Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial.

BACKGROUND: Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with patellofemoral pain syndrome. METHODS: Twenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35 years old participated in this study. They were equally and randomly assigned into two groups; the study group which received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance was performed to compare the within and between groups effects for measured variables. RESULTS: The within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed no significant statistical difference between both groups in all variables, except in pain, function, and mediolateral stability which showed better improvement compared to the control group. CONCLUSIONS: Adding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability in patients with patellofemoral pain syndrome. TRIAL REGISTRATION: clinicaltrials.gov. NO: NCT05383781. Date 19/ 5/2022.

Efficacy of Isometric Exercises and Somatosensory Training for Pain, Proprioception, and Balance in Runners with Patellofemoral Pain Syndrome.

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.

Patellar resurfacing might not be mandatory in contralateral second total knee replacement even if performed during replacement of the first knee.

INTRODUCTION: The appropriateness or necessity of patellar resurfacing in total knee arthroplasty (TKA) is not clearly established. The objective of the present study was to compare the clinical and functional results of patients with bilateral involvement, operated on in one knee by TKA with patellar resurfacing and in the other knee by TKA without resurfacing. The hypothesis was that there was no difference in results between the two sides. METHOD: This was a retrospective cohort of patients operated on by TKA without patellar resurfacing in a second osteoarthritic knee after contralateral TKA with patellar resurfacing. Twenty consecutive patients who underwent second primary TKA constituted their own control group (40 knees). Iwano scores were comparable. Mean age was 75.9 ± 6.2 years. Mean time between the two procedures was 20.6 ± 11.9 months. RESULTS: There were no differences in SF-36, KOOS or Lille patellofemoral scores between the right and left knees. Sixty-five percent of patients were unable to differentiate the performance of their knees in activities of daily living. CONCLUSION: The present study did not differentiate results according to patellar resurfacing, showing the limitations of resurfacing for early functional gain after primary TKA. Resurfacing might thus not be essential, even if it was performed in replacement of the first knee. LEVEL OF EVIDENCE: IV; retrospective cohort study.

Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is a mature procedure recommended for correcting knee osteoarthritis deformity, relieving pain, and restoring normal biomechanics. Although TKA is a successful and cost-effective procedure, patient dissatisfaction is as high as 50%. Knee pain after TKA is a significant cause of patient dissatisfaction; the most common location for residual pain is the anterior region. Between 4% and 40% of patients have anterior knee pain (AKP). AIM: To investigate the effect of various TKA procedures on postoperative AKP. METHODS: We searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022. Randomized controlled trials with one intervention in the experimental group and no corresponding intervention (or other interventions) in the control group were collected. Two researchers independently read the title and abstract of the studies, preliminarily screened the articles, and read the full text in detail according to the selection criteria. Conflicts were resolved by consultation with a third researcher. And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software. RESULTS: There were 25 randomized controlled trials; 13 were comparative studies with or without patellar resurfacing. The meta-analysis showed no significant difference between the experimental and control groups (P = 0.61). Six studies were comparative studies of circumpatellar denervation vs non-denervation, divided into three subgroups for meta-analysis. The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups (P = 0.31, P = 0.50). One subgroup meta-analysis showed a significant difference between the experimental and control groups (P = 0.001). Two studies compared fixed-bearing TKA and mobile-bearing TKA; the results meta-analysis showed no significant difference between the experimental and control groups (P = 0.630). Two studies compared lateral retinacular release vs non-release; the meta-analysis showed a significant difference between the experimental and control groups (P = 0.002); two other studies compared other factors. CONCLUSION: Patellar resurfacing, mobile-bearing TKA, and fixed-bearing TKA do not reduce the incidence of AKP. Lateral retinacular release can reduce AKP; however, whether circumpatellar denervation can reduce AKP is controversial.

Lumbopelvic manipulation alone versus combined with dry needling in physically active patients with patellofemoral pain syndrome: A randomized clinical trial.

INTRODUCTION: Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD: Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS: The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION: The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.

Trends and associations between kinesiophobia and knee function from preoperatively to three and six months postoperatively in patients post-ACL reconstruction surgery.

OBJECTIVE: This study aimed to clarify the relationship between the transition of kinesiophobia and knee joint function from the preoperative period to three months postoperative, the time to resume running, six months post-ACLR, and the goal time to resume sports. METHODS: 54 patients who underwent initial ACLR were included in this study. The Tampa Scale for Kinesiophobia-11 (TSK-11) was used to assess kinesiophobia. One-way ANOVA was performed for the preoperative, three-month postoperative, and six-month postoperative endpoints. To examine changes in knee function associated with changes in TSK-11, we calculated correlations between the differences at each time point. RESULTS: TSK-11 decreased significantly at both three and six months postoperatively compared with the preoperative level, but there was no significant change between three months and six months postoperatively. Similar to the decrease in TSK-11 from preoperatively to three and six months postoperatively, there was an improvement in flexion ROM, Pain, Subjective knee function, but none of these changed significantly from three to six months postoperatively. CONCLUSION: There may be significant improvements in knee function associated with TSK-11 reduction up to three months postoperatively.

People With Patellofemoral Pain Have Bilateral Deficits in Physical Performance Regardless of Pain Laterality.

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.

Anterior knee pain patients without structural knee abnormalities and normal lower limb skeletal alignment have a higher prevalence of cam-femoroacetabular impingement syndrome than the general population.

OBJECTIVES: This study aimed to ascertain the prevalence of cam femoroacetabular impingement syndrome (cam-FAIS) in anterior knee pain (AKP) patients devoid of both structural patellofemoral joint abnormalities and lower limb skeletal malalignment. A secondary objective was to examine pain and disability differences between AKP patients with and without cam-FAIS. METHODS: A total of 209 AKP patients were screened for eligibility. Inclusion criteria were normal imaging studies and normal lower limb alignment, and exclusion criteria were previous knee surgery and knee and/or hip osteoarthritis. Of those, 49 (23.4%) were eligible and this number matched a previous power analysis to detect statistically significant differences in prevalence of cam-FAIS in a population of AKP patients. The first step in the study sequence was to ask the patient whether they had groin pain. If so, the impingement test was done. Then, the femoral cam morphology defined by an alpha angle greater than or equal to 55° in a 45° Dunn axial view of the hip was ruled out. Additionally, patients completed Kujala and International Knee Documentation Committee (IKDC) functional knee scores for disability assessment. General population control group was obtained from literature. RESULTS: The study included 9 males and 40 females, with an average age of 36 (20-50, ±SD 8.03) years. Groin pain and positive impingement test were found in 26/49 patients (53%). An alpha angle ≥55° was observed in 35/49 patients (71%). A combination of groin pain, positive impingement test and an alpha angle ≥55° was seen in 18/49 patients (37%). The AKP patients with groin pain, a positive impingement test and an alpha angle ≥55° exhibited statistically similar pain and disability levels as AKP patients without cam-FAIS. CONCLUSION: The results of this study suggest that AKP patients without structural abnormalities in the patellofemoral joint and without lower limbs malalignment have a statistically significantly higher prevalence of cam-FAIS than the general population. Moreover, AKP patients with cam-FAIS have a statistically similar degree of pain and disability than AKP patients without it. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: IV.

The multidisciplinary team in the management of chronic pain and pain-related fear: an evidence-based approach in a clinical case.

PURPOSE: Pain is a complex, intimate, and subjective experience influenced by biological, psychological, and social factors. This case report investigates the effectiveness of a multidisciplinary team approach in addressing chronic pain and pain-related fear. CASE DESCRIPTION: The case report describes a 22-year-old female who experienced anterior knee pain for seven years, despite undergoing two knee surgeries and physiotherapy without improvement. Following a comprehensive assessment, which included a detailed medical history, clinical examination, and thoughtful clinical analysis, a multidisciplinary approach was recommended. Employing an evidence-based methodology that integrated neurocognitive rehabilitation techniques, including Pain Neuroscience Education, Graded Motor Imagery, and Tactile Discrimination Training, alongside psychological rehabilitation strategies such as Mindfulness, Acceptance and Commitment Therapy, and Problem-Solving Therapy, the report presents a comprehensive in-depth rehabilitation plan exemplifying the application of this multimodal approach within a clinical setting in a patient with chronic pain. This approach is designed not to address the biomechanical aspects but to delve into the cognitive facets associated with pain perception and avoidance, as well as potential psychological factors that may be influencing the onset and persistence of symptoms. OUTCOMES: The scores from the rating scales provided valuable insights into patient progress in pain management, functional improvement, fear of movement, and overall physical, psychological, and emotional well-being, at six months. CONCLUSION: This case report offers valuable insights into the usefulness of this multidisciplinary and multimodal approach, highlighting its potential as an avenue in the management of chronic pain and pain-related fear.

[Evolving indications for partial knee replacement : New aspects]. / Update Indikation Teilprothese : Neue Aspekte.

BACKGROUND: Partial knee replacement has proven to be an effective therapy for advanced unicompartmental arthrosis of the knee. Despite continuous advancements in implants and surgical techniques over the past decades, the global preference for total knee arthroplasty still persists for historical reasons. OBJECTIVES: This report aims to illuminate advantages and disadvantages of partial knee replacement considering long-term results, the evolution of indication criteria over recent decades and new aspects in patient selection with potential improvements through emerging technologies. MATERIAL AND METHODS: The analysis involves the examination of long-term results from clinical studies and registry data, highlighting the risk factors for potential failures and their influence on the development of indication criteria. RESULTS: Present-day long-term results demonstrate excellent prosthetic survival, aligning with outcomes from total knee arthroplasty. New perspectives for expanding indication criteria are discussed, including the possible application of partial knee replacement in cases of severe varus deformity > 15°, anterior cruciate ligament insufficiency, young active patients, anterior knee pain, and/or patellofemoral arthritis, as well as mild radiographic arthritis with degenerative medial meniscus root tear and meniscal extrusion. DISCUSSION: Indication criteria have consistently expanded in recent years, taking into account modern insights, and the application of advanced technologies can enhance precision and minimize surgical errors. Furthermore, this report emphasizes that revision rates are not the sole criterion for success and underscores the necessity for a comprehensive examination of clinical results.

Inferior patellar mobility before and after knee arthroplasty: A comparison with healthy knees.

PURPOSE: The aim of this study was to evaluate patellar mobility in patients before and after knee arthroplasty (KA) and compare it with that of healthy subjects. It was hypothesised that patellar mobility is diminished in patients with osteoarthritis (OA) and remains unchanged after KA. METHODS: A total of 101 patients (59 females and 42 males) with a mean age of 70.9 ± 9.9 years underwent KA and were compared with 25 healthy individuals (seven females and 18 males) with a mean age of 32.3 ± 9.3 years. Mediolateral patellar displacement was measured by applying a force of 10 N, and the medial and lateral patellar shifts were recorded separately using a validated novel patellostabilometer. Patients were examined preoperatively and at 3 months postoperatively, assessing the range of knee motion and the clinical and functional status based on the Oxford Knee Score (OKS), Kujala Score, subjective Knee Society Score (sKSS), Forgotten Joint Score (FJS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). RESULTS: Total patellar displacement was 42.1 ± 6 mm for healthy subjects, 31 ± 6 mm before surgery and 32.8 ± 7.8 mm after surgery in osteoarthritic patients (p < 0.01). The mean lateral patellar shift differed significantly between healthy individuals (17.9 ± 4 mm) and osteoarthritic patients (15.1 ± 6 mm) (p < 0.01). The mean medial patellar mobility of healthy individuals (24.2 ± 7 mm) was significantly greater than that of osteoarthritic patients (15.8 ± 4.8 mm) (p < 0.01). All scores improved significantly postoperatively. No correlation was found between patellar mobility and OKS, Kujala Score, sKSS, FJS and WOMAC (r = -0.11). Improvement in patellar mobility also showed no correlation with clinical outcomes according to OKS, Kujala Score, sKSS, FJS and WOMAC (r = 0.08). CONCLUSION: This study has demonstrated reduced patellar mobility in patients with OA. While patellar mobility significantly improved after KA, it may not hold clinical significance (p = 0.04). No impact on clinical outcome can be expected when the presurgical patella mobility is preserved in KA. LEVEL OF EVIDENCE: Level IV.

Derotational high tibial osteotomy in cases of anterior knee pain and/or patellofemoral instability: a systematic review.

IMPORTANCE: Derotational high tibial osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain (AKP) and/or patellofemoral instability (PFI). This surgical technique is not yet widely implemented and requires a systematic evaluation of its outcomes. AIM: To assess the effectiveness of derotational HTO in correcting rotational malalignments of the lower limb in patients with AKP and/or PFI through radiological, clinical, and patient-reported outcome measures. EVIDENCE REVIEW: Searches were conducted in the PubMed, Embase, and Web of Science databases up to March 3, 2023, to identify studies utilizing derotational HTO in patients with AKP and/or PFI. The primary outcome measures of interest were measurements of lower limb angular correction. Other radiological, clinical, and patient-reported outcome measures were also analyzed. The risk of bias was judged with the RoBANS tool. FINDINGS: A total of 8 studies were included, comprising 215 patients (27.0 â€‹± â€‹3.9 years) and 245 knees. The most reported angle was tibial torsion (k â€‹= â€‹6 studies, n â€‹= â€‹173 knees), with a mean difference between postoperative and preoperative values (postsurgical correction) ranging from -37.8° to -10.8°. Patient-reported outcome measures showed significant improvements in the postoperative moment, exceeding the minimal clinically important difference in almost all cases, and with high patient satisfaction (93.6%). CONCLUSIONS AND RELEVANCE: Derotational HTO allows the correction of rotational malalignments of the lower limb (tibial torsion) and promotes patient satisfaction. LEVEL OF EVIDENCE: Level IV.

Derotational distal femoral osteotomy corrects excessive femoral anteversion in patients with patellofemoral instability: A systematic review.

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.

Morphologic Evaluation of the Patella: The Impact of Gender and Age.

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.

Development of a Machine-Learning Model for Anterior Knee Pain After Total Knee Arthroplasty With Patellar Preservation Using Radiological Variables.

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.

Clinic- and laboratory-based measures of postural control in patellofemoral pain: A systematic review with meta-analysis and evidence gap map.

BACKGROUND: Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population. RESEARCH QUESTION: This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures. METHODS: We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention. RESULTS: Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = -0.71, 95 %CI:-1.29,-0.14; SMD = -0.63, 95 %CI:-0.94,-0.32) and overall stability index during double-leg stance (SMD = -0.39, 95 %CI:-0.78,-0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:-2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = -0.49, 95 %CI:-0.89,-0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping. SIGNIFICANCE: Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.

Anatomical Variation of Infrapatellar Innervation Determines Clinical Risk of Infrapatellar Neuropathy.

BACKGROUND: Infrapatellar neuropathy arises from traumatic, iatrogenic, or compression injury to the infrapatellar branch (IB) of the saphenous nerve. The risk of infrapatellar neuropathy has been shown to depend on the IB's anatomical course. The infrapatellar branch of the saphenous nerve (ISBN) has been discovered to take varying courses, and the IB can emerge directly from the femoral nerve. The variety of the IBSN's courses and the prevalence of cases involving the infrapatellar branch of the femoral nerve (IBFN) call the uniform IB course described in textbooks into question. OBJECTIVES: In this study, we aim to identify sites of IB emergence and their anatomical relations and evaluate them for their risk of neuropathy. STUDY DESIGN: The study is an anatomical prospective pilot study. SETTING: The setting is a single-center cadaveric study performed at the anatomical institute of the Medical University of Vienna. METHODS: Twenty-two anatomical specimens were evaluated for the relationship of their IBs to anatomical risk sites. The subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle were assessed. The measurements and relations of the IB were determined with callipers and assessed by computational modelling. RESULTS: Nine IBs originated from the saphenous nerve, 11 originated from the femoral nerve, and 2 originated from both. The subsartorial course was most frequent in IBs of saphenous origin. Penetrating and profound distal sartorial relations correlated moderately with emergence type and were highest in the saphenous group. The crossing of the medial femoral epicondyle was the most common relation of IBs that emerged femorally. LIMITATIONS: The study's limitations were the low number of cadavers to examine and the confining of the exploration of knee extension to anatomical specimens that restricted an inferential analysis. CONCLUSION: Infrapatellar innervation can emerge from the saphenous nerve, the femoral nerve, or a combination of both, and the origin of the innervation determines the clinical risk for infrapatellar neuropathy. While innervation from the IBSN may lead to compression at the subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle, innervation from the IBFN carries reduced anatomical risk for infrapatellar neuropathy.

Comparing the effects of positional versus myofascial release of gluteus medius to manage patellofemoral pain syndrome: single blinded randomized clinical trial.

OBJECTIVE: To determine the effects of positional release technique in comparison to myofascial release technique on gluteus medius trigger point along with exercises to manage patellofemoral pain syndrome. METHODS: The single-blind, two-arm, randomised clinical trial was conducted at the Department of Physiotherapy, Sindh Institute of Physical Medicine, Karachi, from December 7, 2020, to March 24, 2021, and comprised patellofemoral pain syndrome of either gender with gluteus medius trigger point. They were randomly allocated to positional release technique group A and myofascial release technique group B. The intervention comprised 3 sessions per week for 6 weeks for a total of 18 sessions, with each session lasting 45 minutes. Function through anterior knee pain scale, pain through visual analogue scale, strength via hand-held dynamometer, and quality of life via World Health Organisation quality of life brief questionnaire were assessed alongside pressure pain threshold via algometer which was taken as the gluteus medius trigger point. All measurements were taken at baseline and 6 week post-intervention. Data was analysed using SPSS 21. RESULTS: Of the 64 participants, 38(59.4%) were females and 26(40.6%) were males. There were 32(50%) subjects in group A with mean age 29.50±5.84 years and 32(50%) in group B with mean age 29.50±5.43 years (p>0.05). Both the groups showed a significant reduction in pain, improvement in function, pressure pain threshold, strength, and quality of life (p;lt;0.05). Intergroup comparisons revealed no significant differences (p>0.05). CONCLUSIONS: Treating myofascial trigger points of gluteus medius muscle, using either positional release technique or myofascial release technique together with exercise therapy was found to be equally beneficial. Clinical Trial gov ID: NCT04667091.

Giant Cell Tumor of Patella with Secondary Aneurysmal Bone Cyst-A Rare Case Report of Anterior Knee Pain in Young Adults.

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.

The Role of Biofeedback in Patellofemoral Pain Conservative Treatment: A Systematic Review.

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.