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Mazzella N, Trowell D, Fox A, Saunders N, Vicenzino B, Bonacci J. The Immediate Biomechanical Effects of a Flat, Flexible School Shoe in Adolescents with Patellofemoral Pain. Med Sci Sports Exerc 2024; 56:745-752. [PMID: 37908025 DOI: 10.1249/mss.0000000000003335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Treatment options for adolescent patellofemoral pain (PFP) are limited. School footwear might be a suitable intervention to modulate patellofemoral joint (PFJ) loads in adolescents with PFP. This study examined the immediate effects of a flat, flexible school shoe compared with a traditional school shoe on knee joint kinematics and kinetics, and PFJ reaction force during walking and running in adolescents with PFP. METHODS A total of 28 adolescents (12 female, 16 male; mean ± SD age, 14.3 ± 1.7 yr) with PFP walked and ran on an instrumented treadmill in two randomly ordered conditions: (i) flat, flexible school shoe and (ii) traditional school shoe. Three-dimensional marker trajectory and ground reaction force data were sampled at 250 and 1000 Hz, respectively. Continuous ankle and knee joint angles and moments, PFJ reaction force, and ankle power were compared between conditions using one-dimensional statistical parametric mapping paired t -tests ( α < 0.05). RESULTS Walking in the flat, flexible school shoe resulted in a significant reduction in knee flexion (15%-35% of gait cycle, P < 0.001), knee extension moment (15%-40% of gait cycle, P < 0.001), and PFJ reaction force (15%-40% of gait cycle, P < 0.001) compared with the traditional school shoe. During running, knee flexion (10%-33% of gait cycle, P < 0.001), knee extension moment (15%-25% of gait cycle, P < 0.001), and PFJ reaction force (15%-25% of gait cycle, P < 0.001) were lower when wearing the flat, flexible school shoe compared with the traditional school shoe. CONCLUSIONS PFJ reaction force is reduced when adolescents walk and run in a flat, flexible school shoe compared with a traditional school shoe. Flat, flexible school shoes may be an effective intervention to modulate biomechanical factors related to PFP.
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Affiliation(s)
- Natalie Mazzella
- Centre for Sport Research, Deakin University, Waurn Ponds Victoria, AUSTRALIA
| | - Danielle Trowell
- Centre for Sport Research, Deakin University, Burwood Victoria, AUSTRALIA
| | - Aaron Fox
- Centre for Sport Research, Deakin University, Waurn Ponds Victoria, AUSTRALIA
| | - Natalie Saunders
- Centre for Sport Research, Deakin University, Burwood Victoria, AUSTRALIA
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, AUSTRALIA
| | - Jason Bonacci
- Centre for Sport Research, Deakin University, Waurn Ponds Victoria, AUSTRALIA
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Xu J, Cai Z, Chen M, Wang X, Luo X, Wang Y. Global research trends and hotspots in patellofemoral pain syndrome from 2000 to 2023: a bibliometric and visualization study. Front Med (Lausanne) 2024; 11:1370258. [PMID: 38566926 PMCID: PMC10985266 DOI: 10.3389/fmed.2024.1370258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Patellofemoral pain syndrome (PFPS) is a prevalent condition in sports medicine, and as sports competitions become more popular, the incidence of sports injuries is on the rise. Despite the increasing research on PFPS, there remains a lack of bibliometric analyses on this topic. The aim of this study was to identify the research hotspots and trends in the field of PFPS by reviewing 23 years of literature in this field. Methods By analyzing the literature on PFPS research from 2000 to 2023 in the core dataset of the Web of Science database and utilizing bibliometric tools like CiteSpace 6.1, VOSviewer 1.6.18, R-bibliometrix 4.6.1, Pajek 5.16, and Scimago Graphica 1.0.26, our aim was to gain insights into the current status and key areas of PFPS research. The study examined various aspects including the number of publications, countries, institutions, journals, authors, collaborative networks, keywords, and more. Through the visualization of relevant data, we also attempted to forecast future trends in the field. Results There were 2,444 publications were included in this visualization study, published in 322 journals by 1,247 authors from 818 institutions in 67 countries. The Journal of Orthopaedic and Sports Physical Therapy had the highest number of publications, with the USA leading in article count. La Trobe University contributed the most articles, while Rathleff MS and Barton CJ emerged as the most prolific authors. Hip and knee strength and core strength, lower extremity kinematics and biomechanics, females (runners), muscle activation, risk factors, gait retraining, clinical practice guidelines, and rehabilitation were research hotspot keywords. Conclusion Current research suggests that there is still significant potential for the development of PFPS research. Key areas of focus include the clinical effectiveness of combined hip and knee strengthening to address PFPS, characterization of lower limb kinematics and biomechanics, gait retraining, risk factors, and clinical practice guidelines. Future research could explore the effectiveness of innovative exercise therapies such as blood flow restricting training, gait retraining, and neuromuscular control training for PFPS improvement. Further investigation into gait retraining for runners, particularly females, and clinical efficacy study of a novel PRP formulation for the treatment of PFPS.
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Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Zijuan Cai
- College of Physical Education and Health, Geely University of China, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Xin Wang
- Health Science Center, Peking University, Beijing, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Yanjie Wang
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
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Kogan F, Yoon D, Teeter MG, Chaudhari AJ, Hales L, Barbieri M, Gold GE, Vainberg Y, Goyal A, Watkins L. Multimodal positron emission tomography (PET) imaging in non-oncologic musculoskeletal radiology. Skeletal Radiol 2024:10.1007/s00256-024-04640-4. [PMID: 38492029 DOI: 10.1007/s00256-024-04640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
Musculoskeletal (MSK) disorders are associated with large impacts on patient's pain and quality of life. Conventional morphological imaging of tissue structure is limited in its ability to detect pain generators, early MSK disease, and rapidly assess treatment efficacy. Positron emission tomography (PET), which offers unique capabilities to evaluate molecular and metabolic processes, can provide novel information about early pathophysiologic changes that occur before structural or even microstructural changes can be detected. This sensitivity not only makes it a powerful tool for detection and characterization of disease, but also a tool able to rapidly assess the efficacy of therapies. These benefits have garnered more attention to PET imaging of MSK disorders in recent years. In this narrative review, we discuss several applications of multimodal PET imaging in non-oncologic MSK diseases including arthritis, osteoporosis, and sources of pain and inflammation. We also describe technical considerations and recent advancements in technology and radiotracers as well as areas of emerging interest for future applications of multimodal PET imaging of MSK conditions. Overall, we present evidence that the incorporation of PET through multimodal imaging offers an exciting addition to the field of MSK radiology and will likely prove valuable in the transition to an era of precision medicine.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Daehyun Yoon
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Western University, London, ON, Canada
| | | | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Marco Barbieri
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Yael Vainberg
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ananya Goyal
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Lauren Watkins
- Department of Radiology, Stanford University, Stanford, CA, USA
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Haghighat F, Rezaie M, Ebrahimi S, Shokuhian SM, Motealleh A, Salehi R, Parnianpour M. The Correlation between Intersegmental Coordination Variability and Frontal Plane Hip Kinematics during Running in Persons with Patellofemoral Pain. J Biomed Phys Eng 2024; 14:89-98. [PMID: 38357605 PMCID: PMC10862119 DOI: 10.31661/jbpe.v0i0.2101-1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/15/2021] [Indexed: 02/16/2024]
Abstract
Background Despite the existing evidence indicating altered hip kinematics as well as the studies showing altered movement coordination variability in persons with patellofemoral pain (PFP), there is no study investigating the correlation between hip joint kinematic and movement coordination variability in persons with patellofemoral pain (PFP). Objective This study aims to evaluate the correlation between peak hip adduction and variability of thigh frontal-shank transverse coordination during running in persons with PFP. Material and Methods In this cross-sectional correlational study, kinematic data were collected from 34 females (17 with and 17 without PFP) aged 18-35 years during treadmill running at preferred and fixed speeds, each for 30 s. The continuous relative phase method was used to calculate the coordination of thigh frontal-shank transverse. To calculate the deviation phase as the variability of intersegmental coordination, the standard deviation of the ensemble continuous relative phase curve points was averaged. The parameters of interest were peak hip adduction and coordination variability of thigh frontal-shank transverse. The Pearson Correlation Coefficient (r) was used to calculate the correlation between the variables. Results The Pearson correlation coefficient showed a significant negative correlation between the peak hip adduction angle and variability of thigh frontal- shank transverse during running at both fixed (r=-0.553, P<0.05) and preferred (r=-0.660, P<0.01) speeds in persons with PFP while the control group showed a small nonsignificant correlation (r<0.29, P>0.05). Conclusion The results indicated that greater adduction of the hip joint in persons with PFP during running is contributed to lesser variability of thigh frontal-shank transverse.
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Affiliation(s)
- Farzaneh Haghighat
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Rezaie
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ebrahimi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Motealleh
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Salehi
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Wei Z, Hou X, Qi Y, Wang L. Influence of foot strike patterns and cadences on patellofemoral joint stress in male runners with patellofemoral pain. Phys Ther Sport 2024; 65:1-6. [PMID: 37976905 DOI: 10.1016/j.ptsp.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This study aimed to determine the effect of foot strike patterns and cadences in male runners with patellofemoral pain (PFP). DESIGN Cross-sectional study. SETTING Biomechanics lab. METHODS 20 male runners with PFP were instructed to randomly complete six running conditions (three cadence conditions in rearfoot strike pattern (RFS) or forefoot strike (FFS)) under a preferred running speed. MAIN OUTCOME MEASURES The primary outcomes were peak knee joint and moment, and secondary outcomes were patellofemoral joint stress. RESULTS Running with increased cadence has a lower flexion angle (P = 0.027, η2 = 0.45), lower extension moment (P = 0.011, η2 = 0.29), lower internal rotation moment (P = 0.040, η2 = 0.17), lower patellofemoral stress (P = 0.029, η2 = 0.52) than preferred cadence. FFS running performed significantly lower flexion angle (P = 0.003, η2 = 0.39), lower extension moment (P < 0.001, η2 = 0.91), lower adduction moment (P = 0.020, η2 = 0.25) lower patellofemoral stress (P < 0.001, η2 = 0.81) than RFS running for all cadence. CONCLUSIONS Preliminary findings provide new perspectives for male runners with PFP to unload patellofemoral joint stress in managing PFP through the combination of the FFS pattern and increased cadence.
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Affiliation(s)
- Zhen Wei
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, 200438, China.
| | - Xihe Hou
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, 200438, China; School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China.
| | - Yujie Qi
- Shanghai Nanxiang Community Health Service Center, Shanghai, China.
| | - Lin Wang
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, 200438, China.
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Watkins LE, Haddock B, MacKay JW, Baker J, Uhlrich SD, Mazzoli V, Gold GE, Kogan F. [ 18F]Sodium fluoride PET-MRI detects increased metabolic bone response to whole-joint loading stress in osteoarthritic knees. Osteoarthritis Cartilage 2022; 30:1515-1525. [PMID: 36031138 PMCID: PMC9922526 DOI: 10.1016/j.joca.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Altered joint function is a hallmark of osteoarthritis (OA). Imaging techniques for joint function are limited, but [18F]sodium fluoride (NaF) PET-MRI may assess the acute joint response to loading stresses. [18F]NaF PET-MRI was used to study the acute joint response to exercise in OA knees, and compare relationships between regions of increased uptake after loading and structural OA progression two years later. METHODS In this prospective study, 10 participants with knee OA (59 ± 8 years; 8 female) were scanned twice consecutively using a PET-MR system and performed a one-legged squat exercise between scans. Changes in tracer uptake measures in 9 bone regions were compared between knees that did and did not exercise with a mixed-effects model. Areas of focally large changes in uptake between scans (ROIfocal, ΔSUVmax > 3) were identified and the presence of structural MRI features was noted. Five participants returned two years later to assess structural change on MRI. RESULTS There was a significant increase in [18F]NaF uptake in OA exercised knees (SUV P < 0.001, KiP = 0.002, K1P < 0.001) that differed by bone region. CONCLUSION There were regional differences in the acute bone metabolic response to exercise and areas of focally large changes in the metabolic bone response that might be representative of whole-joint dysfunction.
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Affiliation(s)
- L E Watkins
- Department of Radiology, Stanford University, Stanford CA, USA
| | | | - J W MacKay
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - J Baker
- Department of Radiology, Stanford University, Stanford CA, USA
| | - S D Uhlrich
- Department of Mechanical Engineering, Stanford University, Stanford CA, USA
| | - V Mazzoli
- Department of Radiology, Stanford University, Stanford CA, USA
| | - G E Gold
- Department of Radiology, Stanford University, Stanford CA, USA
| | - F Kogan
- Department of Radiology, Stanford University, Stanford CA, USA.
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Finite element analysis informed variable selection for femoral fracture risk prediction. J Mech Behav Biomed Mater 2021; 118:104434. [PMID: 33756419 DOI: 10.1016/j.jmbbm.2021.104434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/07/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
Logistic regression classification (LRC) is widely used to develop models to predict the risk of femoral fracture. LRC models based on areal bone mineral density (aBMD) alone are poor, with area under the receiver operator curve (AUROC) scores reported to be as low as 0.63. This has led to researchers investigating methods to extract further information from the image to increase performance. Recently, the use of active shape (ASM) and appearance models (AAM) have resulted in moderate improvements, but there is a risk that inclusion of too many modes will lead to overfitting. In addition, there are concerns that the effort required to extract the additional information does not justify the modest improvement in fracture risk prediction. This raises the question, are we reaching the limits of the information that can be extracted from an image? Finite element analysis was used in combination with active shape and appearance modelling to select variables to develop LRC models of fracture risk. Active shape and active appearance models were constructed based on a previously reported cohort of 94 post-menopausal Caucasian women (47 with and 47 without a fracture). T-tests were used to identify differences between the two groups for each mode of variation. Femur strength was predicted for two load cases, stance and a fall. Stepwise multi-variate linear regression was used to identify shape and appearance modes that were predictors of strength for the femurs in the training set. Femurs were also synthetically generated to explore the influence of the first 10 modes of the shape and appearance models. Identified modes of variation were then used to generate LRC models to predict fracture risk. Only 6 modes, 4 active appearance and 2 active shape modes, were identified that had a significant influence on predicted fracture strength. Of these, only two active appearance modes were needed to substantially improve the predictive mode performance (ΔAUROC = 0.080). The addition of 3 more modes (1 AAM and two ASM) further improved the performance of the classifier (ΔAUROC = 0.123). Further addition of modes did not result in any further substantial improvements. Based on these findings, it is suggested that we are reaching the limits of the information that can be extracted from an image to predict fracture risk.
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Identifying Musculoskeletal Pain Generators Using Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bonacci J, Fox A, Hall M, Fuller JT, Vicenzino B. Effect of gait retraining on segment coordination and joint variability in individuals with patellofemoral pain. Clin Biomech (Bristol, Avon) 2020; 80:105179. [PMID: 32980619 DOI: 10.1016/j.clinbiomech.2020.105179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/26/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait retraining is advocated for the management of patellofemoral pain. This case series examined changes in lower limb variability following 6-weeks of gait retraining in individuals with patellofemoral pain. METHODS Six runners with patellofemoral pain completed a 6-week physiotherapist-guided gait retraining program using minimalist footwear and increased cadence. Approximate entropy joint variability and segment coordination variability were calculated across the entire gait cycle during running at baseline, 6 and 12 weeks and compared using repeated measures analysis of variance and the standardised mean difference (SMD). FINDINGS Compared to baseline, there were large increases in hip joint transverse plane kinematic variability at 6 (SMD = 1.7) and 12 weeks (SMD = 1.3). Moderate increases in hip joint frontal plane and knee joint sagittal plane kinematic variability were also observed at 6 (SMD = 1.1 & 0.96) and 12 weeks (SMD = 1.1 & 0.89). Knee joint frontal plane and hip joint transverse plane kinetic variability demonstrated large increases from baseline at 6 (SMD = 1.3 & 0.9) and 12 weeks (SMD = 0.9 & 1.0). There was no main effect of time for segment coordination variability. All participants had clinically meaningful improvements in pain (visual analogue change score > 20 mm). INTERPRETATION Gait retraining increased joint kinematic and kinetic variability in those with patellofemoral pain and these changes persisted over 12 weeks. Increased variability was observed in joint kinematics and kinetics known to influence patellofemoral joint stress, which may vary patellofemoral joint loading patterns and partly explain the clinical effect.
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Affiliation(s)
- Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Joel T Fuller
- Facullty of Medicine and Health Sciences, Macquarie University, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, Australia
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Yoon D, Kogan F, Gold GE, Biswal S. Identifying Musculoskeletal Pain Generators Using Clinical PET. Semin Musculoskelet Radiol 2020; 24:441-450. [DOI: 10.1055/s-0040-1713607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractIdentifying the source of a person's pain is a significant clinical challenge because the physical sensation of pain is believed to be subjective and difficult to quantify. The experience of pain is not only modulated by the individual's threshold to painful stimuli but also a product of the person's affective contributions, such as fear, anxiety, and previous experiences. Perhaps then to quantify pain is to examine the degree of nociception and pro-nociceptive inflammation, that is, the extent of cellular, chemical, and molecular changes that occur in pain-generating processes. Measuring changes in the local density of receptors, ion channels, mediators, and inflammatory/immune cells that are involved in the painful phenotype using targeted, highly sensitive, and specific positron emission tomography (PET) radiotracers is therefore a promising approach toward objectively identifying peripheral pain generators. Although several preclinical radiotracer candidates are being developed, a growing number of ongoing clinical PET imaging approaches can measure the degree of target concentration and thus serve as a readout for sites of pain generation. Further, when PET is combined with the spatial and contrast resolution afforded by magnetic resonance imaging, nuclear medicine physicians and radiologists can potentially identify pain drivers with greater accuracy and confidence. Clinical PET imaging approaches with fluorine-18 fluorodeoxyglucose, fluorine-18 sodium fluoride, and sigma-1 receptor PET radioligand and translocator protein radioligands to isolate the source of pain are described here.
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Affiliation(s)
- Daehyun Yoon
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Feliks Kogan
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Garry E. Gold
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Sandip Biswal
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
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Katal S, Gholamrezanezhad A, Nikpanah M, Christensen TQ, Werner TJ, Saboury B, Alavi A, Hess S. Potential Applications of PET/CT/MR Imaging in Inflammatory Diseases: Part I: Musculoskeletal and Gastrointestinal Systems. PET Clin 2020; 15:547-558. [PMID: 32768367 DOI: 10.1016/j.cpet.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
During the past decades, the role of fludeoxyglucose (FDG)-PET and hybrid PET/computed tomography (CT) has been established clinically in the diagnostic workup of a multitude of infectious and inflammatory disorders. In recent years, the fusion of MR imaging to PET has also been increasingly explored, and this may be especially useful in musculoskeletal and gastrointestinal inflammatory diseases due to exceptional soft tissue contrast and reduced radiation dose. This article outlines the current potential for hybrid molecular imaging in the musculoskeletal system and the gastrointestinal tract with special focus on the potential for fused PET/CT/MR imaging.
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Affiliation(s)
- Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, California 90033, USA.
| | - Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Thomas Q Christensen
- Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark 5000
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark 6700
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De Oliveira Silva D, Willy RW, Barton CJ, Christensen K, Pazzinatto MF, Azevedo FM. Pain and disability in women with patellofemoral pain relate to kinesiophobia, but not to patellofemoral joint loading variables. Scand J Med Sci Sports 2020; 30:2215-2221. [DOI: 10.1111/sms.13767] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
| | - Richard W. Willy
- School of Physical Therapy and Movement Sciences University of Montana Missoula MT USA
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Surgery St Vincent's Hospital University of Melbourne Melbourne Australia
| | - Kelly Christensen
- School of Physical Therapy and Movement Sciences University of Montana Missoula MT USA
| | - Marcella F. Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health, Human Services and Sport La Trobe University Bundoora Australia
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
| | - Fábio M. Azevedo
- Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) Presidente Prudente Brazil
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Sun D, Fekete G, Baker JS, Mei Q, István B, Zhang Y, Gu Y. A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134642. [PMID: 32605170 PMCID: PMC7369810 DOI: 10.3390/ijerph17134642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to compare the inter-limb joint kinematics, joint moments, muscle forces, and joint reaction forces in patients after an Achilles tendon rupture (ATR) via subject-specific musculoskeletal modeling. Six patients recovering from a surgically repaired unilateral ATR were included in this study. The bilateral Achilles tendon (AT) lengths were evaluated using ultrasound imaging. The three-dimensional marker trajectories, ground reaction forces, and surface electromyography (sEMG) were collected on both sides during self-selected speed during walking, jogging and running. Subject-specific musculoskeletal models were developed to compute joint kinematics, joint moments, muscle forces and joint reaction forces. AT lengths were significantly longer in the involved side. The side-to-side triceps surae muscle strength deficits were combined with decreased plantarflexion angles and moments in the injured leg during walking, jogging and running. However, the increased knee extensor femur muscle forces were associated with greater knee extension degrees and moments in the involved limb during all tasks. Greater knee joint moments and joint reaction forces versus decreased ankle joint moments and joint reaction forces in the involved side indicate elevated knee joint loads compared with reduced ankle joint loads that are present during normal activities after an ATR. In the frontal plane, increased subtalar eversion angles and eversion moments in the involved side were demonstrated only during jogging and running, which were regarded as an indicator for greater medial knee joint loading. It seems after an ATR, the elongated AT accompanied by decreased plantarflexion degrees and calf muscle strength deficits indicates ankle joint function impairment in the injured leg. In addition, increased knee extensor muscle strength and knee joint loads may be a possible compensatory mechanism for decreased ankle function. These data suggest patients after an ATR may suffer from increased knee overuse injury risk.
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Affiliation(s)
- Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, 9700 Szombathely, Hungary;
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong 999077, China;
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
| | - Bíró István
- Department of Technology, Faculty of Engineering, University of Szeged, 6727 Szeged, Hungary;
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
- Correspondence: ; Tel.: +86-574-87600208
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Ho KY, Cummins A, Khuu C, Parker S, Shepherd S. Comparisons of patellar bone mineral density between individuals with and without patellofemoral pain. Knee 2020; 27:846-853. [PMID: 32359941 DOI: 10.1016/j.knee.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/12/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although bone stress injuries have been reported in individuals with patellofemoral pain (PFP), especially within the lateral patella, it remains unclear whether persons with PFP exhibit altered patellar regional bone mineral density (BMD). The primary purpose of this study was to compare BMD of the patella (lateral, medial, and total regions) between individuals with and without PFP using quantitative computed tomography (QCT). The secondary aim was to examine the associations between patellar regional BMD and patellofemoral joint (PFJ) alignment. METHODS Ten individuals with retropatellar pain and 10 sex, age, weight, height, and activity matched pain-free controls underwent a QCT scan to obtain patellar BMD. To quantify PFJ alignment, patellar lateral displacement was measured using bisect-offset (BSO) index and patellar mediolateral tilt was quantified using patellar tilt angle (PTA). A two-factor repeated-measures ANOVA was used to compare BMD across the three patellar regions and between the two groups. Pearson correlation coefficient analyses were used to evaluate the associations between BMD and PFJ alignment of all participants. RESULTS There was no difference in BMD between the two groups. However, BMD was highest within the lateral patella and was lowest within the medial patella across both groups. There were significantly moderate to large correlations between BSO index/PTA and BMD within lateral, medial, and total regions. CONCLUSIONS While individuals with PFP and pain-free controls have similar patellar BMD, the lateral patella exhibits the highest BMD. Additionally, higher patellar regional BMD is related to increased patellar lateral displacement and lateral tilt.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV 89154, United States..
| | - Allina Cummins
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV 89154, United States
| | - Chris Khuu
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV 89154, United States
| | - Shane Parker
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV 89154, United States
| | - Steven Shepherd
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV 89154, United States
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15
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Bonacci J, Fox A, Hall M, Fuller JT, Vicenzino B. Footwear and Cadence Affect Gait Variability in Runners with Patellofemoral Pain. Med Sci Sports Exerc 2020; 52:1354-1360. [PMID: 32028455 DOI: 10.1249/mss.0000000000002267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the effects of increased cadence and minimalist footwear on lower-limb variability in runners with patellofemoral pain (PFP). METHODS Fifteen (12 female, 3 male) runners with PFP ran on an instrumented treadmill with three-dimensional motion capture in three randomly ordered conditions: (i) standard shoe at preferred cadence, (ii) standard shoe +10% cadence, and (iii) minimalist shoe at preferred cadence. Vector coding was used to calculate coordination variability between strides for select lower-limb joint couplings. Approximate entropy was calculated to assess continuous variability for segment kinematic and kinetic data and compared between conditions using repeated-measures ANOVA. One-dimensional statistical parametric mapping repeated-measures ANOVA was performed on the coordination variability data. Cohen's d effect size was calculated for all comparisons. RESULTS Larger approximate entropy values (i.e., greater variability) were observed for the standard shoe +10% cadence versus the standard shoe at preferred cadence for hip flexion/extension (P < 0.001; d = 1.12), hip adduction/abduction (P < 0.001; d = 0.99) and ankle dorsiflexion/plantarflexion (P < 0.001; d = 1.37) kinematics, and knee flexion/extension moments (P < 0.001; d = 0.93). Greater variability was also observed in the minimalist shoe versus the standard shoe at preferred cadence for hip internal/external rotation moments (P < 0.001; d = 0.76), knee adduction/abduction moments (P < 0.001; d = 0.51), and knee internal/external rotation moments (P < 0.001; d = 1.02). One-dimensional statistical parametric mapping repeated-measures ANOVA revealed no significant differences in coordination variability between running conditions. CONCLUSIONS Greater hip and knee kinematic and kinetic variability observed with either increased cadence or minimalist footwear may be beneficial for those with PFP.
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Affiliation(s)
- Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, AUSTRALIA
| | - Joel T Fuller
- Faculty of Medicine and Health Science, Macquarie University, AUSTRALIA
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, AUSTRALIA
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16
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Sisk D, Fredericson M. Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain. Curr Rev Musculoskelet Med 2019; 12:534-541. [PMID: 31773479 DOI: 10.1007/s12178-019-09593-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. RECENT FINDINGS The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.
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Affiliation(s)
- Daniel Sisk
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
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17
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Relationship between lower lumbar spine shape and patient bone metabolic activity as characterised by 18F NaF bio-markers. Comput Biol Med 2019; 116:103529. [PMID: 31715382 DOI: 10.1016/j.compbiomed.2019.103529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/20/2022]
Abstract
Chronic lower lumbar pain has been associated with elevated bone metabolic activity in the spine. Diagnosis of bone metabolic activity is currently through integrating Positron Emission Tomography (PET) with Sodium Fluoride (18F-NaF) biomarkers. It has been reported that numerous observable pathologies including lumbar fusion, disc abnormalities and scoliosis have often been associated with increased 18F-NaF uptake. The aim of this study was to identify what features of lower lumbar shape most strongly correlate with 18F-NaF uptake. Following a principal component analysis of 23 patients who presented with lumbar pain and underwent 18F-NaF PET-CT, it was revealed that three modes interpreted as (i) sacral tilt, (ii) vertebral disc spacing and (iii) spine size were the three characteristics that described 88.7% of spine shape in our study population. 18F-NaF was described by two modes including 18F-NaF intensity and spatial variation (anterior-inferior to posterior-superior). 18F-NaF was most sensitive to sacral tilt followed by vertebral disc spacing. A predictive model derived from that spine population was able to predict 18F-NaF 'hot-spot' locations with 85 ± 5% accuracy and with 71 ± 3% accuracy for the 18F-NaF magnitude. These results suggest that patients reporting with lower lumbar pain and who present with increased sacral tilt profiles and/or reduced disc spacing are good candidates for further 18F-NaF PET-CT imaging, evidenced by the high association between those shape profiles and 18F-NaF uptake.
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18
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Kogan F, Broski SM, Yoon D, Gold GE. Applications of PET-MRI in musculoskeletal disease. J Magn Reson Imaging 2019; 48:27-47. [PMID: 29969193 DOI: 10.1002/jmri.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
New integrated PET-MRI systems potentially provide a complete imaging modality for diagnosis and evaluation of musculoskeletal disease. MRI is able to provide excellent high-resolution morphologic information with multiple contrast mechanisms that has made it the imaging modality of choice in evaluation of many musculoskeletal disorders. PET offers incomparable abilities to provide quantitative information about molecular and physiologic changes that often precede structural and biochemical changes. In combination, hybrid PET-MRI can enhance imaging of musculoskeletal disorders through early detection of disease as well as improved diagnostic sensitivity and specificity. The purpose of this article is to review emerging applications of PET-MRI in musculoskeletal disease. Both clinical applications of malignant musculoskeletal disease as well as new opportunities to incorporate the molecular capabilities of nuclear imaging into studies of nononcologic musculoskeletal disease are discussed. Lastly, we discuss some of the technical considerations and challenges of PET-MRI as they specifically relate to musculoskeletal disease. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2018;48:27-47.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Daehyun Yoon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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19
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Abstract
Patellofemoral pain (PFP) is a common musculoskeletal-related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. The onset of symptoms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running). Symptoms can restrict participation in physical activity, sports, and work, as well as recur and persist for years. This clinical practice guideline will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. J Orthop Sports Phys Ther. 2019;49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302.
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20
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Patellar bone strain after total knee arthroplasty is correlated with bone mineral density and body mass index. Med Eng Phys 2019; 68:17-24. [PMID: 30979584 DOI: 10.1016/j.medengphy.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/20/2022]
Abstract
Patella-related complications after total knee arthroplasty (TKA) remain a major clinical concern. Previous studies have suggested that increased postoperative patellar bone strain could be related to such complications, but there is limited knowledge on patellar strain after TKA. The objective of this study was to predict patellar bone strain after TKA and evaluate correlations with various preoperative data. Fourteen TKA patients with a minimum follow-up of one year were included in this study. Using preoperative CT datasets, preoperative planning, and postoperative X-rays, a method is presented to generate patient-specific finite element models after virtual TKA. Patellar kinematics and forces were predicted during a squat movement, and patellar bone strain was evaluated at 60° of knee flexion. Strain varied greatly among patients, but was strongly negatively correlated (r = -0.85, p < 0.001) with bone mineral density (BMD) and moderately positively (r = 0.54, p = 0.05) with body mass index (BMI). The BMI/BMD ratio explained 87% of strain, and should be further investigated as a potential risk factor for clinical complications. This study represents a preliminary step towards the identification of patients at risk of patellar complications after TKA.
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21
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Affiliation(s)
- M. Spriet
- School of Veterinary Medicine University of California, Davis Davis California USA
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22
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Bolgla LA, Gordon R, Sloan G, Pretlow LG, Lyon M, Fulzele S. COMPARISON OF PATELLA ALIGNMENT AND CARTILAGE BIOMARKERS IN YOUNG ADULT FEMALES WITH AND WITHOUT PATELLOFEMORAL PAIN: A PILOT STUDY. Int J Sports Phys Ther 2019; 14:46-54. [PMID: 30746291 PMCID: PMC6350658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Evidence suggests that individuals with patellofemoral pain (PFP) may develop patellofemoral joint osteoarthritis (PFJOA). Limited data exist regarding an absolute association between PFP and PFJOA. Understanding this relationship will support the need for early interventions to manage PFP. HYPOTHESIS/PURPOSE This study was conducted to determine if females with PFP have a patella position and cartilage biomarkers similar to individuals with PFJOA. It was hypothesized that females with PFP and excessive patella lateralization would have higher cartilage biomarker levels than controls. It also was hypothesized that a significant association would exist between pain and cartilage biomarker levels in subjects with excessive patella lateralization. STUDY DESIGN Single-occasion, cross-sectional, observational. METHODS Pain was assessed using a 10-cm visual analog scale (VAS) for activity pain over the previous week. Patella offset position (RAB angle) was measured using diagnostic ultrasound. Urine was collected and cartilage biomarkers quantified by analyzing C-telopeptide fragments of type II collagen (uCTX-II). Independent t-tests were used to determine between-group differences for RAB angle and uCTX-II. Bivariate correlations were used to determine associations between VAS and uCTX-II for females with PFP. RESULTS Subjects (age range 20 to 30 years) had similar RAB angles (p = 0.21) and uCTX-II (p = 0.91). A significant association only existed between VAS scores and uCTX-II for females with PFP who had a RAB angle > 13 ° (r = 0.86; p = 0.003). Comparison of uCTX-II in the 25-to-30-year-old females with PFP and excessive patella lateralization in the current study to published normative data showed that this cohort had elevated biomarkers. CONCLUSION These findings support that a certain cohort of individuals with PFP have features similar to individuals with confirmed PFJOA (patella lateralization and elevated biomarkers). Additional studies are needed to determine if interventions can reverse not only pain but biomarker levels. LEVEL OF EVIDENCE 2b (diagnosis).
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Affiliation(s)
- Lori A Bolgla
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Richard Gordon
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gloria Sloan
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Lester G. Pretlow
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Matthew Lyon
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sadanand Fulzele
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
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23
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Yoder JS, Kogan F, Gold GE. Applications of PET-Computed Tomography-Magnetic Resonance in the Management of Benign Musculoskeletal Disorders. PET Clin 2019; 14:1-15. [PMID: 30420212 PMCID: PMC6245663 DOI: 10.1016/j.cpet.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although computed tomography (CT) and MR imaging alone have been used extensively to evaluate various musculoskeletal disorders, hybrid imaging modalities of PET-CT and PET-MR imaging were recently developed, combining the advantages of each method: molecular information from PET and anatomical information from CT or MR imaging. Furthermore, different radiotracers can be used in PET to uncover different disease mechanisms. In this article, potential applications of PET-CT and PET-MR imaging for benign musculoskeletal disorders are organized by benign cell proliferation/dysplasia, diabetic foot complications, joint prostheses, degeneration, inflammation, and trauma, metabolic bone disorders, and pain (acute and chronic) and peripheral nerve imaging.
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Affiliation(s)
- James S Yoder
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
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24
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Spriet M, Espinosa‐Mur P, Cissell DD, Phillips KL, Arino‐Estrada G, Beylin D, Stepanov P, Katzman SA, Galuppo LD, Garcia‐Nolen T, Murphy B, Stover SM. 18
F‐sodium fluoride positron emission tomography of the racing Thoroughbred fetlock: Validation and comparison with other imaging modalities in nine horses. Equine Vet J 2018; 51:375-383. [DOI: 10.1111/evj.13019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- M. Spriet
- School of Veterinary Medicine University of California Davis California USA
| | - P. Espinosa‐Mur
- School of Veterinary Medicine University of California Davis California USA
| | - D. D. Cissell
- School of Veterinary Medicine University of California Davis California USA
| | - K. L. Phillips
- School of Veterinary Medicine University of California Davis California USA
| | - G. Arino‐Estrada
- School of Veterinary Medicine University of California Davis California USA
| | - D. Beylin
- Brain Biosciences, Inc. Rockville Maryland USA
| | - P. Stepanov
- Brain Biosciences, Inc. Rockville Maryland USA
| | - S. A. Katzman
- School of Veterinary Medicine University of California Davis California USA
| | - L. D. Galuppo
- School of Veterinary Medicine University of California Davis California USA
| | - T. Garcia‐Nolen
- School of Veterinary Medicine University of California Davis California USA
| | - B. Murphy
- School of Veterinary Medicine University of California Davis California USA
| | - S. M. Stover
- School of Veterinary Medicine University of California Davis California USA
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25
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Wulster KB. Diagnosis of Skeletal Injury in the Sport Horse. Vet Clin North Am Equine Pract 2018; 34:193-213. [DOI: 10.1016/j.cveq.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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26
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The influence of cadence and shoes on patellofemoral joint kinetics in runners with patellofemoral pain. J Sci Med Sport 2018; 21:574-578. [DOI: 10.1016/j.jsams.2017.09.593] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/07/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022]
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27
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Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med 2018; 46:1797-1808. [PMID: 27142536 DOI: 10.1007/s40279-016-0545-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
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Effect of Posttrial Visual Feedback and Fatigue During Drop Landings on Patellofemoral Joint Stress in Healthy Female Adults. J Appl Biomech 2018; 34:82-87. [PMID: 28952846 DOI: 10.1123/jab.2017-0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patellofemoral pain (PFP) is common in females. Patellofemoral joint stress (PFJS) may be important in the development of PFP. Ground reaction force (GRF) during landing activities may impact PFJS. Our purpose was to determine how healthy females alter their landing mechanics using visual posttrial feedback on their GRF and assess how PFJS changes. Seventeen participants performed a series of drop landings during 3 conditions: baseline, feedback, and postfatigue feedback. The fatigue protocol used repetitive jump squats. Quadriceps force was estimated through inverse-dynamics-based static optimization approach. Then, PFJS was calculated using a musculoskeletal model. Multivariate differences were shown across conditions (P = .01). Univariate tests revealed differences in PFJS (P = .014), knee range of motion (P = .001), and GRF (P = .005). There were no differences in quadriceps force (P = .125). PFJS and GRF decreased from baseline to feedback (P = .002, P = .007, respectively), while PFJS increased from feedback to postfatigue feedback (P = .03). Knee range of motion increased from baseline to feedback (P = .043), then decreased from feedback to postfatigue feedback (P < .001). Visual feedback of GRF may reduce PFJS, but may not effectively transfer to a fatigued state.
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29
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Fox A, Ferber R, Saunders N, Osis S, Bonacci J. Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain. Med Sci Sports Exerc 2017; 50:502-509. [PMID: 29077638 DOI: 10.1249/mss.0000000000001465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP) and healthy controls. METHODS Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) subgroups on the basis of whether they had been experiencing pain for less or greater than 3 months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP and chronic PFP and healthy controls. RESULTS Compared with controls, both the acute and chronic PFP subgroups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP subgroup demonstrated greater transverse plane hip motion across stance compared with healthy controls. In contrast, the chronic PFP subgroup demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared with healthy controls. CONCLUSIONS This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared with healthy controls. Certain discriminating characteristics were shared between both the acute and chronic subgroups when compared with healthy controls, whereas others were specific to the duration of PFP.
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Affiliation(s)
- Aaron Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Reed Ferber
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Sean Osis
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA.,Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, AUSTRALIA
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Mestelle Z, Kernozek T, Adkins KS, Miller J, Gheidi N. EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING. Int J Sports Phys Ther 2017; 12:711-717. [PMID: 29181248 PMCID: PMC5685409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. PURPOSE Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. STUDY DESIGN A repeated-measures research design. METHODS Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. RESULTS When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p<0.001) despite all runners utilizing a heel strike pattern. Dorsiflexion at initial contact was reduced 28% (p=0.016) when heel lifts were donned. No differences in step length and cadence (p>0.05) were shown between conditions. CONCLUSIONS Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Zachary Mestelle
- La Crosse Institute for Movement Science, Department of Health Professions - Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Thomas Kernozek
- La Crosse Institute for Movement Science, Department of Health Professions - Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Kelly S Adkins
- La Crosse Institute for Movement Science, Department of Health Professions - Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Jessica Miller
- La Crosse Institute for Movement Science, Department of Health Professions - Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Naghmeh Gheidi
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI, USA
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Blønd L. Arthroscopic deepening trochleoplasty for chronic anterior knee pain after previous failed conservative and arthroscopic treatment. Report of two cases. Int J Surg Case Rep 2017; 40:63-68. [PMID: 28942225 PMCID: PMC5612785 DOI: 10.1016/j.ijscr.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 01/29/2023] Open
Abstract
This study acknowledge that chronic anterior knee pain or patellofemoral can be caused based on trochlear dysplasia. The paper discuss the scientific background for this. By restoring the patient anatomy performing an arthroscopic trochleoplasty, the patients anterior knee pain was reduced significantly.
Purpose A proportion of patients having years of chronic anterior knee pain(AKP) that have not responded to non-operative modalities. Trochlear dysplasia have been found to be a cause for AKP. By restoring the anatomy with a trochleoplasty procedure the patellofemoral joint is unloaded. This study is a prospective 2 year follow-up study, based on two cases with chronic AKP for several years and having severe trochlear dysplasia and both were successfully treated by arthroscopic deepening trochleoplasty. Methods Case one was a 46 year old women with chronic anterior knee pain (AKP). Imaging showed lateral trochlear inclination angle of 2°, trochlear asymmetry 0.36, central height 81% and medial height 83%. Thepreoperative Kujala score was 70 and Knee injury and Osteoarthritis Outcome Score (KOOS) subscale for pain was 67. Case two was a 26 year old man troubled by AKP and knee knee joint effusion for >8 years without any instability in the history. Imaging showed lateral trochlear inclination angle of 6°, trochlear asymmetry 0.25, central height 76% and medial height 78%. The preoperative Kujala score was 49 and KOOS subscale for pain was 72. Results The postoperative Kujala score was for case one 82 and for case two 81. The postoperative KOOS subscale for pain was for case one 89 and for case two 92. Improvement in the KOOS subscale for sport and recreational activities and quality of living were also found. Conclusion This is the first case report to demonstrate that patient having had years of chronic AKP and trochlear dysplasia can be successfully treated by arthroscopic trochleoplasty.
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Affiliation(s)
- Lars Blønd
- Department of Orthopaedic Surgery, Aleris-Hamlet Parken, Copenhagen, Denmark; Department of Orthopaedic Surgery, The Zealand University Hospital, Koege, Denmark.
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Spriet M, Espinosa P, Kyme AZ, Phillips KL, Katzman SA, Galuppo LD, Stepanov P, Beylin D. 18
F-sodium fluoride positron emission tomography of the equine distal limb: Exploratory study in three horses. Equine Vet J 2017; 50:125-132. [DOI: 10.1111/evj.12719] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/09/2017] [Indexed: 01/03/2023]
Affiliation(s)
- M. Spriet
- University of California; Davis California USA
| | - P. Espinosa
- University of California; Davis California USA
| | - A. Z. Kyme
- University of California; Davis California USA
| | | | | | | | - P. Stepanov
- Brain Biosciences, Inc.; Rockville Maryland USA
| | - D. Beylin
- Brain Biosciences, Inc.; Rockville Maryland USA
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Abstract
Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.
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Affiliation(s)
- Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin
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Boudreau SA, Kamavuako EN, Rathleff MS. Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study. BMC Musculoskelet Disord 2017; 18:160. [PMID: 28420379 PMCID: PMC5395838 DOI: 10.1186/s12891-017-1521-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/07/2017] [Indexed: 12/26/2022] Open
Abstract
Background Detailed pain mapping of extent and distribution in individuals with patellofemoral pain (PFP) within and around a complex structure such as the knee has yet to be explored. Methods Perceptions of on-going pain from adolescents and young adults (N = 35) with long-standing (>10 months) PFP were collected on high-resolution 3D digital body-schema of the knees. Location, area of pain, pain intensity, laterality, worse side of knee pain, symptom duration, and symmetry in bilateral knee pain were recorded. A threshold for naturally occurring variations in symmetrical knee pain drawings were collected from 18 healthy controls and used in combination with the development a symmetry index (0–1) to create a fuzzy rule for classifying symmetrical and non-symmetrical PFP patterns as compared to a PFP expert. The symmetry index was computed and tested using a correlation coefficient alone or in combination with the Jaccard index and the true and false positive rates (TPR and FPR, respectively) determined. Results The peripatellar region was the common report of pain location however, novel and nonconforming PFP patterns were identified and the majority of individuals (22 of 27) with bilateral PFP expressed highly-symmetric mirror-image pain. Individuals with symptom duration of 5 years or more had a greater area of pain, compared to those with symptoms for less than 5 years. The total area of pain was correlated to symptom duration for those with extended symptoms durations and a progression towards an “O” shaped pattern emerged. A TPR of 100% for identifying symmetrical knee pain patterns was found however the expert PFP tended to be stricter, as reflected in FPR of 20%. Conclusions A high proportion of PFP patterns or symptoms occur in mirrored locations and are exceptionally symmetrical, and long duration of symptoms appear to converge to an ‘O’ shape. Classifying symmetrical pain patterns is subjective however simple fuzzy rules and correlations can be used to increase objectivity. This study highlights a gap in knowledge of PFP symptom presentation, reveals what may be a natural progression of symptoms, and provides valuable clinical insight for both pain management and treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1521-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S A Boudreau
- Department of Health Science and Technology, CNAP, SMI® Aalborg University, Fredrik Bajers Vej 7, Aalborg, 9000, Denmark.
| | - E N Kamavuako
- Department of Health Science and Technology, CNAP, SMI® Aalborg University, Fredrik Bajers Vej 7, Aalborg, 9000, Denmark
| | - M S Rathleff
- Department of Health Science and Technology, CNAP, SMI® Aalborg University, Fredrik Bajers Vej 7, Aalborg, 9000, Denmark.,Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Willy RW, Brorsson A, Powell HC, Willson JD, Tranberg R, Grävare Silbernagel K. Elevated Knee Joint Kinetics and Reduced Ankle Kinetics Are Present During Jogging and Hopping After Achilles Tendon Ruptures. Am J Sports Med 2017; 45:1124-1133. [PMID: 28186834 DOI: 10.1177/0363546516685055] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Deficits in plantarflexor function are common after an Achilles tendon rupture. These deficits may result in an altered distribution of joint loads during lower extremity tasks. HYPOTHESIS We hypothesized that, regardless of treatment, the Achilles tendon-ruptured limb would exhibit deficits in ankle kinematics and joint power while exhibiting elevated knee joint power and patellofemoral joint loads during walking, jogging, and hopping. We further hypothesized that this loading pattern would be most evident during jogging and hopping. STUDY DESIGN Controlled laboratory study. METHODS Thirty-four participants (17 participants treated surgically, 17 treated nonsurgically) were tested at a mean 6.1 ± 2.0 years after an Achilles tendon rupture. Lower extremity kinematics and kinetics were assessed while participants completed walking, jogging, and single-legged hopping trials. Patellofemoral joint stress was calculated via a musculoskeletal model. Data were analyzed via mixed-model repeated analyses of variance (α = .05) and the limb symmetry index (LSI). RESULTS No differences ( P ≥ .05) were found between the surgical and nonsurgical groups. In both groups, large side-to-side deficits in the plantarflexion angle at toeoff (LSI: 53.5%-73.9%) were noted during walking, jogging, and hopping in the involved limb. Side-to-side deficits in the angular velocity were only present during jogging (LSI: 93.5%) and hopping (LSI: 92.5%). This pattern was accompanied by large deficits in eccentric (LSI: 80.8%-94.7%) and concentric (LSI: 82.2%-84.7%) ankle joint powers in the involved limb during all tasks. Interestingly, only jogging and hopping demonstrated greater knee joint loads when compared with the uninvolved limb. Concentric knee power was greater during jogging (LSI: 117.2%) and hopping (LSI: 115.9%) compared with the uninvolved limb. Similarly, peak patellofemoral joint stress was greater in the involved limb during jogging (LSI: 107.5%) and hopping (LSI: 107.1%), while only hopping had a greater loading rate of patellofemoral joint stress (LSI: 110.9%). CONCLUSION Considerable side-to-side deficits in plantarflexor function were observed during walking, jogging, and hopping in patients after an Achilles tendon rupture. As a possible compensation, increased knee joint loads were present but only during jogging and hopping. CLINICAL RELEVANCE These data suggest that after an Achilles tendon rupture, patients may be susceptible to greater mechanical loading of the knee during sporting tasks, regardless of surgical or nonsurgical treatment.
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Affiliation(s)
- Richard W Willy
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hayley C Powell
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - John D Willson
- Department of Physical Therapy, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Willy RW, Meira EP. CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN. Int J Sports Phys Ther 2016; 11:877-890. [PMID: 27904791 PMCID: PMC5095941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
UNLABELLED Patellofemoral pain (PFP) has historically been a complex and enigmatic issue. Many of the factors thought to relate to PFP remain after patients' symptoms have resolved making their clinical importance difficult to determine. The tissue homeostasis model proposed by Dye in 2005 can assist with understanding and implementing biomechanical interventions for PFP. Under this model, the goal of interventions for PFP should be to re-establish patellofemoral joint (PFJ) homeostasis through a temporary alteration of load to the offended tissue, followed by incrementally restoring the envelope of function to the baseline level or higher. High levels of PFJ loads, particularly in the presence of an altered PFJ environment, are thought to be a factor in the development of PFP. Clinical interventions often aim to alter the biomechanical patterns that are thought to result in elevated PFJ loads while concurrently increasing the load tolerance capabilities of the tissue through therapeutic exercise. Biomechanics may play a role in PFJ load modification not only when addressing proximal and distal components, but also when considering the involvement of more local factors such as the quadriceps musculature. Biomechanical considerations should consider the entire kinetic chain including the hip and the foot/ankle complex, however the beneficial effects of these interventions may not be the result of long-term biomechanical changes. Biomechanical alterations may be achieved through movement retraining, but the interventions likely need to be task-specific to alter movement patterns. The purpose of this commentary is to describe biomechanical interventions for the athlete with PFP to encourage a safe and complete return to sport. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Richard W Willy
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
| | - Erik P Meira
- Black Diamond Physical Therapy, Portland, OR, USA
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Kogan F, Fan AP, Gold GE. Potential of PET-MRI for imaging of non-oncologic musculoskeletal disease. Quant Imaging Med Surg 2016; 6:756-771. [PMID: 28090451 DOI: 10.21037/qims.2016.12.16] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Early detection of musculoskeletal disease leads to improved therapies and patient outcomes, and would benefit greatly from imaging at the cellular and molecular level. As it becomes clear that assessment of multiple tissues and functional processes are often necessary to study the complex pathogenesis of musculoskeletal disorders, the role of multi-modality molecular imaging becomes increasingly important. New positron emission tomography-magnetic resonance imaging (PET-MRI) systems offer to combine high-resolution MRI with simultaneous molecular information from PET to study the multifaceted processes involved in numerous musculoskeletal disorders. In this article, we aim to outline the potential clinical utility of hybrid PET-MRI to these non-oncologic musculoskeletal diseases. We summarize current applications of PET molecular imaging in osteoarthritis (OA), rheumatoid arthritis (RA), metabolic bone diseases and neuropathic peripheral pain. Advanced MRI approaches that reveal biochemical and functional information offer complementary assessment in soft tissues. Additionally, we discuss technical considerations for hybrid PET-MR imaging including MR attenuation correction, workflow, radiation dose, and quantification.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA; Department of Bioengineering, Stanford University, Stanford, California, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Bone scan usefulness in patients with painful hip or knee prosthesis: 10 situations that can cause pain, other than loosening and infection. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:147-156. [DOI: 10.1007/s00590-016-1884-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
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Neal BS, Barton CJ, Gallie R, O'Halloran P, Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis. Gait Posture 2016; 45:69-82. [PMID: 26979886 DOI: 10.1016/j.gaitpost.2015.11.018] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/14/2015] [Accepted: 11/28/2015] [Indexed: 02/02/2023]
Abstract
Patellofemoral pain (PFP) is the most prevalent running pathology and associated with multi-level biomechanical factors. This systematic review aims to guide treatment and prevention of PFP by synthesising prospective, observational and intervention studies that measure clinical and biomechanical outcomes in symptomatic running populations. Medline, Web of Science and CINAHL were searched from inception to April 2015 for prospective, case-control or intervention studies in running-related PFP cohorts. Study methodological quality was scored by two independent raters using the modified Downs and Black or PEDro scales, with meta-analysis performed where appropriate. 28 studies were included. Very limited evidence indicates that increased peak hip adduction is a risk factor for PFP in female runners, supported by moderate evidence of a relationship between PFP and increased peak hip adduction, internal rotation and contralateral pelvic drop, as well as reduced peak hip flexion. Limited evidence was also identified that altered peak force and time to peak at foot level is a risk factor for PFP development. Limited evidence from intervention studies indicates that both running retraining and proximal strengthening exercise lead to favourable outcomes in both pain and function, but only running retraining significantly reduces peak hip adduction, suggesting a possible kinematic mechanism. Put together, these findings highlight limited but coherent evidence of altered biomechanics which interventions can alter with resultant symptom change in females with PFP. There is a clear need for high quality prospective studies of intervention efficacy with measurement of explanatory mechanisms.
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Affiliation(s)
- Bradley S Neal
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Christian J Barton
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom; Complete Sports Care, Melbourne, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Rosa Gallie
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Patrick O'Halloran
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
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Latypova A, Arami A, Becce F, Jolles-Haeberli B, Aminian K, Pioletti DP, Terrier A. A patient-specific model of total knee arthroplasty to estimate patellar strain: A case study. Clin Biomech (Bristol, Avon) 2016; 32:212-9. [PMID: 26651475 DOI: 10.1016/j.clinbiomech.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inappropriate patellar cut during total knee arthroplasty can lead to patellar complications due to increased bone strain. In this study, we evaluated patellar bone strain of a patient who had a deeper patellar cut than the recommended. METHODS A patient-specific model based on patient preoperative data was created. The model was decoupled into two levels: knee and patella. The knee model predicted kinematics and forces on the patella during squat movement. The patella model used these values to predict bone strain after total knee arthroplasty. Mechanical properties of the patellar bone were identified with micro-finite element modeling testing of cadaveric samples. The model was validated with a robotic knee simulator and postoperative X-rays. For this patient, we compared the deeper patellar cut depth to the recommended one, and evaluated patellar bone volume with octahedral shear strain above 1%. FINDINGS Model predictions were consistent with experimental measurements of the robotic knee simulator and postoperative X-rays. Compared to the recommended cut, the deeper cut increased the critical strain bone volume, but by less than 3% of total patellar volume. INTERPRETATION We thus conclude that the predicted increase in patellar strain should be within an acceptable range, since this patient had no complaints 8 months after surgery. This validated patient-specific model will later be used to address other questions on groups of patients, to eventually improve surgical planning and outcome of total knee arthroplasty.
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Affiliation(s)
- Adeliya Latypova
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Arash Arami
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Fabio Becce
- Lausanne University Hospital (CHUV), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland
| | | | - Kamiar Aminian
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Lausanne, Switzerland
| | - Dominique P Pioletti
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland
| | - Alexandre Terrier
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland.
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Affiliation(s)
- Lars Blønd
- Koege University Hospital and Teres Medical Group, Copenhagen, Denmark.
| | - Simon Donell
- Norfolk and Norwich University Hospital, Colney Lane, Colney, Norwich, NR4 7UY, UK.
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Willson JD, Loss JR, Willy RW, Meardon SA. Sex differences in running mechanics and patellofemoral joint kinetics following an exhaustive run. J Biomech 2015; 48:4155-4159. [PMID: 26525514 DOI: 10.1016/j.jbiomech.2015.10.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
Patellofemoral joint pain (PFP) is a common running-related injury that is more prevalent in females and thought to be associated with altered running mechanics. Changes in running mechanics have been observed following an exhaustive run but have not been analyzed relative to the sex bias for PFP. The purpose of this study was to test if females demonstrate unique changes in running mechanics associated with PFP following an exhaustive run. For this study, 18 females and 17 males ran to volitional exhaustion. Peak PFJ contact force and stress, PFJ contact force and stress loading rates, hip adduction excursion, and hip and knee joint frontal plane angular impulse were analyzed between females and males using separate 2 factor ANOVAs (2 (male/female)×2 (before/after exhaustion)). We observed similar changes in running mechanics among males and females over the course of the exhaustive run. Specifically, greater peak PFJ contact force loading rate (5%, P=.01), PFJ stress loading rate (5%, P<.01), hip adduction excursion (1.3°, P<.01), hip abduction angular impulse (4%, P<.01), knee abduction angular impulse (5%, P=.03), average vertical ground reaction force loading rate (10%, P<.01) and step length (2.1cm, P=.001) were observed during exhausted running. These small changes in suspected PFP pathomechanical factors may increase a runner׳s propensity for PFP. However, unique changes in female running mechanics due to exhaustion do not appear to contribute to the sex bias for PFP.
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Affiliation(s)
- John D Willson
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States.
| | - Justin R Loss
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States; Proaxis Physical Therapy, 304 W Weaver Street, Suite 103, Carrboro, NC 27510, United States
| | - Richard W Willy
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States
| | - Stacey A Meardon
- East Carolina University, Department of Physical Therapy, 600 Moye Boulevard, Greenville, NC 27834, United States
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44
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Lenhart RL, Smith CR, Vignos MF, Kaiser J, Heiderscheit BC, Thelen DG. Influence of step rate and quadriceps load distribution on patellofemoral cartilage contact pressures during running. J Biomech 2015; 48:2871-8. [PMID: 26070646 DOI: 10.1016/j.jbiomech.2015.04.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 11/30/2022]
Abstract
Interventions used to treat patellofemoral pain in runners are often designed to alter patellofemoral mechanics. This study used a computational model to investigate the influence of two interventions, step rate manipulation and quadriceps strengthening, on patellofemoral contact pressures during running. Running mechanics were analyzed using a lower extremity musculoskeletal model that included a knee with six degree-of-freedom tibiofemoral and patellofemoral joints. An elastic foundation model was used to compute articular contact pressures. The lower extremity model was scaled to anthropometric dimensions of 22 healthy adults, who ran on an instrumented treadmill at 90%, 100% and 110% of their preferred step rate. Numerical optimization was then used to predict the muscle forces, secondary tibiofemoral kinematics and all patellofemoral kinematics that would generate the measured primary hip, knee and ankle joint accelerations. Mean and peak patella contact pressures reached 5.0 and 9.7MPa during the midstance phase of running. Increasing step rate by 10% significantly reduced mean contact pressures by 10.4% and contact area by 7.4%, but had small effects on lateral patellar translation and tilt. Enhancing vastus medialis strength did not substantially affect pressure magnitudes or lateral patellar translation, but did shift contact pressure medially toward the patellar median ridge. Thus, the model suggests that step rate tends to primarily modulate the magnitude of contact pressure and contact area, while vastus medialis strengthening has the potential to alter mediolateral pressure locations. These results are relevant to consider in the design of interventions used to prevent or treat patellofemoral pain in runners.
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Affiliation(s)
- Rachel L Lenhart
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States
| | - Colin R Smith
- Department of Mechanical Engineering, University of Wisconsin-Madison, United States
| | - Michael F Vignos
- Department of Mechanical Engineering, University of Wisconsin-Madison, United States
| | - Jarred Kaiser
- Department of Mechanical Engineering, University of Wisconsin-Madison, United States
| | - Bryan C Heiderscheit
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, United States; Badger Athletic Performance, University of Wisconsin-Madison, Madison, WI, United States
| | - Darryl G Thelen
- Department of Biomedical Engineering, University of Wisconsin-Madison, United States; Department of Mechanical Engineering, University of Wisconsin-Madison, United States; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, United States.
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VANNATTA CHARLESNATHAN, KERNOZEK THOMASW. Patellofemoral Joint Stress during Running with Alterations in Foot Strike Pattern. Med Sci Sports Exerc 2015; 47:1001-8. [DOI: 10.1249/mss.0000000000000503] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chen JTN, Tang ACW, Lin SC, Tang SFT. Anterior knee pain caused by patellofemoral pain syndrome can be relieved by Botulinum toxin type A injection. Clin Neurol Neurosurg 2015; 129 Suppl 1:S27-9. [PMID: 25683309 DOI: 10.1016/s0303-8467(15)30008-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the therapeutic effects of Botulinum toxin type A (BTA) for anterior knee pain caused by patellofemoral pain syndrome (PFPS). DESIGN Prospective case control study for intervention. SETTING A tertiary hospital rehabilitation center. PARTICIPANTS Twelve bilateral PFPS patients with anterior knee pain were recruited. The worse pain knee was selected for injection, and the counterpart was left untreated. INTERVENTION Injection of BTA to vastus lateralis (VL) muscle. MAIN OUTCOME MEASURES Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and functional status of the knee, and CYBEX isokinetic dynamometer to assess isokinetic muscle force before and after BTA application to VL. RESULTS Remarkable improvement after receiving BTA injection was obtained not only in the questionnaire of WOMAC (p<0.05), but also in knee flexion torque (p<0.05). No significant change of knee extension torque was noted (p=0.682). CONCLUSION BTA injection is a good alternative treatment to improve anterior knee pain, knee function and isokinetic flexion torque.
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Affiliation(s)
| | - Alice Chu-Wen Tang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Cherng Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Simon Fuk-Tan Tang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan.
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Willson JD, Ratcliff OM, Meardon SA, Willy RW. Influence of step length and landing pattern on patellofemoral joint kinetics during running. Scand J Med Sci Sports 2015; 25:736-43. [DOI: 10.1111/sms.12383] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. D. Willson
- Department of Physical Therapy; East Carolina University; Greenville North Carolina USA
| | - O. M. Ratcliff
- Department of Physical Therapy; East Carolina University; Greenville North Carolina USA
| | - S. A. Meardon
- Department of Physical Therapy; East Carolina University; Greenville North Carolina USA
| | - R. W. Willy
- Department of Physical Therapy; East Carolina University; Greenville North Carolina USA
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48
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Bley AS, Correa JCF, Reis ACD, Rabelo NDDA, Marchetti PH, Lucareli PRG. Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study. PLoS One 2014; 9:e97606. [PMID: 24830289 PMCID: PMC4022617 DOI: 10.1371/journal.pone.0097606] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/22/2014] [Indexed: 01/04/2023] Open
Abstract
Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.
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Affiliation(s)
- Andre Serra Bley
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - João Carlos Ferrari Correa
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Amir Curcio Dos Reis
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Nayra Deise Dos Anjos Rabelo
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Henrique Marchetti
- Post Graduation Program in Human Movement Science, Universidade Metodista de Piracicaba, UNIMEP, Piracicaba, São Paulo, Brazil
- Faculty of Physical Education (YMCA), Sorocaba, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
- * E-mail:
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49
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Willson JD, Sharpee R, Meardon SA, Kernozek TW. Effects of step length on patellofemoral joint stress in female runners with and without patellofemoral pain. Clin Biomech (Bristol, Avon) 2014; 29:243-7. [PMID: 24439063 DOI: 10.1016/j.clinbiomech.2013.12.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patellofemoral pain is common among runners and is frequently attributed to increased patellofemoral joint stress. The purpose of our study was to examine the effects of changing step length during running on patellofemoral joint stress per step and stress per mile in females with and without patellofemoral pain. METHODS Ten female runners with patellofemoral pain and 13 healthy female runners performed running trials at 3.7m/s in three conditions: preferred step length, at least +10% step length, and at least -10% step length. Knee flexion angles and internal knee extension moments served as inputs for a biomechanical model to estimate patellofemoral joint stress per step. We also estimated total patellofemoral joint stress per mile based on the number of steps necessary to run a mile during each condition. FINDINGS Patellofemoral joint stress per step increased 31% in the long step length condition (P<.001) and decreased 22.2% in the short step length condition (P<.001). Despite the inverse relationship between step length and number of steps required to run a mile, patellofemoral joint stress per mile increased 14% in the long step length condition (P<.001) and decreased 7.5% in the short step length condition (P<.001). INTERPRETATION These results suggest a direct relationship between step length and patellofemoral joint loads. Total stress per mile experienced at the patellofemoral joint decreased with a short step length despite the greater number of steps necessary to cover this distance. These findings may have relevance with respect to both prevention and treatment of patellofemoral joint pain.
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Affiliation(s)
- John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC 28734, USA.
| | - Ryan Sharpee
- La Crosse Institute for Movement Science, Department of Health Professions - Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI 54601, USA
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, NC 28734, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Department of Health Professions - Physical Therapy Program, University of Wisconsin - La Crosse, La Crosse, WI 54601, USA
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Fernandez J, Sartori M, Lloyd D, Munro J, Shim V. Bone remodelling in the natural acetabulum is influenced by muscle force-induced bone stress. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:28-41. [PMID: 23982908 DOI: 10.1002/cnm.2586] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/12/2013] [Accepted: 07/18/2013] [Indexed: 06/02/2023]
Abstract
A modelling framework using the international Physiome Project is presented for evaluating the role of muscles on acetabular stress patterns in the natural hip. The novel developments include the following: (i) an efficient method for model generation with validation; (ii) the inclusion of electromyography-estimated muscle forces from gait; and (iii) the role that muscles play in the hip stress pattern. The 3D finite element hip model includes anatomically based muscle area attachments, material properties derived from Hounsfield units and validation against an Instron compression test. The primary outcome from this study is that hip loading applied as anatomically accurate muscle forces redistributes the stress pattern and reduces peak stress throughout the pelvis and within the acetabulum compared with applying the same net hip force without muscles through the femur. Muscle forces also increased stress where large muscles have small insertion sites. This has implications for the hip where bone stress and strain are key excitation variables used to initiate bone remodelling based on the strain-based bone remodelling theory. Inclusion of muscle forces reduces the predicted sites and degree of remodelling. The secondary outcome is that the key muscles that influenced remodelling in the acetabulum were the rectus femoris, adductor magnus and iliacus.
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Affiliation(s)
- Justin Fernandez
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Department of Engineering Science, The University of Auckland, Auckland, New Zealand
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