Taping, Bracing, and Injection Treatment for Patellofemoral Pain and Patellar Tendinopathy.

PURPOSE OF REVIEW: This article will focus on additional treatment options for the two most common causes of anterior knee pain, patellofemoral pain syndrome, and patellar tendinopathy. Conservative management is the first-line treatment for these conditions. For clinicians to maximize the efficacy of conservative treatment options for their patients, they must understand the most up-to-date literature evaluating the potential benefit of taping, bracing, and injections as adjunctive treatments for maximizing treatment success. RECENT FINDINGS: Recent studies of bracing and taping have found them to be helpful for patients in the short-term management of pain and improving function. However, less is known about their exact mechanism but studies are encouraging that they have a subtle role in changing patellofemoral biomechanics. Injections remain a commonly used treatment for musculoskeletal conditions; however, the evidence for their use in patellofemoral pain and patellar tendinopathy is limited. The use of platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections is an exciting new area in the treatment of patellar tendinopathy. However, evidence at this time to recommend these treatments is lacking, and more well-designed studies are needed. The treatment of patellofemoral pain and patellar tendinopathy consists of a multi-faceted approach of physiotherapy and physical modalities. There is evidence for short-term use of taping and bracing for these conditions. The evidence for injections at this time is limited and remains under investigation. Future well-designed randomized controlled studies will provide insight into the efficacy of several different types of injections in the treatment of patellar tendinopathy. Physicians should feel comfortable integrating taping and bracing into their anterior knee pain treatment paradigm while making cautious use of invasive injections as adjunctive therapy.

Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain.

PURPOSE OF REVIEW: Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. RECENT FINDINGS: The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.

Simplifying Disinfectant Choices to Improve Safety in Contact Precaution Rooms.

Both quaternary ammonium and bleach-based cleaning products are effective in reducing the transmission of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in hospitals, but bleach-based compounds demonstrate better control of Clostridium difficile infections. Our pilot study demonstrates the potential to reduce C. difficile transmission in an acute care hospital by eliminating the need for providers to choose the appropriate cleaning product from isolation precaution carts.

New generation NMR bioreactor coupled with high-resolution NMR spectroscopy leads to novel discoveries in Moorella thermoacetica metabolic profiles.

An in situ nuclear magnetic resonance (NMR) bioreactor was developed and employed to monitor microbial metabolism under batch growth conditions in real time. We selected Moorella thermoacetica ATCC 49707 as a test case. M. thermoacetica (formerly Clostridium thermoaceticum) is a strictly anaerobic, thermophilic, acetogenic, gram-positive bacterium with potential for industrial production of chemicals. The metabolic profiles of M. thermoacetica were characterized during growth in batch mode on xylose (a component of lignocellulosic biomass) using the new generation NMR bioreactor in combination with high-resolution NMR (HR-NMR) spectroscopy. In situ NMR measurements were performed using water-suppressed H-1 NMR spectroscopy at 500 MHz, and aliquots of the bioreactor contents were taken for 600-MHz HR-NMR spectroscopy at specific intervals to confirm metabolite identifications and expand metabolite coverage. M. thermoacetica demonstrated the metabolic potential to produce formate, ethanol, and methanol from xylose, in addition to its known capability of producing acetic acid. Real-time monitoring of bioreactor conditions showed a temporary pH decrease, with a concomitant increase in formic acid during exponential growth. Fermentation experiments performed outside of the magnet showed that the strong magnetic field employed for NMR detection did not significantly affect cell metabolism. Use of the in situ NMR bioreactor facilitated monitoring of the fermentation process, enabling identification of intermediate and endpoint metabolites and their correlation with pH and biomass produced during culture growth. Real-time monitoring of culture metabolism using the NMR bioreactor in combination with HR-NMR spectroscopy will allow optimization of the metabolism of microorganisms producing valuable bioproducts.