Biomechanical factors associated with patellofemoral pain in children and adolescents.

To investigate the biomechanical factors associated with patellofemoral pain in children and adolescents. A cross-sectional, population-based study conducted in Brazil from 2019 to 2023, involving students from public schools. Adjusted prevalence ratios and their respective 95% confidence intervals for the outcome in relation to independent variables were calculated for association analysis, adopting a significance level of 5%. Out of the total of 283 students, 152 were female and 182 were aged between 16 and 18 years old. A positive association was observed between the presence of patellofemoral pain and a poor movement quality in both lower limbs (right side: p = 0.04 and left side: p = 0.04) as well as with dynamic valgus of the left lower limb (p < 0.01). Patellofemoral pain in children and adolescents is associated with poor movement quality in the lower limbs and dynamic valgus of the left lower limb. Actions targeting these biomechanical factors may be crucial for early diagnosis and clinical treatment of this disfunction.

[Anterior knee pain: a simplified assessment and management algorithm]. / Dolor anterior de rodilla: algoritmo simplificado de estudio y manejo.

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.

El dolor anterior de rodilla es una condición que afecta a pacientes adolescentes y adultos jóvenes, siendo una de las consultas más comunes y desafiantes para el cirujano de rodilla. La gran cantidad de diagnósticos diferenciales, lo convierten en un síndrome particular, que solo presentan en común la presencia de dolor retro o peripatelar agravado por al menos una actividad que cargue la articulación en flexión. Desde un punto de vista fisiopatológico, debe considerarse una lesión por sobrecarga, donde la unidad estructural del tejido se encuentra dañada o excedida su capacidad de respuesta reparadora. El diagnóstico es clínico. Las imágenes debiesen reservarse para un grupo particular de pacientes. La intervención precoz es fundamental para lograr resultados favorables. El tratamiento conservador es el estándar de oro y se basa en un manejo multimodal validado por consensos internacionales. Basados en una categorización por clínica e imágenes, podemos tener una guía de aquellos cuadros que son susceptibles de manejo quirúrgico. El objetivo de la intervención es reducir el estrés articular. La presente revisión define un algoritmo simplificado de estudio y manejo en dolor anterior de rodilla.

Dolor anterior de rodilla: algoritmo simplificado de estudio y manejo / Anterior knee pain: a simplified assessment and management algorithm

Resumen: El dolor anterior de rodilla es una condición que afecta a pacientes adolescentes y adultos jóvenes, siendo una de las consultas más comunes y desafiantes para el cirujano de rodilla. La gran cantidad de diagnósticos diferenciales, lo convierten en un síndrome particular, que solo presentan en común la presencia de dolor retro o peripatelar agravado por al menos una actividad que cargue la articulación en flexión. Desde un punto de vista fisiopatológico, debe considerarse una lesión por sobrecarga, donde la unidad estructural del tejido se encuentra dañada o excedida su capacidad de respuesta reparadora. El diagnóstico es clínico. Las imágenes debiesen reservarse para un grupo particular de pacientes. La intervención precoz es fundamental para lograr resultados favorables. El tratamiento conservador es el estándar de oro y se basa en un manejo multimodal validado por consensos internacionales. Basados en una categorización por clínica e imágenes, podemos tener una guía de aquellos cuadros que son susceptibles de manejo quirúrgico. El objetivo de la intervención es reducir el estrés articular. La presente revisión define un algoritmo simplificado de estudio y manejo en dolor anterior de rodilla.

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.

Influence of walking and running on patellofemoral pain / Influência da caminhada e da corrida na dor femoropatelar

Abstract Due to the ease of its practice, walking / running can be performed in such a way that there is no adequate control or monitoring, resulting in the appearance of injuries, highlighting patellofemoral pain. Thus, the present study aimed to verify the levels of patellofemoral pain in walk / run practitioners. The sample consisted of 318 individuals, selected in a non-probabilistic manner, for convenience and adherence, including over 18 years old, both sexes, living in the state of Pernambuco, Brazil, who practiced walking / running. Data collection was performed using an online questionnaire on the google platform. Participants who agreed to participate answered a sociodemographic questionnaire, the International Physical Activity Questionnaire (IPAQ) and a subscale of patellofemoral pain and osteoarthritis of the KOOS questionnaire. Data were presented using descriptive statistics (mean and standard deviation), submitted to inferential statistics using Student's t test, ANOVA with Bonferroni's post hoc to show the effect of comparisons, considering a significance level of 5% (p <0.05). There were no significant differences between the variables analyzed (p = 0.599; ES = 0.06), suggesting that there is no difference in patellofemoral pain in practitioners of walking / running between the sexes and different levels of physical activity; research with larger samples and monitoring of more variables, in the search for more assertive results, should be carried out.

Resumo Pela facilidade de sua prática, a caminhada / corrida pode ser realizada de forma que não haja controle ou monitoramento adequado, resultando no aparecimento de lesões, destacando a dor femoropatelar. Assim, o presente estudo teve como objetivo verificar os níveis de dor femoropatelar em praticantes de caminhada / corrida. A amostra foi composta por 318 indivíduos, selecionados de forma não probabilística, por conveniência e adesão, incluindo maiores de 18 anos, ambos os sexos, residentes no estado de Pernambuco, Brasil, que praticavam caminhada / corrida. A coleta de dados foi realizada por meio de questionário online na plataforma google. Os participantes que aceitaram participar responderam a um questionário sociodemográfico, o Questionário Internacional de Atividade Física (IPAQ) e subescala de dor patelofemoral e osteoartrite do questionário KOOS. Os dados foram apresentados através da estatística descritiva (média e desvio padrão), submetidos à estatística inferencial por meio do teste t de Student, ANOVA com post hoc de Bonferroni para mostrar o efeito das comparações, considerando nível de significância de 5% (p<0,05). Não foi observada diferenças significantes entre as variáveis analisadas (p = 0,599), sugerindo que não há diferença no dor femoropatelar em praticantes de caminhada / corrida entre os sexos e diferentes níveis de atividade física; pesquisas com amostras maiores e monitoramento de mais variáveis, na busca por resultados mais assertivos, devem ser realizadas.

Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study

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.

Body fat and skeletal muscle mass, but not body mass index, are associated with pressure hyperalgesia in young adults with patellofemoral pain.

BACKGROUND: Young adults with patellofemoral pain (PFP) have a high prevalence of being overweight or obese, which is associated with impaired lower limb function and muscle weakness. However, the impact of being overweight or obese on pain sensitivity has not been explored. OBJECTIVES: We investigated the association between body fat, skeletal muscle mass, and body mass index (BMI) with pressure hyperalgesia and self-reported pain in young adults with PFP. METHODS: 114 adults with PFP (24 ± 5 years old, 62% women) were recruited. Demographics and self-reported pain (current and worst knee pain intensity in the previous month - 0-100 mm visual analog scale) were recorded. Body fat and skeletal muscle mass were measured using bioelectrical impedance. Pressure hyperalgesia was measured using a handheld algometer (pressure pain threshold) at three sites: center of patella of the painful knee, ipsilateral tibialis anterior, and contralateral upper limb. The association between body fat, skeletal muscle mass, and BMI with pressure hyperalgesia and self-reported pain were investigated using partial correlations and hierarchical regression models (adjusted for sex, bilateral pain, and symptoms duration). RESULTS: Higher body fat and lower skeletal muscle mass were associated with local, spread, and widespread pressure hyperalgesia (ΔR2=0.09 to 0.17, p ≤ 0.001; ΔR2=0.14 to 0.26, p<0.001, respectively), and higher current self-reported pain (ΔR2=0.10, p<0.001; ΔR2=0.06, p = 0.007, respectively). Higher BMI was associated with higher current self-reported pain (ΔR2=0.10, p = 0.001), but not with any measures of pressure hyperalgesia (p>0.05). CONCLUSION: Higher body fat and lower skeletal muscle mass help to explain local, spread, and widespread pressure hyperalgesia, and self-reported pain in people with PFP. BMI only helps to explain self-reported pain. These factors should be considered when assessing people with PFP and developing their management plan, but caution should be taken as the strength of association was generally low.

Assessment of Dynamic Knee Valgus between Lateral Step-Down Test and Running in Female Runners with and without Patellofemoral Pain Using Two-Dimensional Video Analysis.

Dynamic knee valgus (DKV) is a frontal plane knee kinematic alteration that has been associated with patellofemoral pain (PFP) in female runners. DKV is commonly assessed in clinical practice by measuring frontal plane knee projection angle (FPPA) during squat tests. However, it remains unclear whether the DKV observed in these tests is similar to or correlates with that observed during running in female runners. The aims of this cross-sectional study were to correlate and compare DKV, by measuring FPPA values, in a lateral step-down (LSD) squat test and running in female runners with and without PFP. A two-dimensional (2D) video analysis of the LSD test and running was carried out for 21 asymptomatic female runners and 17 PFP female runners in order to determine FPPA values. A Pearson correlation test and a factorial ANOVA with Bonferroni post hoc correction were used for statistical analysis. The FPPAs recorded in the LSD test were significantly higher than those recorded during running in the asymptomatic (16.32° ± 5.38 vs. 4.02° ± 3.26, p < 0.01) and PFP groups (17.54° ± 7.25 vs. 4.64° ± 3.62, p < 0.01). No significant differences were found in FPPA values between asymptomatic and PFP runners during the LSD test (16.32° ± 5.38 vs. 17.54° ± 7.25, p = 0.55) and running (4.02° ± 3.26 vs. 4.64° ± 3.62, p = 0.58). There was a small (r < 0.3) and non-significant (p > 0.05) correlation in FPPAs between the LSD test and running in both groups. According to our results, DKV was not similar during the LSD test and running, and there was no significant correlation in FPPA values between the LSD test and running in both groups. Therefore, clinicians and therapists should be aware of these findings when using the LSD test in clinical practice to evaluate DKV in female runners with or without PFP.

Vascular Occlusion of the Quadriceps Muscle in Postural Control of Women with Patellofemoral Dysfunction / Oclusão Vascular do Músculo Quadríceps no Controle Postural de Mulheres com Disfunção Patelofemoral

Abstract The partial vascular occlusion (PVO) associated with exercises, proposed by the KAATSU Training method, has the objective of strengthening and muscle hypertrophy with low joint overload. Currently, PVO has been associated with exercises to strengthen then quadriceps, however it is not known about its influence on postural control or the possibility of imbalances during the performance of exercises. Objectives: To evaluate the effect of quadriceps vascular occlusion on postural control in women with patellofemoral pain syndrome (PFPS). Methods: The sample in this study was composed of four sedentary women, aged between 18 and 40 years, with a clinical diagnosis of patellofemoral dysfunction. Participants responded to the Visual Analog Pain Scale (VAS) and the Anterior Knee Pain Scale (AKPS). They were submitted to an evaluation of postural control over the force platform, by means of dynamic one-legged squat activity, with and without PVO. The variables of postural control analyzed were Area of pressure center (A-COP), Anteroposterior (AP) and medium-lateral (ML), Velocity AP and ML. Results: No significant differences were found for the variables of postural control analyzed when comparing the moments with and without peripheral vascular occlusion during single-legged squat activities. Conclusion: The single leg squat with vascular occlusion does not change the postural control of patients with PFPS with and without PVO, and that the method can be used for training these patients, without impairments related to postural control. (AU)

Resumo A oclusão vascular parcial (OVP) associada a exercícios, proposta pelo método KAATSU Training, tem como objetivo o fortalecimento e hipertrofia muscular com baixa sobrecarga articular. Atualmente, a OVP tem sido associada a exercícios de fortalecimento do quadríceps, porém não se sabe sobre sua influência no controle postural ou na possibilidade de desequilíbrios durante a execução dos exercícios. Objetivos: Avaliar o efeito da oclusão vascular do quadríceps no controle postural de mulheres com síndrome da dor patelofemoral (SDFP). Métodos: A amostra deste estudo foi composta por quatro mulheres sedentárias, com idade entre 18 e 40 anos, com diagnóstico clínico de disfunção femoropatelar. Os participantes responderam à Escala Visual Analógica de Dor (VAS) e à Escala de Dor Anterior no Joelho (AKPS). Elas foram submetidas à avaliação do controle postural sobre a plataforma de força, por meio da atividade de agachamento unipodal dinâmico, com e sem OVP. As variáveis de controle postural analisadas foram área do centro de pressão (A-COP), ântero-posterior (AP) e médio-lateral (ML), velocidade AP e ML. Resultados: Não foram encontradas diferenças significativas para as variáveis de controle postural analisadas na comparação dos momentos com e sem OVP durante o agachamento unipodal. Conclusão: O agachamento unipodal com OVP não alterou o controle postural de mulheres com SDFP, e o método pode ser utilizado para treinar esses pacientes, sem prejuízos relacionados ao controle postural. (AU)

Fortalecimiento muscular de cadera y rodilla en el síndrome doloroso patelofemoral: Revisión sistemática y metaanálisis / Hip and knee muscle strengthening in patellofemoral pain syndrome: Systematic review and meta-analysis / Fortalecimento muscular do quadril e joelho na síndrome da dor patelofemoral: revisão sistemática e meta-análise

El síndrome doloroso patelofemoral (SDPF) es una condición musculoesquelética frecuente que se manifiesta con dolor retro y peripatelar. El fortalecimiento muscular de cadera y rodilla (FCR) ha sido propuesto como un tratamiento apropiado para el SDPF. Es precisa una revisión que compare los resultados del FCR con otras intervenciones utilizando evidencia científica actual. OBJETIVO: evaluar la efectividad del FCR en pacientes con SDPF. MATERIALES Y MÉTODOS: la revisión sistemática (RS) y metaanálisis (MA) siguieron las directrices PRISMA. El cribaje y selección de estudios se realizó mediante el programa Rayyan. Nueve artículos fueron incluidos y evaluados con la escala PEDro y la herramienta Riesgo de Sesgo de Cochrane. El MA se realizó en la aplicación Jamovi. Las variables utilizadas fueron dolor, funcionalidad y fuerza muscular. RESULTADOS: el MA demostró que el FCR fue superior en la disminución del dolor (2.30;1.18, 3.42; 95%IC) (1.76; 0.70, 2.81; 95%IC) y el incremento de la funcionalidad (14.30 ;7.49, 21.11; 95%IC) (8.66 ;3.08, 14.23; 95%IC) comparado con los grupos sin intervención (NI) y los del fortalecimiento de rodilla (FR), respectivamente; mientras que la adición de intervenciones al fortalecimiento de cadera y rodilla (FCR+) demostró mayores beneficios en la funcionalidad (-5.71; -8.32, -3.10; 95%IC) al compararse con el FCR. Así mismo, el análisis cualitativo de la variable fuerza muscular estableció que el FCR obtuvo mejores resultados que los grupos de FR y FCR+ ejercicios de control motor. CONCLUSIONES: el FCR es una intervención efectiva en la reducción del dolor, el incremento de la funcionalidad y fuerza muscular en pacientes con SDPF.

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition that manifests with retro- and peripatellar pain. Hip and knee muscle strengthening (HKS) has been proposed as an appropriate treatment for PFPS. A review comparing the results of HKS with other interventions using current scientific evidence is needed. OBJECTIVE: to evaluate the effectiveness of HKS in patients with PFPS. MATERIALS AND METHODS: the systematic review (SR) and meta-analysis (MA) followed PRISMA guidelines. Screening and selection of studies was performed using the Rayyan program. Nine articles were included and evaluated with the PEDro scale and the Cochrane Risk of Bias tool. The MA was performed in the Jamovi application. The variables used were pain, functionality and muscle strength. RESULTS: the MA showed that the HKS was superior in decreasing pain (2.30; 1.18, 3.42; 95%CI) (1.76; 0.70, 2.81; 95%CI) and increasing functionality (14.30; 7.49, 21.11; 95%CI) (8.66; 3.08, 14.23; 95%CI) compared to the no intervention (NI) and knee strengthening (KS) groups, respectively; while the addition of interventions to hip and knee strengthening (HKS+) demonstrated greater benefits in functionality (-5.71; -8.32, -3.10; 95%CI) when compared to HKS. Likewise, qualitative analysis of the muscle strength variable established that the HKS obtained better results than the KS and HKS+ motor control exercises groups. CONCLUSIONS: HKS is an effective intervention in reducing pain, increasing functionality and muscle strength in patients with PFPS.

A síndrome da dor patelofemoral (SDPF) é uma condição musculoesquelética comum que se manifesta com dor retro e peripatelar. O fortalecimento dos músculos do quadril e joelho (FQJ) foi proposto como um tratamento adequado para o SDPF. É necessária uma revisão comparando os resultados da FQJ com outras intervenções utilizando as evidências científicas atuais. OBJETIVO: avaliar a eficácia da FQJ em pacientes com SDPF. MATERIAIS E MÉTODOS: a revisão sistemática (RS) e a meta-análise (MA) seguiram as diretrizes do PRISMA. A triagem e seleção dos estudos foi realizada utilizando o software Rayyan. Nove artigos foram incluídos e avaliados utilizando a escala PEDro e a ferramenta Cochrane Risk of Bias. O MA foi realizado na aplicação Jamovi. As variáveis utilizadas foram dor, funcionalidade e força muscular. RESULTADOS: o MA mostrou que o FQJ foi superior em diminuição da dor (2,30; 1,18, 3,42; 95%CI) (1,76; 0,70, 2,81; 95%CI) e aumento da função (14,30; 7,49, 21,11; 95%CI) (8,66; 3,08, 14.23; 95%CI) em comparação com os grupos sem intervenção (NI) e de fortalecimento do joelho (FJ), respectivamente; enquanto a adição de intervenções de fortalecimento do quadril e joelho (FQJ+) demonstrou maiores benefícios em função (-5,71; -8,32, -3,10; 95%CI) quando comparado com o FQJ. Da mesma forma, a análise qualitativa da variável força muscular estabeleceu que o FQJ teve melhor desempenho do que os grupos FJ e FQJ+ exercícios de controlo do motor. CONCLUSÕES: o FQJ é uma intervenção eficaz na redução da dor, aumentando a funcionalidade e a força muscular em pacientes com SDPF.

Current Concepts in the Management of Patellofemoral Pain Syndrome / Conceptos Actuales en el Manejo del Síndrome de Dolor Patelofemoral

Introduction Patellofemoral pain syndrome (PFPS) is one of the leading causes of knee pain, manifesting itself during daily life activities. This study presents a review on PFPS treatment modalities. Materials and methods State of the art review on the treatment of PFPS with grades of recommendation. Active and passive conservative interventions are reviewed, as well as surgical alternatives. Results Hip and lower-limb muscle strengthening and stretching are active interventions that provide long-lasting benefits. Passive interventions include patellofemoral joint bracing, kinesiotaping and foot orthoses, and are considered useful coadjuvants to active interventions, with quick relief for patients but usually in the short term. Surgical treatment is only recommended in a small subset of patients with specific anatomic abnormalities in the patellofemoral joint. Discussion Conservative treatment remains as the mainstream in the management of patellofemoral pain syndrome.

Introducción El síndrome de dolor patelofemoral (SDPF) es una de las principales causas de dolor de rodilla y se presenta con actividades diarias de la vida cotidiana. Este estudio presenta una revisión de la literatura acerca de las modalidades de tratamiento actual para el SDPF. Materiales y métodos Revisión estado del arte acerca del tratamiento del SDPF con grados de recomendación según la evidencia. Se revisan las intervenciones conservadoras activas y pasivas, así mismo las alternativas quirúrgicas. Resultados El fortalecimiento de los músculos de la cadera y del miembro inferior, así como el estiramiento, son intervenciones activas que ofrecen beneficios en el largo plazo para el SDPF. Las intervenciones pasivas como las rodilleras, el kinesiotaping y las ortesis para los pies, ofrecen alivio rápido pero de corta duración. El tratamiento quirúrgico solamente se recomienda en un subgrupo de pacientes que no han respondido a otros tratamientos y que tienen ciertas anormalidades anatómicas específicas que alteran la articulación patelofemoral. Discusión El tratamiento conservador continúa siendo la piedra angular en el tratamiento del síndrome de dolor patelofemoral

SEBT in individuals with patellofemoral pain: an integrative review / SEBT em indivíduos com dor patelofemoral: uma revisão integrativa

Abstract Introduction: Decreased postural stability can be observed in individuals with patellofemoral pain (PP). The Star Excursion Balance Test (SEBT) is widely used to assess deficits that need to be improved, with different application methods and result presentation formats. Objective: To map SEBT use in individuals with PP, characterizing the studies that applied it to identify different application methods and result presentation formats. Methods: The review included randomized and non-randomized clinical trials, cross-sectional, case-control and cohort studies. Searches were performed in Pubmed and SciElo databases. Data extracted from eligible studies were divided into categories: (I) study characterization (II) SEBT application methods and result presentation formats. Results: A total of 177 studies were identified in the databases, 13 of which were selected. There are a growing number of new studies that assess the dynamic postural control of individuals with PP using the SEBT, and a variety of test application and result presentation formats. Conclusion: The SEBT is a useful, easy-to-apply test that identifies changes in dynamic postural control in individuals with PP. Different application and result presentation formats are in accordance with the literature, but it is recommended that future studies apply the protocols most widely used in previous studies that exhibit a low risk of bias, in order to improve repeatability and comparisons between studies.

Resumo Introdução: A diminuição da estabilidade postural pode ser observada em indivíduos com dor patelofemoral (DP). O Star Excursion Balance Test (SEBT) é um teste amplamente utilizado para a avaliação de déficits que precisam ser melhorados e também pode apresentar diferentes maneiras de aplicabilidade e apresentação dos resultados obtidos. Objetivo: Mapear a utilização do SEBT em indivíduos com DP, caracterizando os estudos que utilizaram o teste, de maneira a identificar diferentes formas de aplicabilidade e apresentação dos resultados. Métodos: A presente revisão incluiu ensaios clínicos randomizados e não randomizados, estudos transversais, caso-controle e estudos de coorte. As buscas foram realizadas nas bases de dados Pubmed e SciELO. Dados extraídos dos estudos elegíveis foram designados em categorias: (I) caracterização dos estudos, (II) formas de aplicação do SEBT e apresentação de resultados. Resultados: Foram identificados um total de 177 registros nas bases de dados analisadas e 13 destes foram selecionados. Existe um número crescente de novos estudos que buscam avaliar o controle postural dinâmico de indivíduos com DP utilizando o SEBT, sendo que existe uma variabilidade na aplicabilidade do teste e também na apresentação dos resultados. Conclusão: O SEBT é um teste útil, de fácil aplicabilidade e que identifica alterações do controle postural dinâmico em indivíduos com DP. Diferentes formas de aplicação e apresentação dos resultados do teste estão de acordo com a literatura, porém recomenda-se que estudos futuros utilizem os protocolos mais utilizados em estudos prévios que apresentem baixo risco de viés, para que seja possível melhorar a repetibilidade e as comparações entre estudos.

Anterior knee pain in runners after a half-marathon race.

BACKGROUND: Anterior knee pain has been associated with sports activity, especially long-distance running and endurance sports. It is important to determine the incidence of anterior knee pain (AKP) in runners after a half-marathon race and identify possible risk factors associated. METHODS: Cross-sectional study where runners from a half marathon race were randomly invited to participate. Participants were recruited at the race kit pickup site the day before the race. Eligible participants completed a survey regarding demographic information, running experience and training details. An orthopedic surgeon performed a physical examination and recorded the medical history. At the finish line, the participants were evaluated again for possible new injuries. RESULTS: A total of 205 runners were included in the study, with a 98.5% follow-up rate (n = 203). 24% of runners had an injury at the end of the race (n = 49). Anterior knee pain was the most frequent injury (n = 12), followed by iliotibial band syndrome (n = 10), muscle cramps (n = 7) and hamstring tears (n = 4). Anterior knee pain had a statistically significant association with insufficient stretching of the hamstrings (p = 0.048) and finishing the race in more than 2 h (p = 0.014). CONCLUSIONS: Anterior knee pain was the most frequent new injury in the half-marathon runners after the competition. Spending more than 2 h to finish the race and stretching the hamstrings by less than 70° in the supine position were risk factors for anterior knee pain.

One-year results of bracing for patello-femoral osteoarthritis. prospective randomized study / Um ano de uso de órtese para osteoartrite fêmoro-patelar. estudo prospectivo randomizado

ABSTRACT Objective: To compare the long-term effects of a brace designed to stabilize the patellofemoral (PF) joint in comparison to a standard neoprene sleeve for the knee with patellar hole in patients with patellofemoral osteoarthritis (PFOA). Methods: 38 patients with PFOA and comorbidities received either a functional PF brace (Study Group, SG) or a neoprene sleeve for the knee (Control Group, CG). Both groups received clinical treatment to OA and comorbidities according to a program from the institution. Patients were evaluated with Western Ontario and MacMaster (WOMAC) and Lequesne questionnaires, 30-second chair stand test (30CST), Timed Up and Go (TUG), anthropometric measures and self-reported physical activity in minutes/week at inclusion, one, three and twelve months after placing the brace. X-Rays were taken to measure the angles. Results: At one year there was more abandonment in the CG without differences in weight and body mass index between groups during the study. The SG maintained improvements in Lequesne and WOMAC total and subsets during the year, whereas the CG returned to baseline values for pain, function and total (p < 0.01). TUG and 30CST results were always better in the study group without any clinically important improvement in both groups. Conclusion: Long-term use of functional brace added to self-management program improves pain and function in patients with PFOA. Level of Evidence II, Lesser quality RCT (eg, < 80% followup, no blinding, or improper randomization).

RESUMO Objetivo: Comparar o efeito a longo prazo de uma órtese destinada a estabilizar a articulação fêmoro-patelar em comparação com uma de neoprene com orifício para patela em pacientes com osteoartrite fêmoro-patelar (OAFP). Métodos: Trinta e oito pacientes com OAFP e comorbidades receberam ou uma órtese funcional fêmoro-patelar (grupo estudo, GE) ou uma joelheira de neoprene com orifício para patela (grupo controle, GC). Os grupos receberam tratamento clínico da osteoartrite e comorbidades conforme programa da instituição. Foram avaliados com os questionários de WOMAC e Lequesne, testes de senta e levanta em 30 segundos (TSL30) e Timed-Up-and-Go (TUG), medidas antropométricas e minutos de atividade física semanal à inclusão, com um, três e doze meses depois da colocação da órtese. Radiografias foram realizadas para mensurar ângulos fêmoro-tibiais. Resultados: Houve mais abandono no GC, sem diferenças de peso, índice de massa corpórea e atividade física entre os grupos durante o estudo. GE manteve melhoras de Lequesne e WOMAC total e subdomínios durante todo o estudo, enquanto o GC piorou progressivamente após o primeiro mês (p < 0,01). TUG e TSL30 tiveram melhoras não clinicamente relevantes para ambos os grupos. Conclusão: O uso a longo prazo da órtese funcional adicionado ao tratamento clínico melhora a dor e a função dos pacientes com OAFP. Nível de Evidência II, Evidence II,ECRC de menor qualidade (por exemplo, < 80% de acompanhamento, sem mascaramento do código de randomização ou randomização inadequada).

ONE-YEAR RESULTS OF BRACING FOR PATELLO-FEMORAL OSTEOARTHRITIS. PROSPECTIVE RANDOMIZED STUDY.

OBJECTIVE: To compare the long-term effects of a brace designed to stabilize the patellofemoral (PF) joint in comparison to a standard neoprene sleeve for the knee with patellar hole in patients with patellofemoral osteoarthritis (PFOA). METHODS: 38 patients with PFOA and comorbidities received either a functional PF brace (Study Group, SG) or a neoprene sleeve for the knee (Control Group, CG). Both groups received clinical treatment to OA and comorbidities according to a program from the institution. Patients were evaluated with Western Ontario and MacMaster (WOMAC) and Lequesne questionnaires, 30-second chair stand test (30CST), Timed Up and Go (TUG), anthropometric measures and self-reported physical activity in minutes/week at inclusion, one, three and twelve months after placing the brace. X-Rays were taken to measure the angles. RESULTS: At one year there was more abandonment in the CG without differences in weight and body mass index between groups during the study. The SG maintained improvements in Lequesne and WOMAC total and subsets during the year, whereas the CG returned to baseline values for pain, function and total (p < 0.01). TUG and 30CST results were always better in the study group without any clinically important improvement in both groups. CONCLUSION: Long-term use of functional brace added to self-management program improves pain and function in patients with PFOA. Level of Evidence II, Lesser quality RCT (eg, < 80% followup, no blinding, or improper randomization).

OBJETIVO: Comparar o efeito a longo prazo de uma órtese destinada a estabilizar a articulação fêmoro-patelar em comparação com uma de neoprene com orifício para patela em pacientes com osteoartrite fêmoro-patelar (OAFP). MÉTODOS: Trinta e oito pacientes com OAFP e comorbidades receberam ou uma órtese funcional fêmoro-patelar (grupo estudo, GE) ou uma joelheira de neoprene com orifício para patela (grupo controle, GC). Os grupos receberam tratamento clínico da osteoartrite e comorbidades conforme programa da instituição. Foram avaliados com os questionários de WOMAC e Lequesne, testes de senta e levanta em 30 segundos (TSL30) e Timed-Up-and-Go (TUG), medidas antropométricas e minutos de atividade física semanal à inclusão, com um, três e doze meses depois da colocação da órtese. Radiografias foram realizadas para mensurar ângulos fêmoro-tibiais. RESULTADOS: Houve mais abandono no GC, sem diferenças de peso, índice de massa corpórea e atividade física entre os grupos durante o estudo. GE manteve melhoras de Lequesne e WOMAC total e subdomínios durante todo o estudo, enquanto o GC piorou progressivamente após o primeiro mês (p < 0,01). TUG e TSL30 tiveram melhoras não clinicamente relevantes para ambos os grupos. CONCLUSÃO: O uso a longo prazo da órtese funcional adicionado ao tratamento clínico melhora a dor e a função dos pacientes com OAFP. Nível de Evidência II, Evidence II,ECRC de menor qualidade (por exemplo, < 80% de acompanhamento, sem mascaramento do código de randomização ou randomização inadequada).

Cross-cultural translation and validation of the Spanish version of the patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF).

OBJECTIVE: The aim of this study was to translate to Spanish the patellofemoral pain and osteoarthritis subscale of the knee injury and osteoarthritis outcome score (KOOS-PF) and validate this Spanish version of a disease-specific patient-reported outcome measure (PROM) for patellofemoral pain. RESULTS: The KOOS-PF was translated to Spanish and sixty patients with patellofemoral pain and/or osteoarthritis accepted to complete the questionnaire. 1-week later 58 patients answered the questions again for the test-retest reliability validation and finally 55 patients completed 1-month later for the responsiveness assessment. The Spanish version showed very good internal consistency (Cronbach's alpha: 0.93) and test-retest reliability (intraclass correlation coefficient: 0.82). Responsiveness was confirmed, showing a strong correlation with the global rating of change (GROC) score (r 0.64). The minimal detectable change was 11.1 points, the minimal important change was 17.2 points, and there were no floor or ceiling effects for the score.

Therapeutic effect of two muscle strengthening programs in patients with patellofemoral pain syndrome. A randomized controlled clinical trial / Efecto terapéutico de dos programas de fortalecimiento muscular en pacientes con síndrome de dolor pátelofemoral. Ensayo clínico controlado aleatorizado

Abstract Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients. ClinicalTrials.gov Identifier: NCT04011436

Resumen Introducción. El síndrome de dolor pátelofemoral (SPF) es una de las alteraciones musculoesqueléticas más frecuentes que afectan la articulación de la rodilla. El tratamiento conservador reduce el dolor y mejora la capacidad funcional en el corto y mediano plazo. Objetivo. Establecer el efecto terapéutico de dos programas de ejercicios de fortalecimiento muscular en pacientes con SPF de Bogotá, Colombia, con edades entre 15 y 40 años. Materiales y métodos. Ensayo clínico controlado aleatorio experimental realizado en 40 pacientes con SPF de Bogotá, Colombia, con edades entre los 15 y 40 años, con nivel de actividad física leve a moderada y que fueron distribuidos de forma aleatoria en 2 grupos de intervención: Grupo A: programa de ejercicios de fortalecimiento de los músculos del core, la cadera y la rodilla con una duración de 8 semanas; Grupo B: programa de ejercicios de fortalecimiento de los músculos de la cadera y la rodilla con la misma duración. El nivel de dolor se midió a través de la Escala Visual Analógica y de la Escala de Kujala para dolor patelofemoral. Resultados. La adición de ejercicios de fortalecimiento de los músculos del core al tratamiento tradicional mejoró la calidad de vida de los participantes en el grupo de intervención A, donde se observó una reducción significativa del dolor con una diferencia estadísticamente significativa en la puntuación total de la escala Kujala (p=0.025). Conclusiones. Incluir ejercicios de fortalecimiento de los músculos del core al manejo conservador del SPF aumenta su efectividad para reducir el dolor y mejorar la calidad de vida de estos pacientes. ClinicalTrials.gov Identifier: NCT04011436

Relationship between Knee Symptoms and Biological Features in Recreational Runners.

Objective The main objective of the present study was to compare the subjective perception of pain and symptoms of anterior knee pain with the different body mass index (BMI) classifications. The secondary objective was to verify the association between biological and anthropometric variables with the results of subjective questionnaires. Methods A total of 126 recreational runners from both genders, aged between 20 and 59 years old, were recruited. Data regarding the biological variable (age), anthropometric variables (weight, height), visual analog scale (VAS), and Lysholm and Kujala questionnaires scores were collected. Information was obtained with a digital platform, available through a single link, allowing volunteers to answer these questions using electronic devices. Normality was verified by the Shapiro-Wilk test. T-tests and Wilcoxon tests were used to compare mean values. The association between variables was determined by the Pearson linear correlation. Results There were significant differences in height between overweight and grade 1 obesity subjects ( p = 0.029), in weight and BMI comparing normal weight subjects and both overweight and grade 1 obesity subjects ( p < 0.001 and p < 0.05, respectively). An unclear significant correlation was observed between BMI values and specific questionnaires and subjective scale scores ( p < 0.05). Conclusion Recreational runners who present high BMI values are more likely to experience knee pain than those with normal BMI values.

Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial.

OBJECTIVE: The objective of this study was to verify the effects of resisted and proprioceptive exercises program for the treatment of patients diagnosed with patellofemoral pain syndrome (PFPS). DESIGN METHOD: Randomized Controlled Trial - level of evidence, II. METHODS: Sixty female patients, clinically diagnosed with PFPS, were allocated into two experimental groups. The exercise group (ExG) underwent 6 weeks of a resisted and proprioceptive exercises for the trunk muscles, abductors and lateral hip rotators and knee extensors. The Guidance Group (GG) received educational, cognitive and behavioral guidance on healthcare. Before and after the program implementation period, all participants were evaluated in relation to the injured limb for pain assessment, subjective functionality, maximum isometric strength and 2D biomechanical analysis. RESULTS: After a six-week follow-up, ExG showed significant improvement in the Numerical Pain Rating Scale, Anterior Knee Pain Scale and Knee Outcome Survey- Activities of Daily Living Scale when compared to the control group (p ≤ 0,05). The ExG also proved superior for increased muscle strength of knee extensors, hip abductors, decreased dynamic knee valgus and pelvic drop in relation to GG (p ≤ 0.05). However, when we consider the strength of the hip lateral rotator muscles there was no difference between the two interventions (p > 0.05). CONCLUSION: Resisted and proprioceptive exercises yielded superior results to those of a treatment focused on educational, cognitive and behavioral guidance in improving pain and lower limb function for women with PFPS.

The role of viscosupplementation in patellar chondropathy.

Patellar chondropathy has a high incidence in the general population, being more common in patients younger than 50 years, female and recreational athletes, and overweight and obese patients. The most common complaints are pain, limited mobility, crepitus, difficulty climbing and descending stairs, and joint instability, usually showing unsatisfactory results with anti-inflammatory, physiotherapy, rehabilitation, and many other conservative treatment methods. The presumed hyaluronic acid (HA) disease-modifying activity may include effects on cartilage degradation, endogenous HA synthesis, synoviocyte and chondrocyte function, and other cellular inflammatory processes. Currently, HA is widely used as a safe and effective conservative treatment for osteoarthritis in the knee and other joints. HA improves the physiological environment in an osteoarthritic joint and the shock absorption and lubrication properties of the osteoarthritic synovial fluid, thus restoring the protective viscoelasticity of the synovial HA, reducing the pain, and improving the mobility. The complete mechanism of HA in the joint is not fully understood, but a wide range of actions in the joint is recognized. Its anti-inflammatory, analgesic, and chondroprotective action is related to the modulation of the intra- and extracellular inflammation cascade. HA has been shown to be safe and effective in the treatment of pain related to patellar chondropathy.

Effect of photobiomodulation in the patellofemoral pain syndrome; randomized clinical trial in young women.

OBJECTIVE: patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders in the knee joint, affecting mainly physically active adolescents and young adults; its main symptom is pain. Physiotherapy has several therapeutic modalities aimed at pain relief, among which are photobiomodulation (PBM). The aim of the study was to analyze the effects of using PBM in cluster form (Laser + LED) in patients with PFPS. PATIENTS AND METHODS: This study is characterized as quantitative, experimental, randomized, composed of 30 women with PFPS, randomized into two groups: Control Group (CG) and PBM Group (PBMG). Both groups underwent three evaluations: pre-intervention, post-intervention, and after one month of follow-up. Participants of the PBMG were presented to the application of the cluster device, three times a week, for four weeks. The intensity of spontaneous pain and movement were evaluated, knee function tests and function questionnaires. The results showed a reduction in pain only for the landing of the jump. As for the other variables there was no interaction of factors; the questionnaires used showed larger effect sizes for PBMG when compared to CG. It is possible to conclude that the use of PBM showed benefit in reducing pain at the time of landing of the jump and functional assessment questionnaires.