What is the incidence of subsequent adjacent joint injury after patellofemoral pain?

OBJECTIVE: To investigate the incidence of subsequent lumbar spine, hip, and ankle-foot injuries after a diagnosis of patellofemoral pain. DESIGN: Retrospective cohort study. SETTING: Military Health System. PARTICIPANTS: Individuals (n = 92,319) ages 17-60 diagnosed with patellofemoral pain between 2010-2011. INTERVENTIONS: Therapeutic exercise. MAIN OUTCOME MEASURES: Frequency of adjacent joint injuries in the 2-year period after initial patellofemoral pain injury, and hazard ratios (HR) with 95% confidence interval (CI) and Kaplan-Meier survival curves for risk of adjacent joint injury based on receiving therapeutic exercise for the initial injury. RESULTS: After initial patellofemoral pain diagnosis, 42,983 (46.6%) individuals sought care for an adjacent joint injury. Of these, 19,587 (21.2%) were subsequently diagnosed with a lumbar injury, 2837 (3.1%) a hip injury, and 10,166 (11.0%) an ankle-foot injury. One in five (19.5%; n = 17,966) received therapeutic exercise which reduced the risk of having a subsequent lumbar (HR = 0.78, 95% CI 0.76-0.81), hip (HR = 0.93, 95% CI 0.87-0.98) or ankle-foot (HR = 0.86, 95% CI 0.83-0.90) injury. CONCLUSION: The results suggest that a high number of individuals with patellofemoral pain will sustain an adjacent joint injury within 2 years although causal relationships cannot be determined. Receiving therapeutic exercise for the initial knee injury reduced the risk of sustaining an adjacent joint injury. This study helps provide normative data for subsequent injury rates in this population and guide development of future studies designed to understand causal factors.

Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength.

PURPOSE: This study aimed to (a) investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain (PFP) and (b) explore the association of body mass index (BMI), body fat, and lean mass with functional capacity and hip and knee strength in people with PFP. METHODS: We included a mixed-sex sample of young adults (18-35 years old) with PFP (n = 100). Measurements for BMI, percentage of body fat, and lean mass (assessed by bioelectrical impedance) were obtained. Functional capacity was assessed by the Anterior Knee Pain Scale, plank test, and single-leg hop test. Strength of the knee extensors, knee flexors, and hip abductors was evaluated isometrically using an isokinetic dynamometer. The proportion of overweight/obesity was calculated based on BMI. The association between BMI, body fat, and lean mass and functional capacity and strength was investigated using partial correlations, followed by hierarchical regression analysis, adjusted for covariates (sex, bilateral pain, and current pain level). RESULTS: A total of 38% of our cohort had their BMI categorized as overweight/obese. Higher BMI was associated with poor functional capacity (ΔR2 = 0.06-0.12, p ≤ 0.001) and with knee flexion strength only (ΔR2 = 0.04, p = 0.030). Higher body fat was associated with poor functional capacity (ΔR2 = 0.05-0.15, p ≤ 0.015) and reduced strength (ΔR2 = 0.15-0.23, p < 0.001). Lower lean mass was associated with poor functional capacity (ΔR2 = 0.04-0.13, p ≤ 0.032) and reduced strength (ΔR2 = 0.29- 0.31, p < 0.001). CONCLUSION: BMI, body fat, and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength.

Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated.

PURPOSE: Recent data suggest that individual morphologic factors should be respected to restore preoperative patellofemoral alignment and thus reduce the likelihood of anterior knee pain. The goal of this study was to investigate the effect of excessive femoral torsion (FT) on clinical outcome of TKA. METHODS: Patients who underwent TKA and complete preoperative radiographic evaluation including a long-leg radiograph and CT scan were included. 51 patients showed increased FT of > 20° and were matched for age/sex to 51 controls (FT < 20°). Thirteen patients were lost to follow-up. Thirty-eight matched pairs were compared after a 2 year follow-up clinically (Kujala and patellofemoral score for TKA) and radiographically (FT, frontal leg axis, TT-TG, patellar thickness, patellar tilt, and lateral displacement of patella). Functional alignment of TKA was performed (hybrid-technique). All patellae were denervated but no patella was resurfaced. RESULTS: There was no significant difference between clinical scores two years after surgery between patients with normal and excessive FT (n.s.). Kujala score was 64.3 ± 16.7 versus 64.8 ± 14.4 (n.s.), and patellofemoral score for TKA was 74.3 ± 21 versus 78.5 ± 20.7 (n.s.) for increased FT group and control group, respectively. There was no correlation between preoperative FT and clinical scores. Other radiographic parameters were similar between both groups. No correlations between clinical outcomes and preoperative/postoperative frontal leg axis or total leg axis correction were found (n.s.). CONCLUSION: If the leg axis deformity is corrected to a roughly neutral alignment during cemented TKA, including patellar denervation, then excessive FT was not associated with patellofemoral pain or instability. LEVEL OF EVIDENCE: Prospective comparative study, level II.

Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.

Patellofemoral pain syndrome (PFPS) is highly prevalent; it can cause severe pain and evolve into progressive functional loss, leading to difficulties performing daily tasks such as climbing and descending stairs and squatting. This systematic review aimed to find evidence, in the literature, of squat movements that can cause or worsen PFPS. This work was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and its protocol was registered in PROSPERO (CRD42019128711). From the 6570 collected records, 37 were included. From these 37 articles, 27 present a causal relationship between knee flexion and PFPS, 8 describe a relationship, considering the greater existence of muscle contractions, and one article did not describe this relationship in its results. The main limitations stem from the fact that different studies used different evaluation parameters to compare the force exerted on the patellofemoral joint. Furthermore, most studies are focused on sports populations. After analysing the included works, it was concluded that all squat exercises can cause tension overload in the knee, especially with a knee flexion between 60° and 90° degrees. The main causal/worsening factors of PFPS symptoms are the knee translocation forward the toes (on the same body side) when flexing the knee, and the muscle imbalance between the thigh muscles.

Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pain and Instability in a Skeletally Mature Population.

BACKGROUND: Patellar instability among adolescents has an incidence of 29 to 43 per 100,000 per year. Trochlear dysplasia has been found in up to 85% of those with recurrent patellar instability. The prevalence of trochlear dysplasia in the general population has not yet been defined. The purpose of the present study was to determine the prevalence of trochlear dysplasia as defined by ultrasound in a skeletally mature population and to characterize associations of trochlear dysplasia with a history of patellofemoral instability or pain. METHODS: Skeletally mature adolescents and parents of patients (≤50 years of age) who had presented to orthopaedic clinics were prospectively enrolled from 2019 to 2020. Those presenting with knee pain, open physes, prior intra-articular fracture, total knee arthroplasty, and syndromic ligamentous laxity or neuromuscular disease were excluded. Information regarding a history of anterior knee pain, patellar instability, and/or surgery was obtained, and an abbreviated Anterior Knee Pain Scale (AKPS) was collected. An AKPS score of ≥4 was considered positive. Bilateral ultrasound of the knee was performed, and the osseous sulcus angle of the trochlea and the trochlear depth were measured. Basic descriptive statistics are reported. RESULTS: One hundred and two patients (203 knees) were studied. The mean sulcus angle was 144.1° ± 6.8°, and the mean trochlear depth was 5.5 ± 1.4 mm. High-grade trochlear dysplasia was defined as the 95th percentile and above, which was shown to be a sulcus angle of ≥154° or a trochlear depth of ≤3 mm for female patients and ≤4 mm for male patients. The prevalence of high-grade trochlear dysplasia was 5.4% based on the sulcus angle and 9.9% based on trochlear depth. Knees with high-grade trochlear dysplasia based on the sulcus angle were 11 times more likely to have had previous patellar instability (p = 0.013). CONCLUSIONS: The prevalence of high-grade trochlear dysplasia in the general population is approximately 10%, and there may be an association with patellar instability. The use of ultrasound to diagnose trochlear dysplasia may prove to be a rapid and useful tool for guiding patient education and treatment decisions. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Gait retraining for runners with patellofemoral pain: A protocol for systematic review and meta-analysis.

INTRODUCTION: Patellofemoral pain (PFP) is highly prevalent in runners. Physical therapies were proved to be effective in the treatment of PFP. Gait retraining is an important method of physical therapy, but its effectiveness and safety for PFP remained controversial. Previous review suggests gait retraining in the treatment of PFP warrants consideration. However, recent publications of randomized controlled studies and case series studies indicated the positive effect of gait retraining in clinical and functional outcomes, which re-raise the focus of gait retraining. This paper will systematically review the available evidence, assessing the safety and effectiveness for the use of gait retraining for runners with PEP. METHOD AND ANALYSIS: A systematic review of relevant studies in Pubmed, Embase, SCOPUS, and Cochrane Library were synthesized. Inclusion criteria are studies evaluating clinical outcomes (i.e., changes to pain and/or function) following running retraining interventions in symptomatic running populations; Studies with less than 10 participants in total or in the running retraining intervention group were excluded. The primary outcomes measured will be pain score, Lower extremity functional scale and training related injuries or complications. Review Manager (Revman Version 5.3) software will be used for data synthesis, sensitivity analysis, meta regression, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. ETHICS AND DISSEMINATION: Our aim is to publish this systematic review in a peer-reviewed journal. Our findings will provide information about the safety of gait retraining and their effect on reliving pain and improving function of lower limb on runners with PEP. This review will not require ethical approval as there are no issues about participant privacy.

Validation and utilisation of a digital version of the survey instrument for natural history, Aetiology and Prevalence of Patellofemoral pain studies (eSNAPPS).

OBJECTIVE: This study validated the newly adapted electronic SNAPPS (eSNAPPS) against the original paper SNAPPS. Subsequently, the study estimated the prevalence of PFP in running participants and spectators attending three mass-participant running events in the United Kingdom by using the eSNAPPS tool. DESIGN: This study had two parts. Firstly, a validation of the original paper version of the SNAPPS tool. Secondly, if validation was achieved, eSNAPPS was used in a prevalence study. PARTICIPANTS: A convenience sample of running participants and spectators aged 18-40 years attending the mass participation running events. MAIN OUTCOME MEASURE: The 12-month prevalence of PFP. RESULTS: eSNAPPS was valid in identifying those with PFP (ICC 0.99 for Overall agreement, p < 0.0001). In the prevalence study, a total of 1080 running participants and spectators completed the eSNAPPS. The overall prevalence of PFP was 17.4% (95%CI: 15.2%, 19.8%); 20.5% of males (16.5, 24.9) and 15.7% of females (13.1, 18.7) had PFP. Prevalence was 17.4% (15.2, 19.8) in spectators and 16.7% in running participants (14.5, 19.0). CONCLUSION: The overall PFP prevalence in this study was slightly smaller than those previously reported in the literature. Findings also show that there were similar prevalence estimates in spectators and running participants.

Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome.

BACKGROUND: Whether vastus medialis obliquus atrophy exists in patients with patellofemoral pain syndrome and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown. MATERIALS: From June 2016 to March 2019, 61 patients with patellofemoral pain syndrome were retrospectively included in the study group, and an age-, sex-, and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group. All enrolled subjects had undergone CT scans in the supine position. The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0, 5, 10, 15, and 20 mm above the upper pole of the patella were measured, and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated. RESULTS: In the study group, the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0, 5, 10, 15, and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group (P < 0.05). The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella (the section 0 mm above the upper pole of the patella) than the corresponding ratio in the control group (P < 0.05). No significant difference was noted between the two groups in the sections 5, 10, 15, and 20 mm above the upper pole of the patella (P > 0.05). CONCLUSION: In patients with patellofemoral pain syndrome, vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0-20 mm above the upper pole of the patella, compared with normal controls, and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella. These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation programme for the patients with patellofemoral pain syndrome.

Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review.

OBJECTIVES: Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises. The purpose of this review was to (1) examine the quality/comprehensiveness of exercise reporting in this field; (2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP. DESIGN: Systematic review: a systematic survey of RCTs. METHODS: PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions. RESULTS: 19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms. CONCLUSIONS: The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented. Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.

A Contemporary Approach to Patellofemoral Pain in Runners.

Patellofemoral pain (PFP) is among the most common injuries in recreational runners. Current evidence does not identify alignment, muscle weakness, and patellar maltracking or a combination of these as causes of PFP. Rather than solely investigating biomechanics, we suggest a holistic approach to address the causes of PFP. Both external loads, such as changes in training parameters and biomechanics, and internal loads, such as sleep and psychological stress, should be considered. As for the management of runners with PFP, recent research suggested that various interventions can be considered to help symptoms, even if these interventions target biomechanical factors that may not have caused the injury in the first place. In this Current Concepts article, we describe how the latest evidence on education about training modifications, strengthening exercises, gait and footwear modifications, and psychosocial factors can be applied when treating runners with PFP. The importance of maintaining relative homeostasis between load and capacity will be emphasized. Recommendations for temporary or longer-term interventions will be discussed. A holistic, evidence-based approach should consist of a graded exposure to load, including movement, exercise, and running, while considering the capacity of the individual, including sleep and psychosocial factors. Cost, accessibility, and the personal preferences of patients should also be considered.

Impact-Related Ground Reaction Forces Are More Strongly Associated With Some Running Injuries Than Others.

BACKGROUND: Inconsistent associations have been reported for impact-related ground reaction force variables and running injuries when grouping all injuries together. However, previous work has shown more consistent associations when focusing on specific injuries. PURPOSE: To compare ground reaction force variables between healthy and injured runners as a group and within specific common injuries. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 125 runners presenting with patellofemoral pain, tibial bone stress injury, plantar fasciitis, Achilles tendinopathy, or iliotibial band syndrome and 65 healthy controls completed an instrumented treadmill assessment at a self-selected speed. Impact-related ground reaction force variables included vertical average (VALR) and instantaneous (VILR) load rates, posterior and medial/lateral instantaneous load rates, and vertical stiffness at initial loading (VSIL). Mean comparisons were made between the general and specific injury and control groups (α = .05). Cutoff thresholds were established and evaluated using several criteria. RESULTS: VALR (+17.5%; P < .01), VILR (+15.8%; P < .01), and VSIL (+19.7%; P < .01) were significantly higher in the overall injured versus control groups. For individual injuries, VALR, VILR, and VSIL were significantly higher for patellofemoral pain (+23.4%-26.4%; P < .01) and plantar fasciitis (+17.5%-29.0%; P < .01), as well as VSIL for Achilles tendinopathy (+29.4%; P < .01). Cutoff thresholds showed better diagnostic criteria for individual versus grouped injuries. CONCLUSION: Impact variables (VALR, VILR, and VSIL) were significantly higher when assessing the injured group as a whole. However, these findings were driven by specific injury groups, highlighting the importance of taking an injury-specific approach to biomechanical risk factors for running injury. CLINICAL RELEVANCE: These results suggest that practitioners may want to address impact loading in their treatment of injured runners, especially in those with patellofemoral pain and plantar fasciitis.

Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis.

BACKGROUND: Foot and ankle characteristics are associated with patellofemoral pain (PFP) and may also relate to patellofemoral osteoarthritis (PFOA). A greater understanding of these characteristics and PFOA, could help to identify effective targeted treatments. OBJECTIVES: To determine whether foot and ankle characteristics are associated with knee symptoms and function in individuals with PFOA. METHODS: For this cross-sectional study we measured weightbearing ankle dorsiflexion range of motion, foot posture (via the Foot Posture Index [FPI]), and midfoot mobility (via the Foot Measurement Platform), and obtained patient-reported outcomes for knee symptoms and function (100 mm visual analogue scales, Anterior Knee Pain Scale [AKPS], Knee injury and Osteoarthritis Outcome Score, repeated single step-ups and double-leg sit-to-stand to knee pain onset). Pearson's r with significance set at p < 0.05 was used to determine the association between foot and ankle charateristics, with knee symptoms and function, adjusting for age. RESULTS: 188 participants (126 [67%] women, mean [SD] age of 59.9 [7.1] years, BMI 29.3 [5.6] kg/m2) with symptomatic PFOA were included in this study. Lower weightbearing ankle dorsiflexion range of motion had a small significant association with higher average knee pain (partial r = - 0.272, p < 0.001) and maximum knee pain during stair ambulation (partial r = - 0.164, p = 0.028), and lower scores on the AKPS (indicative of greater disability; partial r = 0.151, p = 0.042). Higher FPI scores (indicating a more pronated foot posture) and greater midfoot mobility (foot mobility magnitude) were significantly associated with fewer repeated single step-ups (partial r = - 0.181, p = 0.023 and partial r = - 0.197, p = 0.009, respectively) and double-leg sit-to-stands (partial r = - 0.202, p = 0.022 and partial r = - 0.169, p = 0.045, respectively) to knee pain onset, although the magnitude of these relationships was small. The amount of variance in knee pain and disability explained by the foot and ankle characteristics was small (R2-squared 2 to 8%). CONCLUSIONS: Lower weightbearing ankle dorsiflexion range of motion, a more pronated foot posture, and greater midfoot mobility demonstrated small associations with worse knee pain and greater disability in individuals with PFOA. Given the small magnitude of these relationships, it is unlikely that interventions aimed solely at addressing foot and ankle mobility will have substantial effects on knee symptoms and function in this population. TRIAL REGISTRATION: The RCT was prospectively registered on 15 March 2017 with the Australia and New Zealand Clinical Trials Registry ( ANZCTRN12617000385347 ).

Sex differences in neuromuscular control of quadriceps.

PURPOSE: Patellofemoral pain syndrome (PFPS) is twice as prevalent in females as males, yet a few studies have evaluated differences in quadriceps muscle control between sexes or across force levels. This study investigated sex differences in quadriceps EMG onset times and amplitude at different force levels during isometric knee extension in asymptomatic males and females and in females with PFPS. METHODS: Thirteen healthy males, 12 healthy females, and 10 females with PFPS performed isometric knee extension ramp contractions at 25%, 50%, and 75% of maximal voluntary contraction (MVC). Surface EMG was recorded from the vastus lateralis (VL), vastus medialis oblique (VMO), vastus medialis (VM), and rectus femoris (RF). RESULTS: Healthy females showed delayed VL (222 ± 67 ms, p = 0.002), VMO (357 ± 101 ms, p = 0.001), and VM (258 ± 62 ms, p < 0.001) recruitment in comparison with healthy males. Healthy males activated the VL earlier than the VM (156 ± 51 ms, p = 0.02) and RF (379 ± 74 ms, p < 0.001), and at a similar time as the VMO; healthy females activated the VL earlier than the VM (192 ± 53 ms, p = 0.004) and VMO (239 ± 73 ms, p = 0.01). A lower VMO:VL activation ratio was found at 25% MVC (p < 0.001) than at higher force levels. CONCLUSIONS: Delayed activation of the VMO relative to the VL has been proposed as a risk factor for PFPS. This study confirms a delay in VMO onset time in females.

Driving the Musculoskeletal Diagnosis Train on the High-Value Track.

Clinicians who provide high-value musculoskeletal care offer evidence-based management that can improve pain, function, and quality of life. However, the current approach to improving outcomes emphasizes treatment strategies at the expense of accurate diagnosis. Guidelines rarely provide quality information on differential diagnosis and prognosis. The disconnect is worrying, because accurate diagnosis can lead to more appropriate care and improved patient outcomes. In this Viewpoint, we reflect on how the clinician can refine musculoskeletal diagnoses to provide high-value care. We (1) argue that the link between musculoskeletal diagnosis and patient outcomes must be strengthened, (2) introduce a diagnostic framework to help clinicians go beyond "special tests," and (3) present new methods for researchers to move forward from diagnostic accuracy studies. J Orthop Sports Phys Ther 2020;50(3):118-120. doi:10.2519/jospt.2020.0603.

Common Medical Concerns of the Female Athlete.

Women are increasingly participating in more and more sporting activities. For years, women athletes have been treated as the "female" equivalent of male athletes, with similar medical approaches but this is changing. The concept that women are unique in their "athletic arena" is further underscored with emerging scientific evidence--from the physiologic details not visible to the eye, to the more overt biomechanical and anatomic differences. We review a handful of conditions active women potentially may encounter: pregnancy, the female athlete triad, patellofemoral pain, potential injuries to the anterior cruciate ligament, and anemia.

Current concepts in the management of patellofemoral pain - The role of alignment.

BACKGROUND: Patellofemoral pain is a prevalent and significant clinical problem that is often reported to persist even following evidence based intervention. It is clear therefore that there is much about this complex patient group that is not presently fully understood. This is particularly concerning given the reported links between patellofemoral pain in adolescence and the subsequent development of osteoarthritis and anxiety. ASSESSMENT: Clinical assessment has historically focussed on biomechanical factors such as altered lower limb kinematics, muscle weakness and late muscle 'onset or activation' during activity. However when examined it is clear that study findings from patellofemoral populations are often inconsistent. Reasons for this are discussed and specifically the limitations around current 'gold standard' measurement methods, such as motion capture are outlined. A biomechanical approach is applied to demonstrate the importance of ensuring optimal patient alignment during rehabilitation, where optimal is defined as ensuring the most energy efficient muscle or muscles are used by the patient to perform a movement. This in turn ensures that the direction, magnitude and location of load applied to the skeleton during activity is optimal and therefore less likely to lead to injury. TREATMENT: The role of alignment in patellofemoral pain and the importance of correcting this during rehabilitation is discussed, and examples provided. Validated, reliable, and reproducible methods of measuring skeletal geometry, muscle geometry, muscle force and direction, and kinematics of activity must be developed as a priority in order for us to further our understanding and improve outcomes in this complex clinical population.

[Correction of the lumbosacral orthosis in the patients presenting with patellofemoral pain syndrome with the use of physical exercise therapy]. / Korrektsiia myshechnogo korseta poiasnichno-kresttsovogo otdela pozvonochnika u patsientov s patellofemoral'nym bolevym sindromom metodom lechebnoi fizkul'tury.

THE RATIONALE: The differential approach taking into consideration the pathogenetic aspects of the pathological condition of interest with the identification of the principal cause of disorders in the musculo-skeletal system is a topical issue in the development of the measures for the rehabilitative treatment of the affected patients. Despite a great variety of methods and guidelines currently available for the conservative treatment of the musculoskeletal system diseases, further investigations and the development of the approaches and recommendations are needed for the correction and prevention of pathobiomechanical disorders and securing the optimal motor stereotype. AIM: The objective of the present study was to improve the existing methods for the correction of the lumbosacral orthosis in the patients presenting with patellofemoral pain syndrome with the use of physical exercise therapy for the improvement of their locomotor activity. MATERIAL AND METHODS: We have undertaken a randomized controlled clinical study involving 60 outpatients. They were divided into two groups designated as the main and control ones. The inclusion criteria were the age between 18 and 35 years, the feeling of discomfort or pain in the lumbosacral region, and the combined patellofemoral syndrome. All the patients underwent the comprehensive examination of the musculoskeletal system, and evaluation of pain intensity based on the relevant visual-analogue scales, stabilometry before and after the treatment of the patients comprising the main group with the use of the combined correction and of the control patients with the application of the conventional correction methods. RESULTS: The treatment with the use of the proposed original physical exercise therapy of the patients presenting with the pain syndrome in the lumbosacral region resulted in a reduction of its intensity by 27% on the average (p<0.05) and a significant 40% decrease in the frequency of dysfunction of the thoracoabdominal diaphragm. Simultaneously, the frequency of dysfunction of the muscles stabilizing the lumbosacral spine and the lower extremity on the side of the patellofemoral complex decreased by 53.4% and 17.8% on the average, respectively. Parameters of stabilometry evaluated from the results of the 'Mishen' (Target) test and the Romberg test with eyes closed improved by 1.9 times (p<0.05) and 2.5 times (p<0.05) on the average, respectively. CONCLUSION: The study has demonstrated that dysfunction of the sacral bone and muscles in the lumbosacral spine region responsible for the formation of the pain syndrome in the lower part of the back develops in 67% of the patients presenting with the patellofemoral pain syndrome. Physiotherapy including endurance-type exercises and activation of the muscles stabilizing the lumbosacral spine and lower extremities can improve results of rehabilitation.

Do the Loss of Thigh Muscle Strength and Tibial Malrotation Cause Anterior Knee Pain after Tibia Intramedullary Nailing?

PURPOSE: Anterior knee pain (AKP) is a common complication after tibia intramedullary nailing surgery, but yet the etiology is not fully revealed. Our study had two hypotheses. The first one is "after tibia intramedullary nailing with transtendinous approach, thigh muscles strength decreases and this loss of muscle strength causes AKP." Secondly, "lower extremity rotational profile is affected after tibia intramedullary nailing." Methods. Our study was planned retrospectively and included 40 patients, who underwent tibia intramedullary nailing surgery. Mean follow-up time was 22.5 months. Tegner Lysholm knee scoring scale was applied to evaluate postoperative functional outcomes of all patients. Isometric muscle strengths of bilateral knee extensor and flexor muscle groups were compared with hand-held dynamometer. In addition, bilateral lower extremity Staheli rotational profile angles (foot progression angle (FPA), thigh-foot angle (TFA), and transmalleolar angle (TMA)) were compared. RESULTS: Lysholm knee score was evaluated as excellent in 28 patients. AKP were detected in 15 patients and there was no significant difference between the injured limb with contralateral quadriceps mean muscle strength (injured limb mean (ILM) = 201.97 Newton (N) - contralateral mean (CM) = 205.4 N). However, there was a significant difference (p<0,05) between injured limb with contralateral extremity hamstring mean muscle strength (ILM = 153.2 N- CM=158.95 N). Although there was a significant difference between the two extremities' rotational profile angles, there was no significant correlation between the rotational profile angles and knee pain. CONCLUSION: As a result of our study, AKP appears to be significantly related to the loss of hamstring muscle strength. We suppose that hamstring exercises will gain importance in rehabilitation programs of tibia intramedullary nailing surgery in future.

Risk factors for patellofemoral pain: a systematic review and meta-analysis.

BACKGROUND: Patellofemoral pain (PFP) is a prevalent condition commencing at various points throughout life. We aimed to provide an evidence synthesis concerning predictive variables for PFP, to aid development of preventative interventions. METHODS: We searched Medline, Web of Science and SCOPUS until February 2017 for prospective studies investigating at least one potential risk factor for future PFP. Two independent reviewers appraised methodological quality using the Newcastle-Ottawa Scale. We conducted meta-analysis where appropriate, with standardised mean differences (SMD) and risk ratios calculated for continuous and nominal scaled data. RESULTS: This review included 18 studies involving 4818 participants, of whom 483 developed PFP (heterogeneous incidence 10%). Three distinct subgroups (military recruits, adolescents and recreational runners) were identified. Strong to moderate evidence indicated that age, height, weight, body mass index (BMI), body fat and Q angle were not risk factors for future PFP. Moderate evidence indicated that quadriceps weakness was a risk factor for future PFP in the military, especially when normalised by BMI (SMD -0.69, CI -1.02, -0.35). Moderate evidence indicated that hip weakness was not a risk factor for future PFP (multiple pooled SMDs, range -0.09 to -0.20), but in adolescents, moderate evidence indicated that increased hip abduction strength was a risk factor for future PFP (SMD 0.71, CI 0.39, 1.04). CONCLUSIONS: This review identified multiple variables that did not predict future PFP, but quadriceps weakness in military recruits and higher hip strength in adolescents were risk factors for PFP. Identifying modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.

Association between patellofemoral congruence and patellofemoral chondropathy in patients with anterior knee pain: A T2 mapping knee MRI study.

OBJECTIVES: In this study, the T2 mapping magnetic resonance imaging technique was used to evaluate early cartilage changes associated with patellofemoral alignment and morphology. PATIENTS AND METHODS: Fifty four patients (Study group: 38 females, 16 males) with anterior knee pain and a randomly selected and age-matched 50 controls (Control group; 37 females, 13 males) were compared by two blinded authors in terms of T2 values of the patella medial, lateral facet, and trochlea, Insall-Salvatti index, lateral trochlear inclination angle, patellar tilt angle, sulcus angle, and patella medial and lateral facet lengths. The inter- and intra-observer reliability tests were assessed. RESULTS: The T2 medial patellar facet value, T2 lateral patellar facet value, T2 trochlea value, Visual Analog Scale, tibial tubercle - greater trochanter distance, and patellar tilt angle measure were statistically significantly higher in the study group. CONCLUSION: Based on our study findings, the T2 mapping magnetic resonance imaging (MRI) technique was found to be reliable test that can be used to diagnose early cartilage damage in patients with anterior knee pain. In patients with anterior knee pain, especially with decreased Insall Salvatti index, low lateral trochlear inclination angle, and higher patellar tilt angle, adding a T2 mapping sequence to the standard knee MRI protocol is recommended to help detect early cartilage damage.