Clinical trial of manual therapy in the treatment of chondromalacia patellae.

BACKGROUND: Chondromalacia patellae (CP) is a common and main cause of knee pain, the prevalence of the disease in the general population is as high as 36.2%, especially in middle-aged patients aged between 30 and 40 years (up to 50%). The use of manual therapy (MT) to dredge the meridians and muscles around the knee joint and stimulate the relevant acupoints can play vital roles in relieving pain and improving function. The purpose of this study is to assess the effectiveness, safety and further comprehensively, completely and multi-dimensionally explain the mechanism and treatment advantages of MT for CP. METHODS: A prospective randomized controlled clinical trial design was used to study the efficacy and safety of MT in the treatment of CP. One hundred and twenty cases of CP patients will be recruited and randomly divided into experimental group and control group according to 1:1. The control group: sodium hyaluronate; experimental group: MT added on the basis of the control group. Both groups will receive standard treatment for 4 weeks and followed up for 3 months. And at the same time, pay attention to its efficacy and safety indicators. Observation indicators include: the visual analogue scale pain score; the Western Ontario and McMaster Universities Arthritis Index scores; the Lysholm scores, and Bristol scores, adverse reactions, etc. Data analysis was performed using SPSS 25.0 software. DISCUSSION: This study will precisely evaluate the effectiveness and safety of MT in the treatment of CP. The results of this experiment will provide more reliable clinical basis for the selection of MT for patients with CP.

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

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.

Chondromalacia patellae: current options and emerging cell therapies.

Chondromalacia patellae (CMP), also known as runner's knee, typically occurs in young patients, which is characterized by anterior knee pain (AKP) that is associated with visible changes in patellar cartilage. The initial pathological changes include cartilage softening, swelling, and edema. CMP is caused by several factors, including trauma, increased cartilage vulnerability, patellofemoral instability, bony anatomic variations, abnormal patellar kinematics, and occupation hazards. CMP may be reversible or may progress to develop patellofemoral osteoarthritis. Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications. Additionally, radiological examinations are also necessary for diagnosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic method, which holds a promise in having the unique ability to potentially identify cartilage lesions. Modalities are conventionally proposed to treat cartilage lesions in the PF joint, but none have emerged as a gold standard, neither to alleviated symptoms and function nor to prevent OA degeneration. Recently, researchers have been focused on cartilage-targeted therapy. Various efforts including cell therapy and tissue emerge for cartilage regeneration exhibit as the promising regime, especially in the application of mesenchymal stem cells (MSCs). Intra-articular injections of variously sourced MSC are found safe and beneficial for treating CMP with improved clinical parameters, less invasiveness, symptomatic relief, and reduced inflammation. The mechanism of MSC injection remains further clinical investigation and is tremendously promising for CMP treatment. In this short review, etiology, MRI diagnosis, and treatment in CMP, especially the treatment of the cell-based therapies, are reviewed.

Bone-cartilage mismatch in the medial tibial plateau: A MRI study.

BACKGROUND: Bone-cartilage mismatch is a variation in which the surface curvature of the articular cartilage is incongruent with the curvature of the underlying subchondral bone. The purpose of this study is to investigate the prevalence of this variant in the medial tibial plateau (MTP) and examine potential association with clinical findings and intra-articular derangements using MRI. METHODS: A quantitative and qualitative retrospective analysis of 98 knee MRI studies was performed. Bone and cartilage depths of the MTP were measured to assess bone-cartilage morphology and classified into congruent (concave bone-concave cartilage) and incongruent (concave bone-convex cartilage) patterns. Associations between bone-cartilage mismatch and clinical findings and other MRI changes were assessed using Fisher's exact test. RESULTS: By quantitative assessment, four individuals (4%) had MTP incongruent morphology (bone-cartilage mismatch). The mean bone depth ± standard deviation (SD) was 2.3 ± 0.6 mm concave in the congruent group, and 1.4 ± 0.6 mm concave in the incongruent group. The mean cartilage depth ± SD was 0.7 ± 0.7 mm concave in the congruent group, and 0.9 ± 0.5 mm convex in the incongruent group. By qualitative assessment, three individuals (3%) had incongruent morphology. Although not statistically significant, a higher proportion of individuals (3 of 4; 75%) with incongruent cartilage demonstrated chondromalacia patellae compared to those with congruent cartilage (38 of 94; 40%). CONCLUSION: Bone-cartilage mismatch was present in 3-4% of the knees. Individuals with incongruent cartilage demonstrated a trend of a higher proportion of chondromalacia patellae. Larger studies are needed to evaluate this further.

Osteotomía de Fulkerson modificada por Heatley para tratamiento del dolor patelofemoral: serie de casos / Heatley modified Fulkerson osteotomy for the treatment of patellar femoral pain. A case series

Introducción El síndrome de dolor patelofemoral (SDPF) es una posible causa de dolor anterior en la rodilla que afecta predominantemente a mujeres jóvenes. No existe hasta el momento un consenso en cuanto a la etiología, pero la evidencia sugiere que el malalineamiento patelofemoral probablemente desempeña un papel en la patogénesis del dolor y particularmente en la condromalacia. Las osteotomías clásicamente utilizadas y descritas en la literatura reportan resultados funcionales variables, sin embargo los buenos resultados descritos en la literatura se encuentran en un rango entre el 50%-80%, lo que indica alguna dificultad con la reproducibilidad de la técnica o su eficacia, por lo que queremos evaluar los resultados de una técnica diferente. Materiales y Métodos Estudio de serie de casos prospectivo de pacientes con síndrome de dolor patelofemoral tratados con una nueva técnica de osteotomía de la tuberosidad tibial anterior anteromedializadora en V. Resultados Se evaluaron 19 rodillas, los promedios de intensidad de dolor fueron de 9 en el preoperatorio, 4 y 3 en el seguimiento a tres y seis meses, en la escala de Kujala se obtuvo un promedio de 33 puntos en el preoperatorio, de 75 a los 3 meses y de 87 a los seis meses. Discusión En nuestro estudio consideramos un porcentaje de 94,7% de buenos o excelentes resultados y 5% de malos resultados. La técnica descrita y utilizada en nuestro estudio presenta una tasa de buenos resultados similar a las descritas en la literatura con otras técnicas quirúrgicas y con diferentes escalas funcionales.

Background Patellofemoral pain syndrome (PFPS) is a possible cause of anterior knee pain that predominantly affects young women. To date, there is no consensus regarding the aetiology, but the evidence suggests that patellofemoral misalignment probably plays a role in the pathogenesis of pain and particularly in chondromalacia. Osteotomies classically used and described in the literature report variable functional results. As the good results described in the literature are in a range between 50%-80%, this indicates some difficulty with the reproducibility of the technique, or its effectiveness, we wish to evaluate the results of a different technique. Materials and Methods Prospective case series study of patients with patellofemoral pain syndrome treated with a new osteotomy technique of the anterior tibial tuberosity, anterior-medialized, in V. Results A total of 19 knees were evaluated. The mean pain intensity was 9 in the preoperative period, and 4 and 3 in the follow-up at three and six months, respectively. A mean of 33 points on the Kujala scale was obtained in the pre-operative period, and 75 at 3 months and 87 at six months follow-up. Discussion A percentage of 94.7% was considered good or excellent results, and 5% of considered as bad. The technique described and used in our study presents a rate of good results similar to those described in the literature with other surgical techniques and with different functional scales.

Vibroarthrographic Signal Spectral Features in 5-Class Knee Joint Classification.

Vibroarthrography (VAG) is a non-invasive and potentially widely available method supporting the joint diagnosis process. This research was conducted using VAG signals classified to five different condition classes: three stages of chondromalacia patellae, osteoarthritis, and control group (healthy knee joint). Ten new spectral features were proposed, distinguishing not only neighboring classes, but every class combination. Additionally, Frequency Range Maps were proposed as the frequency feature extraction visualization method. The results were compared to state-of-the-art frequency features using the Bhattacharyya coefficient and the set of ten different classification algorithms. All methods evaluating proposed features indicated the superiority of the new features compared to the state-of-the-art. In terms of Bhattacharyya coefficient, newly proposed features proved to be over 25% better, and the classification accuracy was on average 9% better.

Patella-patellar tendon angle and lateral patella-tilt angle decrease patients with chondromalacia patella.

PURPOSE: The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on the presence and stage of CP, and identify the differences between sexes. METHODS: MRI of 243 patients [146 men (60.1%)] were evaluated retrospectively. Patients were grouped as normal group without chondromalacia, group with mild chondromalacia (grades 1-2) and group with severe chondromalacia (grades 3-4). Sagittal patellofemoral alignment was assessed by the angle between the patella and patellar tendon (P-PTA), and the angle between the quadriceps tendon and patella (Q-PA). Patellar tilt was assessed by lateral patellar tilt angle (LPTA). In addition, patellofemoral joint morphology was evaluated by measuring trochlear depth (TD), trochlear sulcus angle (TSA) and patella angle (PA). RESULTS: P-PTA, Q-PA, LPTA and TD values were significantly lower in patients with severe chondromalacia than in patients with both normal and mild chondromalacia (P < 0.001). TSA values were significantly higher in patients with severe chondromalacia than those with both normal and mild chondromalacia (P < 0.001). TSA was higher and TD was lower in women compared to men (P < 0.001). LPTA and P-PTA were lower in women compared to men, and the difference was significant. There was no difference in PA between the two sexes. CONCLUSIONS: Patellar cartilage degeneration increases with trochlear dysplasia. There is a strong correlation between patellar malalignment (lateral patellar tilt and sagittal patellar tilt) and chondromalacia patella. Women are more prone to developing CP than men.

Relation of the chondromalatia patellae to proximal tibial anatomical parameters, assessed with MRI.

Background Magnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae. Patients and methods 100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge's MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters. Results Tibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03-1.30; 1.02-1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73-0.98, 0.02-0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9). Conclusions The result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.

[Hyaluronate acid for treatment of chondromalacia patellae: a 52-week follow-up study].

OBJECTIVE: To assess the therapeutic effect of hyaluronate acid (HA) injection through the subpatellar route for treatment of chondromalacia patellae (CP). METHODS: Eighty-eight patients with the diagnosis of CP were enrolled in this prospective study, including 38 with early CP (CP group) and 50 with advanced CP (patellofemoral arthritis group) diagnosed based on image presentations. All the patients received intra-articular HA injections through a subpatellar route once a week for 5 consecutive weeks. The primary outcome measures included WOMAC index scores and Lequesne scores before and at 4, 12, 26 and 52 weeks after the injections. The secondary outcome measures included the 30-m walking time and stair ascending and descending time (one floor) before and at 1, 2, 3, and 4 weeks after the injections. RESULTS: In both groups the patients showed significantly decreased WOMAC scores and Lequesne scores at 4, 12, 26 and 52 weeks after HA injections as compared with the baseline scores (all P < 0.01). No significant difference was found between the two groups in WOMAC scores and Lequesne scores at 4 or 12 weeks after the injections (both P>0.05). The WOMAC scores and Lequesne scores at 26 and 52 weeks after the injections were significantly higher in patellofemoral arthritis group than in CP group (both P < 0.05). In both groups, the 30-m walking time and the stair ascending and descending time decreased significantly at 1, 2, 3, and 4 weeks after HA injections (all P < 0.05) without significant differences between the two groups (all P>0.05). CONCLUSIONS: HA injection through the subpatellar route is effective for treatment of CP. HA injection produces better long-term efficacy for treatment of early CP than for advanced CP where patellofemoral arthritis occurs.

Analysis of patellofemoral arthrokinematic motion quality in open and closed kinetic chains using vibroarthrography.

BACKGROUND: Knee movements performed in open (OKC) and closed (CKC) kinetic chains generate various patterns of muscle activities and especially distinct contact stresses in the patellofemoral joint (PFJ). In contrast to these features, the arthrokinematic motion quality (AMQ) of the PFJ has not been compared between mentioned conditions. In this study we performed vibroarthrographic analysis of AMQ in movements performed in OKC and CKC, in healthy subjects and individuals with chondromalacia patellae, to assess which of the test conditions is more efficient in differentiation between healthy and deteriorated joints. Moreover, our analysis will broaden the knowledge related to behavior of normal and pathological synovial joints during motion with and without weight bearing. It is an essential issue, due to the recently observed significant interest in comparing potential benefits and limitations of CKC and OKC exercises as they relate to lower extremity rehabilitation. METHODS: 100 subjects (62 healthy controls and 38 subjects with PFJ chondromalacia) were enrolled. During repeated knee flexion/extension motions performed in OKC (in a sitting position) and CKC (sit-to-stand movements), the vibroarthrographic signals were collected using an accelerometer and described by variability (VMS), amplitude (R4), and spectral power in 50-250 Hz (P1) and 250-450 Hz (P2) bands. RESULTS: Significant differences in VMS [V], R4 [V], P1 [V2/Hz] and P2 [V2/Hz] between OKC and CKC were found (0.0001, 0.969. 0.800 0.041 vs 0.013, 3.973, 6.790, 0.768, respectively, P < 0.001). Moreover, in both analyzed load-related conditions the subjects with chondromalacia were characterized by significantly higher values of all parameters, when compared to controls (P < 0.001), with effect size values over 0.6. CONCLUSIONS: We showed that motion of the physiological, unloaded PFJ articular surfaces in OKC is nearly vibrationless, which corresponds with optimal AMQ of PFJ, while loaded movements in CKC are characterized by a higher vibroacoustic emission level. Moreover, chondral lesions should be considered as an increased friction-related, aggravating factor of AMQ, which is critical in CKC movements under load. Nonetheless, OKC and CKC conditions are characterized by large effect sizes, and provide an efficient test frame for differentiating physiological knees and joints with chondral lesions.

A novel clinical test for assessing patellar cartilage changes and its correlation with magnetic resonance imaging and arthroscopy.

Controversy still exists regarding the best clinical assessment test for chondromalacia patellae (CMP). Our study aims to evaluate the specificity and sensitivity of a novel clinical test for CMP, the "Patella Slide Test" (PST) against the findings of magnetic resonance imaging (MRI) and arthroscopy. We included 221 consecutive patients planned for elective knee arthroscopic surgery. An MRI scan of the symptomatic knee was performed prior to surgery. On the day of surgery, each patient was examined using the PST followed by a knee arthroscopy to assess the quality of the chondral surfaces of the patellofemoral joint. The MRI and PST results were compared against the arthroscopic findings that served as the gold standard. The PST (0.89) was statistically more sensitive than MRI (0.67) in diagnosing CMP. The PST (0.89) also had a greater negative predictive value (NPV) than MRI (0.74). However, MRI (0.94) was more specific than the PST (0.85). The differences in accuracy and positive predictive value of the PST versus MRI were not statically significant. In conclusion, the PST shows high sensitivity and has a greater NPV than MRI as a clinical test for diagnosing CMP.

Hyaluronate acid for treatment of chondromalacia patellae: a 52-week follow-up study / 南方医科大学学报

OBJECTIVE@#To assess the therapeutic effect of hyaluronate acid (HA) injection through the subpatellar route for treatment of chondromalacia patellae (CP).@*METHODS@#Eighty-eight patients with the diagnosis of CP were enrolled in this prospective study, including 38 with early CP (CP group) and 50 with advanced CP (patellofemoral arthritis group) diagnosed based on image presentations. All the patients received intra-articular HA injections through a subpatellar route once a week for 5 consecutive weeks. The primary outcome measures included WOMAC index scores and Lequesne scores before and at 4, 12, 26 and 52 weeks after the injections. The secondary outcome measures included the 30-m walking time and stair ascending and descending time (one floor) before and at 1, 2, 3, and 4 weeks after the injections.@*RESULTS@#In both groups the patients showed significantly decreased WOMAC scores and Lequesne scores at 4, 12, 26 and 52 weeks after HA injections as compared with the baseline scores (all < 0.01). No significant difference was found between the two groups in WOMAC scores and Lequesne scores at 4 or 12 weeks after the injections (both >0.05). The WOMAC scores and Lequesne scores at 26 and 52 weeks after the injections were significantly higher in patellofemoral arthritis group than in CP group (both < 0.05). In both groups, the 30-m walking time and the stair ascending and descending time decreased significantly at 1, 2, 3, and 4 weeks after HA injections (all < 0.05) without significant differences between the two groups (all >0.05).@*CONCLUSIONS@#HA injection through the subpatellar route is effective for treatment of CP. HA injection produces better long-term efficacy for treatment of early CP than for advanced CP where patellofemoral arthritis occurs.

Patellar position in patients with patellofemoral syndrome as characterized by anatomo-radiographic study / Caracterização por estudo anatomorradiográfico da posição patelar em pacientes portadores de síndrome femoropatelar

ABSTRACT Objectives: To determine the prevalence of high patella in adult patients with knee pain, and to correlate patellar height with symptoms of patellar instability, episode of patellofemoral dislocation and anterior pain in the knee; and also verify the concordance correlation between the Insall-Salvati and Caton-Deschamps indices. Method: Cross-sectional study analyzing the medical records of patients with knee pain, using lateral view knee radiographs with 30º degrees of flexion and computed tomography. The values of the Insall-Salvati index and the Caton-Deschamps index were used to determine the patellar height. Results: A total of 756 records were analyzed, resulting in 140 knees studied, 39% men and 61% women. Both indices produced statistically significant associations for the occurrence of high patella and signs of instability and episodes of dislocation, but there was no significant association for anterior knee pain. The Kappa index obtained when analyzing the concordance correlation between the Insall-Salvati index and Caton-Deschamps index points to a regular association between them. Conclusion: Patients with high patella present a higher prevalence of instability. Having a high patella has no significant relationship with the presence of anterior knee pain. The Insall-Salvati and Caton-Deschamps indices demonstrate a regular agreement on the presentation of patellar heights results.

RESUMO Objetivos: Determinar a prevalência de patela alta em pacientes adultos portadores de dor no joelho, correlacionar a altura patelar com sintomas de instabilidade patelar e dor anterior no joelho. Verificar índice de concordância entre os índices de Insall-Salvati e Caton-Deschamps. Métodos: Estudo de corte transversal, com análise de prontuários de pacientes portadores de dor no joelho e radiografias em perfil do joelho a 30º graus de flexão e tomografia computadorizada. Usadas as medidas do Índice de Insall-Salvati e Índice de Caton-Deschamps para determinar a altura patelar. Resultados: Foram analisados 756 prontuários, 140 joelhos, 39% de homens e 61% de mulheres. Para ambos os índices obtivemos associações estatisticamente significantes para a ocorrência de patela alta e sinais de instabilidade patelar, entretanto não houve associação significativa para a dor anterior no joelho. O índice Kappa obtido para analisar a relação de concordância entre o Índice de Insall-Salvati e Caton-Deschamps aponta para uma associação regular entre eles. Conclusão: Pacientes portadores de patela alta apresentam maior prevalência de instabilidade na população estudada. Ter patela alta não apresenta relação significativa com a presença de dor anterior do joelho. Os Índices de Insall-Salvati e Caton-Deschamps apresentam concordância regular na apresentação dos resultados das alturas patelares.

Does the grading of chondromalacia patellae influence anterior knee pain following total knee arthroplasty without patellar resurfacing?

OBJECTIVES: The influence of chondromalacia patellae (CMP) on post-operative anterior knee pain (AKP) following total knee arthroplasty (TKA) remains controversial, and few studies have focused on the relationship between them. The purpose of this study was to determine whether different CMP grades affect the incidence of AKP after TKA without patellar resurfacing. METHODS: We performed a retrospective analysis of prospectively collected data on 290 TKAs with the use of the low contact stress mobile-bearing prosthesis, without patellar resurfacing in 290 patients from February 2009 to January 2013. Patients were assessed by the Outerbridge classification for CMP, visual analog scale for AKP, the Knee Society clinical scoring system of knee score (KS), function score (FS), the patellar score (PS) for clinical function, and patients' satisfaction. RESULTS: The intra-operative grading of CMP: grade I in 30 patients, grade II in 68 patients, grade III in 97 patients, and grade IV in 95 patients. The incidence of AKP at 36-month follow-up was 10.3% (30/290). No statistical difference was detected among the different CMP grades in terms of the incidence of AKP (p = 0.995), patients' satisfaction (p = 0.832), KS (p = 0.228), FS (p = 0.713), and PS (p = 0.119) at 36-month follow-up. CONCLUSIONS: The findings may suggest no relevant influence of CMP grading on the incidence of AKP after TKA without patellar resurfacing.

Analysis and multiclass classification of pathological knee joints using vibroarthrographic signals.

BACKGROUND AND OBJECTIVE: Vibroarthrography (VAG) is a method developed for sensitive and objective assessment of articular function. Although the VAG method is still in development, it shows high accuracy, sensitivity and specificity when comparing results obtained from controls and the non-specific, knee-related disorder group. However, the multiclass classification remains practically unknown. Therefore the aim of this study was to extend the VAG method classification to 5 classes, according to different disorders of the patellofemoral joint. METHODS: We assessed 121 knees of patients (95 knees with grade I-III chondromalacia patellae, 26 with osteoarthritis) and 66 knees from 33 healthy controls. The vibroarthrographic signals were collected during knee flexion/extension motion using an acceleration sensor. The genetic search algorithm was chosen to select the most relevant features of the VAG signal for classification. Four different algorithms were used for classification of selected features: logistic regression with automatic attribute selection (SimpleLogistic in Weka), multilayer perceptron with sigmoid activation function (MultilayerPerceptron), John Platt's sequential minimal optimization algorithm implementation of support vector classifier (SMO) and random forest tree (RandomForest). The generalization error of classification algorithms was evaluated by stratified 10-fold cross-validation. RESULTS: We obtained levels of accuracy and AUC metrics over 90%, more than 93% sensitivity and more than 84% specificity for the logistic regression-based method (SimpleLogistic) for a 2-class classification. For the 5-class method, we obtained 69% and 90% accuracy and AUC respectively, and sensitivity and specificity over 91% and 69%. CONCLUSIONS: The results of this study confirm the high usefulness of quantitative analysis of VAG signals based on classification techniques into normal and pathological knees and as a promising tool in classifying signals of various knee joint disorders and their stages.

Etiologia e diagnóstico da condromalácia patelar: relato de caso / Etiology and diagnosis of patellar chondromalacia: case report

A incidência de dor anterior no joelho é amplamente documentada em todo o mundo, sendo mais comuns casos em que o uso excessivo apresenta maior influência do que traumas no joelho. As mulheres são mais da metade desses pacientes, que podem alcançar 22 a cada mil pessoas todos os anos. Afecções que acometem a articulação patelofemoral contribuem consideravelmente para a dor no joelho entre pacientes jovens e apresentam etiologia multifatorial. A síndrome da hiperpressão lateral da patela é amplamente associada à dor anterior do joelho em casos nos quais não se verifica instabilidade concomitante, porém são raros os casos em que a referida síndrome pode ser claramente identificada. O aumento do ângulo Q, indicativo de desalinhamento do mecanismo extensor, resulta em maior contato da superfície entre a face lateral da patela e o côndilo lateral do fêmur durante atividades de suporte de peso, aumentando a incidência de dor patelofemoral. Em face da relevância e elevada prevalência da condição, este estudo tem o objetivo de expandir o conhecimento sobre a etiologia e diagnóstico da condromalácia patelar. Procedeu-se de revisão de literatura sobre artigos publicados de 2008 a 2018. A condromalácia patelar resulta do amolecimento, afinamento e degradação da cartilagem da patela. No caso de pacientes jovens, a condição decorre, de forma mais comum, de lesões que causam uma ruptura da cartilagem intra-articular podendo, em casos mais graves, levar a uma osteoartrite resultante. Como fatores que podem levar ao desenvolvimento da condição ressalta-se trauma no joelho, uso excessivo da articulação patelofemoral, alterações anatômicas, desvios de eixo, encurtamentos musculares, desequilíbrios musculares principalmente da musculatura do quadríceps, alterações na biomecânica do quadril, bem como insuficiência vascular no osso subcondral. A literatura sugere que não existe apenas uma causa para o desenvolvimento da condromalácia, de modo que todos devem ser considerados quando o paciente procura atendimento médico por dor anterior no joelho. Diferentes métodos de tratamento vêm sendo sugeridos e avaliados, porém, para que a seleção ocorra de forma adequada é preciso verificar em cada caso as causas do desenvolvimento da condromalácia.

Patellofemoral Pain: An Enigma Explained by Homeostasis and Common Sense.

We present a rational, scientific, low-risk approach to patellofemoral pain (anterior knee pain) based on an understanding of tissue homeostasis. Loss of tissue homeostasis from overload and/or injury produces pain. Bone overload and synovial inflammation are common sources of such pain. Chondromalacia and malalignment are findings that almost always do not need to be "corrected" to relieve pain. Patience and persistence in nonoperative care results in consistent success. Surgery should be rare and done only after extensive nonoperative management and in the setting of clearly defined pathology. Rational surgical treatment is explained in the context of restoring tissue homeostasis to relieve pain.

The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

PURPOSE: To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS: Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS: Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). CONCLUSIONS: An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.