Adolescent patellofemoral pain: Implicating the medial patellofemoral ligament as the main pain generator

Luhmann, Scott J.; Schoenecker, Perry L.; Dobbs, Matthew B.; Gordon, Joel

doi:10.1007/s11832-008-0104-2

Cited by 26 publications

(17 citation statements)

References 70 publications

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“…Further, the majority of studies evaluating the epidemiology or risk factors for PFP in this population include pubescent, post-pubescent, and even pre-pubescent individuals. 3, 21, 23, 25 PFP may be unique in each of these groups based purely on developmental status. Specifically, open physes, incongruent increases in limb mass relative to limb length, hormonal fluctuations, and underdeveloped neuromuscular control patterns likely expose adolescents to various pathologies and injuries that are not typically seen in adult patients with PFP.…”

Section: Discussionmentioning

confidence: 99%

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

2016

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Background Patellofemoral pain is a prevalent disorder among female adolescents. Overuse is frequently cited as the etiology of pain for this population. What is currently unclear, however, is if the patella demonstrates abnormal tracking patterns relative to the femoral trochlear groove in adolescent females with patellofemoral pain. Purpose The aim of this case-control study is to determine if abnormal patellar tracking patterns are present in adolescent females with patellofemoral pain. The secondary aim is to identify if an increased distance between the tibial tuberosity and trochlear groove (TT_TG) is associated with the observed kinematic patterns. Study Design Case Control Methods Twenty female adolescent knees from 12 subjects with patellofemoral pain and 20 age-matched female knees from 13 healthy controls were recruited for this study. Patellofemoral kinematics (e.g., lateral patellar displacement) during a repetitive knee extension-flexion maneuver were quantified from dynamic cine-phase-contrast magnetic resonance imaging techniques. Static magnetic resonance images were used to determine the TT-TG distance. Results Relative to the control cohort, female adolescents with patellofemoral pain demonstrated significantly greater lateral displacement at 10° (3.2mm, p<0.001), 20° (2.3mm, p<0.001), and 30° (1.7mm, p=0.014) of knee flexion. A subgroup within this cohort (7 knees from 5 subjects) demonstrated extreme lateral maltracking >2 standard deviations beyond the average control. This subgroup also demonstrated a greater distance between the tibial tuberosity and trochlear grove relative to controls (Δ=4.2mm, p=0.001). Conclusions This study demonstrates that abnormal patellar tracking patterns are present in adolescent females with patellofemoral pain. Since all subjects from both cohorts participated in impact sports, it appears that rigorous athletic training alone is inadequate to produce symptoms in this population. Rather, patellofemoral pain may derive from a combination of physical activity in the context of pathologic kinematics.

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Section: Discussionmentioning

confidence: 99%

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

2016

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“…It is suggested that the proportion of acute versus overuse injuries in youth is approximately 50:50; however, it is feared that the number of overuse injuries is rising ( 12). Conditions such as patellofemoral pain ( 65,87), Osgood-Schlatter disease (41), calcaneal apophysitis (96), little league elbow ( 5 2 ) and little league shoulder ( 114), spondylolysis (53), and osteochondritis dissecans ( 101) are all common overuse injuries seen in children and adolescents subject to repetitive sports training. As youth engage earlier in formal-ized sport and specialize in sport(s) at younger ages, they may be at increased risk of experiencing overuse injury ( 45).…”

Section: Problem 3: Early Sport Specializationmentioning

confidence: 99%

Long-Term Athletic Development, Part 2

Lloyd¹,

Oliver²,

Faigenbaum

et al. 2015

Journal of Strength and Conditioning Research

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“…A severe lateral subluxation of the patella at active terminal extension of the knee is called the J-sign [1,2] or J-tracking [3]. It is a straight forward clinical sign, sometimes shortly referred to as "dislocation in extension" [4].…”

Section: Introductionmentioning

confidence: 99%

Demystifying Tibial-Tuberosity Trochlear Groove Distance, the J-Sign and Trochlear Dysplasia: An Imaging Encomium

GL¹,

K²,

Gupta³

2017

J Med Diagn Meth

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Aims and objective: The purpose of our study was to examine the association of the clinical J-sign with trochlear dysplasia and TTTG distance in patients with symptomatic patellofemoral instability. Material and methods:After obtaining approval from the institutional review board (class: 8.1-16/47-2, Nr.: 02/21AG, April 11, 2017), in our retrospective cross-sectional review study, 2 raters mutually assessed the type of trochlear dysplasia and separately measured the TTTG distance at 4-week intervals using 2 methods (standard and by Nizi#) on static and dynamic CT-images of 55 knees (46 patients) with clinical record of J-sign and anterior knee pain.Statistical analysis: All reported P values were 2-tailed with a level of <0.05 indicating statistical significance. The associations between variables were analyzed with appropriate correlation coefficients (Pearson, rp, pointbiserial, rpb, and phi, r#). The Wilcoxon signed-rank test for paired samples was used to evaluate the differences between static and dynamic tibial tuberosity-trochlear groove. Conclusion:The clinical manifestation of the J-sign, considered a dynamic marker of patellofemoral instability, has been frequently associated with numerous conditions, such as trochlear dysplasia, higher values of the Q-angle, and lateralized tibial tuberosity, yet its fundamental cause remains unknown, and the diagnostic value uncertain.

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Adolescent patellofemoral pain: Implicating the medial patellofemoral ligament as the main pain generator

Cited by 26 publications

References 70 publications

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

Patellofemoral Kinematics and Tibial Tuberosity–Trochlear Groove Distances in Female Adolescents With Patellofemoral Pain

Long-Term Athletic Development, Part 2

Demystifying Tibial-Tuberosity Trochlear Groove Distance, the J-Sign and Trochlear Dysplasia: An Imaging Encomium

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