were 45 patients (45 knees) evaluated retrospectively to assess standing lower extremity alignment and functional results by generating a knee stability score after revision TKA with medial pivot implant design. RESULTS Revision TKA using the medial-pivot TKA lowered the joint line by 3.6 millimeters (mm) (P<0.001) and positioned the tibia anteriorly by 3.5 mm (P<0.001) on radiographic measurements as compared with results after primary TKA. Moreover, medial pivot revision TKA improved AP stability by a 56-point change in score (P<0.001). CONCLUSIONS Revision TKA using a medial pivot design improved AP stability and anterior knee pain after failed primary procedures.
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Affiliation(s)
- Shigeru Takagi
- Department of Orthopaedic Surgery, University of Michigan, Michigan, USA;; Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - John David Blaha
- Department of Orthopaedic Surgery, University of Michigan, Michigan, USA
| | - Tomoharu Mochizuki
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Department of Orthopaedic Surgery, University of Michigan, Michigan, USA
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28
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Krishna MLVS, Mittal R, Chauhan N. Bone Grafting of the Bone Defects after Harvesting the Bone Patellar Tendon Bone Graft - A Novel Surgical Technique. J Orthop Case Rep 2023; 13:72-75. [PMID: 37187812 PMCID: PMC10178818 DOI: 10.13107/jocr.2023.v13.i03.3590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2022] [Indexed: 05/17/2023] Open
Abstract
Introduction The anterior knee pain is the most common post-operative complaint associated with anterior cruciate ligament reconstruction (ACLR) using bone patellar tendon bone graft. It has been attributed to various factors such as loss of terminal extension, infrapatellar branch neuroma, and also due to the bone harvest site defect itself. Bone grafting of the defects in the patella and tibia has been shown to decrease anterior knee pain. At the same time, it also prevents post-operative stress fractures. Surgical Technique Numerous bone pieces were produced in the knee joint as a result of the drilling during ACL reconstruction. Using a wash cannula and tissue grasper, all the bone fragments were gathered into a kidney tray. The bony fragments with the saline which were collected in the metal container were allowed to sediment at the bottom. The bone that was sedimented in the metal container was collected by decantation and placed into the bony defects of the patellar and tibial sides. Conclusion Bone grafting of the defects in the patella and tibia has been shown to decrease anterior knee pain. Our technique is cost-effective as there is no requirement for special instrumentation like coring reamers, and no requirement for allograft or bone substitutes. Second, there is no morbidity associated with autografts harvested from elsewhere, we used the bone generated during the ACLR itself.
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Affiliation(s)
- M L V Sai Krishna
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
- Address of Correspondence: Dr. M L V Sai Krishna, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Ravi Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Chauhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Debbi EM, Mayman DJ, Sapountzis N, Hawes J, Cororaton AD, Potter HG, Haas SB, Chalmers BP. Significantly Worse Fixation of Cemented Patellar Components on Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging Compared to Femoral and Tibial Components: A Cause for Concern? J Arthroplasty 2023; 38:S368-S373. [PMID: 36801475 DOI: 10.1016/j.arth.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The etiology of anterior knee pain after total knee arthroplasty (TKA) remains unclear. Few studies have examined patellar fixation quality. The purpose of the present study was to evaluate the patellar cement-bone interface after TKA on magnetic resonance imaging (MRI) and to correlate the patella fixation grade with the incidence of anterior knee pain. METHODS We retrospectively reviewed 279 knees undergoing metal artifact reduction MRI for either anterior or generalized knee pain at least 6 months after cemented, posterior-stabilized TKA with patellar resurfacing with one implant manufacturer. MRI cement-bone interfaces and percent-integration of the patella, femur, and tibia were assessed by a fellowship-trained senior musculoskeletal radiologist. The grade and character of the patella interface were compared to the femur and tibia. Regression analyses were used to determine the association between patella integration with anterior knee pain. RESULTS There were more patellar components with ≥75% zones of fibrous tissue (50%) compared to the femur (18%) or tibia (5%) (P < .001). There were a greater number of patellar implants with poor cement integration (18%) compared to the femur (1%) or tibia (1%) (P < .001). MRI findings showed more evidence of patellar component loosening (8%) compared to the femur (1%) or tibia (1%) (P < .001). Anterior knee pain was correlated with worse patella cement integration (P = .01), with women predicted to have better integration (P < .001). CONCLUSION The quality of the patellar cement-bone interface after TKA is worse compared to the femoral or tibial component interface. Poor patellar cement-bone interface may be a source of anterior knee pain after TKA, but further investigation is required.
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Affiliation(s)
- Eytan M Debbi
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Nicolas Sapountzis
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Joseph Hawes
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Agnes D Cororaton
- Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Steven B Haas
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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30
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Jeon H, Donovan L, Thomas AC. Exercise-Induced Changes in Femoral Cartilage Thickness in Patients With Patellofemoral Pain. J Athl Train 2023; 58:128-135. [PMID: 35476136 PMCID: PMC10072095 DOI: 10.4085/1062-6050-0602.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Rehabilitative exercises alleviate pain in patients with patellofemoral pain (PFP); however, no researchers have analyzed the cartilage response after a bout of those athletic activities in patients with PFP. OBJECTIVE To determine if a single session of rehabilitative exercises alters femoral cartilage morphology. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve participants with PFP (age = 21.0 ± 2.0 years, height = 1.72 ± 0.1 m, mass = 68.7 ± 12.6 kg) and 12 matched healthy participants (age = 21.3 ± 2.8 years, height = 1.71 ± 0.1 m, mass = 65.9 ± 12.2 kg) were enrolled. INTERVENTION(S) Participants completed treadmill running, lower extremity strengthening exercises, and plyometric exercises for 30 minutes each. MAIN OUTCOME MEASURE(S) Patient-reported outcomes on the visual analog scale, Anterior Knee Pain Scale (AKPS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Knee Injury and Osteoarthritis Outcome Score for Patellofemoral Pain and Osteoarthritis were collected. Femoral cartilage ultrasonographic images were obtained at 140° of knee flexion. Ultrasound images were segmented into medial and lateral images using the intercondylar notch. Medial and lateral cartilage cross-sectional area (mm2) and echo intensity (EI), defined as the average grayscale from 0 to 255, were analyzed by ImageJ software. The difference between loading conditions was calculated using repeated-measures analysis of variance. The Spearman correlation was calculated to find the association between the cartilage percentage change (Δ%) and patient-reported outcomes. RESULTS Pain increased in the PFP group after all loading conditions (P values < .007). No differences were found in cartilage cross-sectional area or EI alteration between or within groups (P values > .06). The KOOS was negatively associated with the Δ% of the lateral femoral cartilage EI after plyometric loading (ρ = -0.87, P = .001), and the AKPS score was positively correlated with the Δ% of lateral femoral cartilage EI (ρ = 0.57, P = .05). CONCLUSIONS Ultrasound imaging did not identify cartilaginous deformation after all loading conditions. However, because lateral cartilaginous EI changes were associated with the AKPS and KOOS score, those questionnaires may be useful for monitoring changes in femoral cartilage health.
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Affiliation(s)
- Hyunjae Jeon
- Dunnigan Movement Analysis Lab, School of Health Sciences, University of Evansville, IN
| | - Luke Donovan
- Biodynamics Laboratory, Department of Applied Physiology, Health, and Clinical Sciences, University of North Carolina at Charlotte
| | - Abbey C. Thomas
- Biodynamics Laboratory, Department of Applied Physiology, Health, and Clinical Sciences, University of North Carolina at Charlotte
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Teh HL, Kassim AF, Chopra S, Selvaratnam V. A Rare Presentation of Patella Button Aseptic Loosening After a Total Knee Replacement Without Evidence of Radiographic Loosening. Cureus 2023; 15:e34665. [PMID: 36909109 PMCID: PMC9997687 DOI: 10.7759/cureus.34665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Patella resurfacing in total knee replacement (TKR) has been shown to reduce the rate of anterior knee pain, but there are complications from patella resurfacing. A 54-year-old male underwent a left primary TKR with patella resurfacing 15 years ago. He developed spontaneous progressive anterior knee pain for six months. At revision surgery, his patella button was found to be loose. Loosening of a three-peg patella button is rare. A high index of suspicion of patella button loosening should be suspected in patients who present with anterior knee pain after patella resurfacing.
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Affiliation(s)
- Hak Lian Teh
- Exeter Hip Unit and Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, GBR
| | | | - Suresh Chopra
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Alor Setar, MYS
| | - Veenesh Selvaratnam
- National Orthopaedic Centre of Excellence in Research and Learning, Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Seijas-Otero D, Alonso-Calvete A, Cuña-Carrera ID, Justo-Cousiño LA. Effects of taping in patellofemoral pain syndrome: A systematic review. J Back Musculoskelet Rehabil 2023; 36:261-269. [PMID: 35964172 DOI: 10.3233/bmr-220099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patellofemoral pain syndrome (PPS) is defined as a condition in the patellofemoral joint that can present with pain, functional deficit, crepitus, and instability. Its etiology appears to lie in excessive loading of the patellofemoral joint due to mispositioning of the patella. The application of taping has recently increased, to manage PPS. However, the level of scientific evidence in this sense is unknown. OBJECTIVE To determine the effect of different types of taping in subjects with PPS. METHODS A bibliographic search was carried out in January and February 2021 in Scopus, Web of Science, PubMed, Medline, SPORTDiscus, PEDro and CINAHL. RESULTS A total of 13 studies were included for qualitative analysis. The mean score on the PEDro scale was 5.30 points. Most of the articles reflect a decrease in pain after the taping intervention, while variables such as functionality, muscle activity and biomechanical modification do not show positive effects. CONCLUSION Taping appears to have positive effects on pain in subjects with PPS. However, the evidence is contradictory with the rest of the variables studied.
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Affiliation(s)
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo, Pontevedra, Spain.,REMOSS Research Group. Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
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Lachowski K, Hammermeister F, Halenz B, Lieckefett F, Götze T, Prill R, Becker R. The Patellostabilometer: A New Device for Quantification of Mediolateral Patella Displacement. Sensors (Basel) 2023; 23:1274. [PMID: 36772314 PMCID: PMC9920919 DOI: 10.3390/s23031274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Mediolateral patella displacement is of interest for diagnostics and clinically relevant research questions. Apart from manual testing, no standardized method is currently available. Proper quantification of patella mobility is necessary to better understand pathologies at the patellofemoral joint. Patella mobility was assessed in 25 healthy individuals using a Patellostabilometer, a new prototype instrument for quantification of the mediolateral patella displacement. The participants underwent measurements of the mediolateral displacement three times using the Patellostabilometer. A maximal force of 10 N was applied for patella movement. Additionally, leg length and circumference of the knee, upper- and lower-leg were measured. Lateral patella displacement of 18.27 ± 3.76 mm (range 15.85-20.64 mm, interquartile range (IQR) of 4.79) was measured. The medial patella displacement showed 24.47 ± 6.59 mm (range 19.29-29.76 mm, IQR of 10.47). The test-retest measurement error was 2.32 ± 1.76 mm (IQR of 2.38 mm), with five outliers. There was greater test-retest variability between the measurements of the medial displacement compared to the lateral one. The test-retest variability reached 7% of the patella displacement. Other parameters provided no significant correlations. Based on the natural patellofemoral mobility, a precise and clinically relevant quantification of patella mobility is allowed.
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Affiliation(s)
- Krzysztof Lachowski
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770 Brandenburg a.d.H., Germany
| | - Florian Hammermeister
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Bastian Halenz
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Florian Lieckefett
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Thomas Götze
- Technical Faculty, Brandenburg University of Applied Sciences, 14770 Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770 Brandenburg a.d.H., Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg a.d.H., Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770 Brandenburg a.d.H., Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg a.d.H., Germany
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Adam R, Moldovan C, Tudorache S, Hârșovescu T, Orban C, Pogărășteanu M, Rusu E. Patellar Resurfacing in Total Knee Arthroplasty, a Never-Ending Controversy; Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13030383. [PMID: 36766489 PMCID: PMC9914207 DOI: 10.3390/diagnostics13030383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Total knee arthroplasty (TKA) remains a lifesaving procedure for advanced gonarthrosis. However, patella resurfacing (PR) in TKA remains a controversial procedure, leading to extensive discussions amongst orthopedic surgeons, regarding its indications and results. Based on these premises, we present a clinical case of a 70-year-old Caucasian woman admitted for pain, swelling and limitation of left knee joint mobility. Her medical history records an Ahlback stage IV gonarthrosis with simultaneous bilateral TKA surgery performed in different hospital, when two NexGen cemented total prostheses were implanted with patellar resurfacing being performed only on the right side. Our clinical (American Knee Society Score, Lonner and Feller scales) and radiological evaluations (CT scan and Xray) revealed left patellar arthrosis and a slight lateral subluxation of the patella. The chosen treatment plan was revision surgery for PR and patellar prosthesis with a cemented patellar component, cross-linked polyethylene, no 32 NexGen model with 8.5 mm thickness. The immediate and distant postoperative evolution was favorable. Extensive literature review shows that, at present, PR remains at surgeon's discretion mainly based on his previous results. Therefore, we believe there is an imperative need to develop high quality studies based on accurate scientific evidence to universally establish valid guidelines for PR in TKA.
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Affiliation(s)
- Răzvan Adam
- Department of Orthopedics and Traumatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Department of First Aid and Disaster Medicine, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
| | - Cosmin Moldovan
- Department of Clinical Sciences, General Surgery, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
- Department of General Surgery, Witting Clinical Hospital, 010243 Bucharest, Romania
- Correspondence: (C.M.); (T.H.); Tel.: +40-723504207 (C.M.); +40-723234060 (T.H.)
| | - Sorin Tudorache
- Department of Preclinical Sciences, Anatomy and Embryology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
| | - Tudor Hârșovescu
- Department of Preclinical Sciences, Anatomy and Embryology, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
- Correspondence: (C.M.); (T.H.); Tel.: +40-723504207 (C.M.); +40-723234060 (T.H.)
| | - Carmen Orban
- Department of Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Intensive Care Unit Department, Monza Oncology Hospital, 013812 Bucharest, Romania
| | - Mark Pogărășteanu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Orthopedics and Traumatology, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Elena Rusu
- Department of Preclinical Sciences, Biochemistry, Faculty of Medicine, Titu Maiorescu University of Bucharest, 040051 Bucharest, Romania
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Pazzinatto MF, Barton CJ, Willy RW, Ferreira AS, Azevedo FM, de Oliveira Silva D. Are Physical Function and Fear of Movement Risk Factors for Patellofemoral Pain? A 2-Year Prospective Study. J Sport Rehabil 2023; 32:24-30. [PMID: 35894902 DOI: 10.1123/jsr.2021-0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 01/03/2023]
Abstract
CONTEXT To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. DESIGN Prospective observational study. METHODS A total of 114 asymptomatic females (18-22 y old) completed assessment of physical function (forward step-down test and single-leg hop for distance) and fear of movement using the Tampa Scale for Kinesiophobia at baseline and 2-year follow-up. Presence of symptoms of PFP was monitored bimonthly. RESULTS Ninety participants (retention rate = 79%) completed the 2-year follow-up assessment, with 27 (24% of the cohort) developing PFP. Physical function, including forward step-down test (P = .659) and single-leg hop for distance (P = .825), and fear of movement (P = .479) were not associated with the risk of developing PFP. Females who developed PFP presented with reduced forward step-down repetitions (mean difference = 2.8; 95% confidence interval, 0.2 to 5.3) and single-leg hop for distance (10.2; 95% confidence interval, 2.7 to 17.7 cm) at 2-year follow-up. There was no statistically significant difference between those who did and did not develop PFP for fear of movement (-3.4; 95% confidence interval, -7.0 to 0.2). CONCLUSIONS Physical function and fear of movement were not associated with the risk of developing PFP in young females. However, the change over time in the step-down and single-leg hop for distance tests may suggest that, even in the early stages of PFP, young females present impaired physical function compared with females who did not develop symptoms. Fear of movement may develop due to persistent PFP, and does not appear to be a risk factor or key feature in females with PFP of short symptoms duration.
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Ji X, Huang X, Zhang Y, Zhao M, Liu Y, Cheng Y. Peripheral patellar denervation has a better effect in reducing postoperative anterior knee pain than patellar resurfacing in TKA. Medicine (Baltimore) 2022; 101:e31584. [PMID: 36397397 PMCID: PMC9666178 DOI: 10.1097/md.0000000000031584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patellar resurfacing (PR) and peripheral patellar denervation (PD) are common surgical treatments for knee osteoarthritis (KOA) in total knee arthroplasty (TKA). The aim of study was to compare preventive effect on postoperative anterior knee pain (AKP) between PR and peripheral PD in TKA. A total of 202 patients who underwent unilateral TKA were randomized into 3 groups: T, TPD, and TPR. Patients in T group received simple TKA, patients in TPD group received TKA combined PD while patients in TPR group received TKA combined PR. Incidence, intensity, and presentation time of AKP and clinical outcomes were evaluated at 3, 6, 9, 12, 18, and 24 months postoperatively. The incidence of AKP was significantly lower and the intensity of AKP and patients' satisfaction score were significantly better at 3 months after surgery in group TPD and TPR compared with group T. Compared with group TPR, the intensity of AKP was significantly better at 3 months after surgery in group TPD. There were no significant difference in Oxford knee score, range of motion (ROM), patellar score, knee society score (KSS) and activities of daily living (ADL) score among 3 groups in the follow-up period. Both PD and PR can effectively reduce the intensity and incidence of AKP after TKA and improve patients' satisfaction at 3 months after TKA. Additionally, PD is more effective on alleviating AKP than PR.
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Affiliation(s)
- Xiaohui Ji
- Department of Orthopedics, Cangzhou Hospital of Integrated TCM-WM, Cangzhou, Hebei, P.R. China
| | - Xiaodan Huang
- Department of Orthopedics, the Third Hospital of Hebei Medical University, Hebei, P.R. China
| | - Yingying Zhang
- Department of pain, the Third Hospital of Hebei Medical University, Hebei, P.R. China
| | - Ming Zhao
- Department of Orthopedics, the Third Hospital of Hebei Medical University, Hebei, P.R. China
| | - Yaming Liu
- Department of pain, the Third Hospital of Hebei Medical University, Hebei, P.R. China
| | - Yanxin Cheng
- Department of pain, the Third Hospital of Hebei Medical University, Hebei, P.R. China
- *Correspondence: Yanxin Cheng, Department of pain, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, P.R. China (e-mail: )
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Dursun M, Ozsahın M, Altun G. Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study. SAO PAULO MED J 2022; 140:755-761. [PMID: 36102448 PMCID: PMC9671558 DOI: 10.1590/1516-3180.2021.0206.r2.10012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.
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Affiliation(s)
- Muhsin Dursun
- MD, PhD. Physician, Department of Orthopedics and Traumatology, EPC Special Hospital, Adana, Turkey
| | - Murat Ozsahın
- MD, PhD. Physician, Department of Orthopedics and Traumatology, Middle East Special Hospital, Adana, Turkey
| | - Guray Altun
- MD, PhD. Physician, Department of Orthopedics and Traumatology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
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Pal S, Choi JH, Delp SL, Fredericson M. Botulinum neurotoxin type A improves vasti muscle balance, patellar tracking, and pain in patients with chronic patellofemoral pain. J Orthop Res 2022; 41:962-972. [PMID: 36031589 DOI: 10.1002/jor.25435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine the effects of botulinum neurotoxin type A (BoNT-A) on vastus lateralis:vastus medialis (VL:VM) muscle balance, patellar tracking, and pain in patients with chronic patellofemoral (PF) pain. We recruited 13 participants (9 females, 4 males) with recalcitrant PF pain who underwent ultrasound-guided BoNT-A injections into the distal third of the VL muscle, followed by a 6-week home exercise program to strengthen their VM muscle. We imaged the participants in a C-arm computed tomography (CT) scanner before and after the intervention. We calculated VL:VM ratios from CT images from a supine, nonweight-bearing condition. We obtained patellar tilt and bisect offset values from CT images from an upright, weight-bearing condition. We recorded functional pain scores before, immediately after, and 2-4 years after the intervention. We classified the participants into normal tracking and maltracking groups based on their patellar tilt and bisect offset values. BoNT-A with home exercise reduced VL:VM ratio (18%; p < 0.001), patellar tilt (19%; p = 0.020), and bisect offset (5%; p = 0.025). Four participants classified as maltrackers before the intervention transitioned to normal tracking after the intervention. Functional pain scores improved immediately after the intervention (13%, p < 0.001) and remained improved at 2-year follow-up (12%, p = 0.011). Statement of Clinical Significance: This study provides new evidence in support of BoNT-A for treatment of PF pain. Classification of patients under weight-bearing conditions may identify individuals who will most benefit from a BoNT-A treatment.
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Affiliation(s)
- Saikat Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Jang-Hwan Choi
- Division of Mechanical and Biomedical Engineering, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Dahlmann S, Ziegeler K, Mau-Möller A, Mittelmeier W, Bergschmidt P. Patellar Tracking in Total Knee Arthroplasty-Influence on Clinical and Functional Outcome. Diagnostics (Basel) 2022; 12:diagnostics12051082. [PMID: 35626238 PMCID: PMC9139248 DOI: 10.3390/diagnostics12051082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/22/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior knee pain is a common problem after primary total knee arthroplasty (TKA). The aim of this study was to find parameters in patellar positioning which influence the clinical and functional outcome after TKA. Included were 59 patients who underwent TKA, of which three patients were treated bilaterally (n = 62 included knees). In a periodical follow-up of up to 5 years, each patient had to answer three questionnaires (HSS, WOMAC, SF-36) and underwent three radiographies of the knee (including merchant view) and a clinical examination, including Range Of Motion (ROM). All radiographs were evaluated by a single observer blinded to clinical data, who collected multiple parameters of sagittal and axial patellar alignment including newly developed methods for measuring patellar shift and tilt. Depending on the measurement results, three groups were built for each parameter and the influence on the outcome was determined. A lateral patellar tilt of more than 4° resulted in lower scores for both the HSS and WOMAC. The rarely investigated patellar facet angle showed a significantly inferior clinical and functional outcome in late follow-up of >24 months if lower than 142°, possibly due to progressive osteosclerotic changes of the patella caused by increased contact stress with corresponding patellar morphology. No significant difference was found for all other parameters. The newly developed method for measuring patellar shift has proven to be a valuable and easy instrument in the postoperative setting.
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Affiliation(s)
- Sebastian Dahlmann
- Department of Radiology, Charité Universitätsmedizin Berlin, Luisenstraße 7, 10117 Berlin, Germany;
- Correspondence:
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Luisenstraße 7, 10117 Berlin, Germany;
| | - Anett Mau-Möller
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
| | - Philipp Bergschmidt
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
- Department for Orthopaedic Surgery, Trauma Surgery and Hand Surgery, Südstadt Hospital Rostock, Südring 81, 18059 Rostock, Germany
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Yang CP, Chang CH, Weng CJ, Hung KT, Chen ACY, Hsu KY, Chan YS. Older age and varus alignment lead to early failure in treating patellofemoral osteoarthritis with Fulkerson osteotomy. J Orthop Surg (Hong Kong) 2022; 29:23094990211061248. [PMID: 34875927 DOI: 10.1177/23094990211061248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: It is unclear the risk factors for the failure of modified Fulkerson osteotomy. Methods: We retrospectively reviewed 40 patients who underwent the modified Fulkerson osteotomy from 1998 to 2015. There were 4 males and 36 females. The mean age of the study group was 50.2 ± 11.2 years. We used standard anteriorization measuring 10-15 mm and medialization measuring 10 mm while maintaining an intact periosteal sleeve. Results: Both the patellofemoral angle and the congruence angle improved significantly after 5.9 years. Preoperatively, the mean preoperative Lysholm score was 56.12, and the Knee Society score was 60.52. At the final follow-up, these scores improved significantly to 88.75 and 86.49, respectively. However, eight patients (20%) underwent total knee arthroplasty in the follow-up period, five of whom underwent the operation within 5 years. Comparing the survival and non-survival groups, there was a significant difference of an older age in the TKA conversion group (survival: 48.3 ± 11.1; non-survival: 57.8 ± 8.7, p = 0.03). For knee alignment, the non-survival group had a mean valgus femorotibial angle of 1.8° ± 4.9° preoperatively, and the survival group had a mean valgus angle of 6.4° ± 4.5° (p = 0.03). Conclusions: we found that patients with older age and those with varus alignment have an increased risk of deteriorated medial femorotibial cartilage.
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Affiliation(s)
- Cheng-Pang Yang
- Department of Orthopedic Surgery, Division of Sports Medicine 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Taoyuan, Taiwan, Republic of China.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyaun, Taiwan
| | - Chun-Hao Chang
- Graduate Institute of Sports Science, 63369National Taiwan Sport University, Taoyuan, Taiwan
| | - Chun-Jui Weng
- Department of Orthopedic Surgery, Division of Sports Medicine 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Taoyuan, Taiwan, Republic of China.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyaun, Taiwan
| | - Kung-Tseng Hung
- Department of Orthopedic Surgery, Division of Sports Medicine 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Taoyuan, Taiwan, Republic of China.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Division of Sports Medicine 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Taoyuan, Taiwan, Republic of China.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyaun, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, Division of Sports Medicine 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Taoyuan, Taiwan, Republic of China.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyaun, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Division of Sports Medicine 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou Taoyuan, Taiwan, Republic of China.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyaun, Taiwan
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Abstract
OBJECTIVE Knee osteochondritis dissecans (OCD) is a still poorly understood pathological condition of the articular subchondral bone and its overlying cartilage. Patellofemoral involvement accounts for less than 1% of cases; tibial plateau and multifocal involvement is an even rarer instance. The purpose of this study is to review what is currently known about patellofemoral OCD (PF-OCD) and to present an unusual case of PF-OCD which progressed to become multifocal in an adult female patient. METHODS A comprehensive literature search was conducted on PubMed/Medline, Cochrane, Embase, Web of Science, and Scopus databases on September 2021 for all levels of evidence and English language. After duplicate removal, 234 papers pertaining to PF-OCD were retrieved. Thirty-nine studies met inclusion criteria and were included in the review. As an example, a unique case of delamination of patellar cartilage consistent with PF-OCD with progressive involvement of trochlea and both tibial plateau in a 35-year-old woman is also presented. RESULTS PF-OCD is a rare localization of knee OCD. Two hundred eighty-eight cases have been reported in the literature to date. Mean age at time of diagnosis was 16 years and the location could also be bilateral and multifocal. The etiology is still debated but traumatic, vascular, and hereditary mechanisms are likely. Management mirrors that of classical OCD. CONCLUSIONS PF-OCD is an uncommon cause of anterior knee pain but should be considered even when physeal plates are closed. Current available evidence on treatment is of low quality, based on single case reports or small retrospective case series.
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Affiliation(s)
- Giovanni Bonaspetti
- Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Brescia, Italy
| | - Giovanni Dib
- Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Brescia, Italy
- Giovanni Dib, Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Via del Franzone, 31, 25127 Brescia, Italy.
| | - Flavio Azzola
- Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Brescia, Italy
| | - Alessia Piovani
- Department of Radiology, Istituto Clinico S. Anna, Brescia, Italy
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Abstract
Individuals with patellofemoral pain (PFP) experience discomfort during various functional activities. Long-term pain is a common consequence of PFP, yet little is known about daily pain variability. Our study consisted of 25 individuals with PFP who completed the Anterior Knee Pain Scale (AKPS) and recorded their daily pain over 10 days. Pain was evaluated using 2 measures of intensity (baseline pain, 10-day average pain) and 2 measures of variability (mean square of successive differences, probability of acute change). Associations between AKPS and the 4 pain measures were calculated with Pearson correlations. We calculated a linear regression to examine the amount of variance in the AKPS explained by the 4 pain measures. Greater mean square of successive differences values were moderately associated with lesser AKPS scores (r = -0.648, P < .001). Mean square of successive differences and 10-day averaged pain were the strongest predictors of AKPS (R2 = 0.565, P < .001). Pain variability provided a unique perspective on the pain experience and predicted patient-oriented function in individuals with PFP.
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Affiliation(s)
| | - Mikayla M. Simon
- School of Exercise and Rehabilitation Sciences, University of Toledo, OH
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Zambarano EK, Bazett-Jones DM, de Oliveira Silva D, Barton CJ, Glaviano NR. Confidence and Knowledge of Athletic Trainers in Managing Patellofemoral Pain. J Athl Train 2022; 57:79-91. [PMID: 35040987 PMCID: PMC8775279 DOI: 10.4085/1062-6050-0279.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Patellofemoral pain (PFP) is prevalent and challenging to manage. Most patients with PFP are unsatisfied with their knee function at 6 months after treatment and report ongoing pain up to 16 years after diagnosis. The confidence and knowledge of athletic trainers (ATs) in providing evidence-based care to people with PFP is unknown. OBJECTIVE To investigate the confidence and knowledge of ATs in the diagnosis, risk factors, prognosis, and treatment with current evidence for PFP. DESIGN Cross-sectional study. SETTING Online survey. PATIENT OR OTHER PARTICIPANTS A random sample of 3000 ATs were invited to participate; 261 completed the survey (10% participation rate, 88% completion rate). MAIN OUTCOME MEASURES(S) We surveyed AT demographics, confidence in PFP management, and knowledge related to diagnosis, risk factors, prognosis, and treatment. The confidence and knowledge of ATs in managing PFP was assessed. Their beliefs about evidence were compared with the available evidence (ie, consensus statements, position statements, systematic reviews). RESULTS Of the ATs surveyed, 91% were confident that their management of PFP aligned with the current evidence, but only 59% were confident in identifying risk factors for PFP development. In addition, 91% to 92% of ATs agreed that quadriceps and hip muscle weakness were risk factors for PFP, which aligns with the current evidence for the former but not the latter. Moreover, 93% to 97% of ATs' responses related to therapeutic exercise aligned with current evidence. However, 35% to 48% supported the use of passive treatments, such as electrophysical agents and ultrasound, which did not align with the current evidence. CONCLUSIONS Most ATs were aware of supporting evidence for therapeutic exercise in PFP management and were confident providing it, creating a strong foundation for evidence-based care. However, varying levels of awareness of the evidence related to risk factors and passive treatments for PFP highlight the need for professional development initiatives to better align ATs' knowledge with the current evidence.
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Affiliation(s)
- Erika K. Zambarano
- School of Exercise and Rehabilitation Sciences, University of Toledo, OH
| | | | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Australia
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Australia
,Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia
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Glaviano NR, Norte GE. Gluteal Central Activation in Females With Patellofemoral Pain: A Preliminary Study. J Sport Rehabil 2021;:1-8. [PMID: 34883467 DOI: 10.1123/jsr.2021-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/14/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Lesser hip muscle strength is commonly observed in females with patellofemoral pain (PFP) compared with females without PFP and is associated with poor subjective function and single-leg squat (SLS) biomechanics. Hip muscle weakness is theorized to be related to PFP, suggesting centrally mediated muscle inhibition may influence the observed weakness. The central activation ratio (CAR) is a common metric used to quantify muscle inhibition via burst superimposition. However, gluteal inhibition has yet to be evaluated using this approach in females with PFP. The study objectives are to (1) describe gluteal activation in the context of subjective function, hip strength, and squatting biomechanics and (2) examine the relationship of gluteal activation with subjective function and squatting biomechanics in females with PFP. DESIGN Cross-sectional. METHODS Seven females with PFP (age = 22.8 [3.6] y; mass = 69.4 [18.0] kg; height = 1.67 [0.05] m, duration of pain = 6-96 mo) completed this study. Subjective function was assessed with the Anterior Knee Pain Scale, while fear-avoidance beliefs were assessed with the Fear-Avoidance Belief Questionnaire physical activity and work subscales. Biomechanical function was assessed with peak hip and knee angles and moments in the sagittal and frontal planes during SLS. Gluteus medius (GMed) and gluteus maximus (GMax) activation were assessed with the CAR. Descriptive statistics were calculated, and relationships between variables were assessed with Spearman rho correlations. RESULTS The CAR of GMed and GMax was 90.5% (8.1%) and 84.0% (6.3%), respectively. Lesser GMed CAR was strongly associated with greater hip adduction during SLS (ρ = -.775, P = .02) and greater fear-avoidance beliefs-physical activity subscale (ρ = -.764, P = .018). CONCLUSION We found a wide range in GMed and GMax activation across females with PFP. Lesser GMed activation was associated with greater hip adduction during SLS and fear of physical activity, suggesting that gluteal inhibition should be assessed in patients with PFP.
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Holden S, Matthews M, Rathleff MS, Kasza J, Vicenzino B; Fohx Group. How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms. J Orthop Sports Phys Ther 2021; 51:602-10. [PMID: 34847699 DOI: 10.2519/jospt.2021.10674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether the effect of hip exercise on patellofemoral pain is mediated through changes in hip muscle strength or psychological factors. DESIGN Secondary mediation analysis of a randomized clinical trial, in which 218 participants with patellofemoral pain were randomly assigned to receive foot orthoses or hip exercises. METHODS Pain (Knee injury and Osteoarthritis Outcome Score pain subscale) and number of pain-free squats at 12 weeks were the outcomes for this mediation analysis, as they are pathognomonic of patellofemoral pain. Hip strength dynamometry (abduction, adduction, and external rotation) and psychological characteristics (pain catastrophizing, kinesiophobia, and anxiety) measured at 6 weeks were considered as potential mediators. We used mediation analysis to decompose the total effect of treatment on the outcome into (1) the "indirect effect" (ie, the portion acting through the mediator) and (2) the "direct effect." RESULTS The effect of hip exercise on pain and squats was not mediated by any of the strength or psychological mediators analyzed. All indirect effects were small and showed wide 95% confidence intervals (CIs) that contained zero (eg, for pain-free squats: abduction strength, -0.13; 95% CI: -0.49, 0.23; Tampa Scale of Kinesiophobia, -0.17; 95% CI: -0.64, 0.30). CONCLUSION Hip strength improved after hip exercise, yet strength did not mediate improvements in pain and pain-free squats, and alternative psychological mediators were not implicated. J Orthop Sports Phys Ther 2021;51(12):602-610. doi:10.2519/jospt.2021.10674.
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Fox AS, Ferber R, Bonacci J. Kinematic and Coordination Variability in Individuals With Acute and Chronic Patellofemoral Pain. J Appl Biomech 2021; 37:463-70. [PMID: 34548419 DOI: 10.1123/jab.2020-0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Cao L, Sun K, Yang H, Wang H, Zeng R, Fan H. Influence of Patellar Morphology Classified by Wiberg Classification on Knee Joint Function and Patellofemoral Tracking After Total Knee Arthroplasty Without Patellar Resurfacing. J Arthroplasty 2021; 36:3148-3153. [PMID: 33962823 DOI: 10.1016/j.arth.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/06/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To evaluate the influence of patellar morphology on knee joint function and patellofemoral tracking in patients with primary osteoarthritis after total knee arthroplasty (TKA) without patellar resurfacing. METHODS We performed a retrospective study of 156 patients with primary osteoarthritis who underwent TKA without patellar resurfacing from April 2018 to July 2019. As per Wiberg classification, patients were divided into Wiberg type I (group A, n = 38), II (group B, n = 88), and III (group C, n = 30) groups. The clinical data, postoperative follow-up data, and radiological data between three groups were compared. RESULTS There was no statistically significant difference in the HSS score and Feller score between the three groups before surgery and at each follow-up point after surgery (P > .05). At the last follow-up, there were no significant differences in the height and relative thickness of the patella between the three groups (P > .05). However, the incidence of anterior knee pain was significantly higher in group C than in the group B (P < .05). The patellar tilt angle was significantly larger in group C than in the groups A and B (both P < .05). The patellar facet angle was significantly larger in group A than in group B and C, which was also significantly larger in group B than in group C (both P < .05). CONCLUSION Patients with three different morphologic types of the patella both exhibited improved knee joint function after TKA, however, patients with Wiberg type Ⅲ patella were more prone to have poor patellofemoral tracking and anterior knee pain after surgery.
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Affiliation(s)
- Le Cao
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Kai Sun
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Haitao Yang
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Hanbang Wang
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Ran Zeng
- Department of Intensive Care Unit, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Haitao Fan
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
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Sigmund KJ, Bement MKH, Earl-Boehm JE. Exploring the Pain in Patellofemoral Pain: A Systematic Review and Meta-Analysis Examining Signs of Central Sensitization. J Athl Train 2021; 56:887-901. [PMID: 33238005 DOI: 10.4085/1062-6050-0190.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyperresponsive. Researchers in this area of PFP have been increasingly productive in the past decade. OBJECTIVE To determine whether evidence supports manifestations of central sensitization in individuals with PFP. DATA SOURCES We searched MeSH terms for quantitative sensory testing (QST) pressure pain thresholds (PPTs), conditioned pain modulation (CPM), temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP in PubMed, SPORTDiscus, CINAHL, Academic Search Complete, and EBSCOhost. STUDY SELECTION Peer-reviewed studies that were written in English and published between 2005 and 2020 and investigated QST or pain mapping in a sample with PFP were included in this review. DATA EXTRACTION The initial search yielded 140 articles. After duplicates were removed, 78 abstracts were reviewed. The full text of 21 studies was examined, and we included 15 studies in our evaluation: 6 in the meta-analysis, 4 in the systematic review, and 5 in both the meta-analysis and systematic review. DATA SYNTHESIS A random-effects meta-analysis was conducted for 4 QST variables (local PPTs, remote PPTs, CPM, temporal summation). Strong evidence supported lower local and remote PPTs, impaired CPM, and facilitated temporal summation in individuals with PFP compared with pain-free individuals. Evidence for heat and cold pain thresholds was conflicting. Pain mapping demonstrated expanding pain patterns associated with long duration of PFP symptoms. CONCLUSIONS Signs of central sensitization were present in individuals with PFP, indicating altered pain modulation. The etiologic and treatment models of PFP should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically, and treatments with central effects should be considered as part of a multimodal plan of care.
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Affiliation(s)
- Kemery J Sigmund
- Department of Rehabilitation Sciences, University of Wisconsin-Milwaukee.,Department of Health and Human Performance, Athletic Training Program, Concordia University Wisconsin, Mequon
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Bleeker NJ, Reininga IHF, van de Wall BJM, Hendrickx LAM, Beeres FJP, Duis KT, Doornberg JN, Jaarsma RL, Kerkhoffs GMMJ, IJpma FFA. Difference in Pain, Complication Rates, and Clinical Outcomes After Suprapatellar Versus Infrapatellar Nailing for Tibia Fractures? A Systematic Review of 1447 Patients. J Orthop Trauma 2021; 35:391-400. [PMID: 34267147 PMCID: PMC8253504 DOI: 10.1097/bot.0000000000002043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the effectiveness of suprapatellar (SP)-nailing versus infrapatellar (IP)-nailing of tibia fractures in anterior knee pain, complications (retropatellar chondropathy, infection, and malalignment) and physical functioning and quality of life. A clinical question-driven and thorough systematic review of current literature is provided. DATA SOURCE PubMed and Embase databases were searched for studies published between 2010 and 2020 relating to SP and IP-nailing of tibia fractures. The study is performed in concordance with PRISMA-guidelines. STUDY SELECTION Studies eligible for inclusion were randomized controlled trials, prospective and retrospective observational studies reporting on outcomes of interest. DATA EXTRACTION Data extraction was performed independently by 2 assessors. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. DATA SYNTHESIS Continuous variables are presented as means with SD and dichotomous variables as frequency and percentages. The weighted mean, standardized weighted mean differences, and 95% confidence interval were calculated. A pooled analysis could not be performed because of differences in outcome measures, time-points, and heterogeneity. RESULTS Fourteen studies with 1447 patients were analyzed. The weighted incidence of anterior knee pain was 29% after SP-nailing and 39% after IP-nailing, without reported significance. There was a significant lower rate of malalignment after the SP-approach (4% vs. 26%) with small absolute differences in all planes. No substantial differences were observed in retropatellar chondropathy, infection, physical functioning, and quality of life. CONCLUSIONS This systematic review does not reveal superiority of either technique in any of the respective outcomes of interest. Definitive choice should depend on the surgeon's experience and available resources. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nils Jan Bleeker
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Inge H. F. Reininga
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bryan J. M. van de Wall
- Department of Orthopaedic Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Laurent A. M. Hendrickx
- Department of Orthopaedic Trauma Surgery, Flinders Medical Centre, Adelaide, Australia; and
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences (AMS), University of Amsterdam, Amsterdam, the Netherlands
| | - Frank J. P. Beeres
- Department of Orthopaedic Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland
| | - Kaj ten Duis
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Orthopaedic Trauma Surgery, Flinders Medical Centre, Adelaide, Australia; and
| | - Ruurd L. Jaarsma
- Department of Orthopaedic Trauma Surgery, Flinders Medical Centre, Adelaide, Australia; and
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences (AMS), University of Amsterdam, Amsterdam, the Netherlands
| | - Frank F. A. IJpma
- Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Bagheri S, Naderi A, Mirali S, Calmeiro L, Brewer BW. Adding Mindfulness Practice to Exercise Therapy for Female Recreational Runners With Patellofemoral Pain: A Randomized Controlled Trial. J Athl Train 2021; 56:902-911. [PMID: 33237990 DOI: 10.4085/1062-6050-0214.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Considering current models that highlight the role of psychological components in pain management, mindfulness practice may be an effective strategy in the management of pain. OBJECTIVE To examine the effects of adding an 8-week mindfulness program to exercise therapy on the perceptions of pain severity, knee function, fear of movement, and pain catastrophizing of female recreational runners with patellofemoral pain (PFP). DESIGN Randomized controlled clinical trial. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty female runners (age = 28.3 ± 7.08 years) with PFP were randomly assigned to the exercise or mindfulness-exercise group. INTERVENTION(S) The exercise-only group followed a protocol (18 weeks, 3 sessions/wk) that featured training modifications to help control injury-related symptoms. The mindfulness-exercise group received an 8-week mindfulness intervention in addition to the exercise protocol. The mindfulness component started 4 weeks before the exercise component; therefore, the 2 components overlapped during the first 4 weeks of the intervention. MAIN OUTCOME MEASURE(S) Usual pain, pain during stepping, and pain during running were assessed using visual analog scales. Functional limitations of the knee were assessed using the Knee Outcome Survey. Fear of movement, pain catastrophizing, and coping strategies were measured via the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Coping Strategies Questionnaire, respectively. These outcomes were assessed at baseline, at week 9, and after 18 weeks. RESULTS Pain during running, pain during stepping, and functional limitations of the knee were less for the mindfulness-exercise group than for the exercise-only group (P values < .05). The mindfulness-exercise group reported greater perceived treatment effects than the exercise-only group (P < .05). Pain catastrophizing was less and coping strategies were more favorable for mindfulness-exercise participants than for exercise-only participants (P values < .05). CONCLUSIONS Mindfulness practice can be an effective adjunct to exercise therapy in the rehabilitation of PFP in recreational female runners.
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Affiliation(s)
| | - Aynollah Naderi
- School of Sport Sciences, Shahrood University of Technology, Iran
| | - Samira Mirali
- Department of Sport Science, University College of Omran and Tosseeh, Hamedan, Iran
| | - Luís Calmeiro
- School of Social and Health Sciences, Abertay University, Dundee, UK
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