Patellofemoral Joint Kinematics in Individuals with and without Patellofemoral Pain Syndrome

MacIntyre, Norma J.; Hill, Nicholas M.; Fellows, R.A.; Ellis, Randy E.; Wilson, David R.

doi:10.2106/jbjs.e.00674

Cited by 132 publications

(92 citation statements)

References 23 publications

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“…The current study did find that PFPS patients had greater patellar and greater superior patellar translation from extension to flexion compared to controls, however, the remaining patellofemoral kinematics and contact area measurements between PFPS and healthy controls were not significantly different which corresponds with prior research in patellofemoral pain [17]. MacIntyre et al selected PFPS patients based on history and physical exam and found no differences in patellar spin (rotation), tilt, and lateral translation between PFPS and healthy controls across knee flexion ranges −4 to 60°, except for more lateral patellar translation at 19° of flexion in the PFPS group [17]. This is in contrast to the study that identified more lateral patellar displacement and patellar tilt in PFPS patients compared to healthy controls that defined patellar maltracking in adolescent patients with known history of patellar dislocation [23].…”

Section: Discussionsupporting

confidence: 84%

Inter- and intra-rater reliability of patellofemoral kinematic and contact area quantification by fast spin echo MRI and correlation with cartilage health by quantitative T1ρ MRI

Lau¹,

Thuillier²,

Pedoia³

et al. 2016

The Knee

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Background Patellar maltracking is a leading cause of patellofemoral pain syndrome (PFPS). The aim of this study was to determine the inter- and intra-rater reliability of a semi-automated program for magnetic resonance imaging (MRI) based patellofemoral kinematics. Methods Sixteen subjects (10 with PFPS [mean age 32.3; SD 5.2; eight females] and six controls without PFPS 19 [mean age 28.6; SD 2.8; three females]) participated in the study. One set of T2-weighted, fat-saturated fast spin-echo (FSE) MRIs were acquired from each subject in full extension and 30° of knee flexion. MRI including axial T1ρ relaxation time mapping sequences was also performed on each knee. Following image acquisitions, regions of interest for kinematic MRI, and patellar and trochlear cartilage were segmented and quantified with in-house designed spline- based MATLAB semi-automated software. Results Intraclass Correlations Coefficients (ICC) of calculated kinematic parameters were good to excellent, ICC > 0.8 in patellar flexion, rotation, tilt, and translation (anterior -posterior, medial -lateral, and superior -inferior), and contact area translation. Only patellar tilt in the flexed position and motion from extended to flexed state was significantly different between PFPS and control patients (p = 0.002 and p = 0.006, respectively). No significant correlations were identified between patellofemoral kinematics and contact area with T1ρ relaxation times. Conclusions A semi-automated, spline-based kinematic MRI technique for patellofemoral kinematic and contact area quantification is highly reproducible with the potential to help better understand the role of patellofemoral maltracking in PFPS and other knee disorders.

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Section: Discussionsupporting

confidence: 84%

Inter- and intra-rater reliability of patellofemoral kinematic and contact area quantification by fast spin echo MRI and correlation with cartilage health by quantitative T1ρ MRI

Lau¹,

Thuillier²,

Pedoia³

et al. 2016

The Knee

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“…high-intensity training). The combination of overload with dynamic valgus and functional lateralization of the patella may lead to overuse of the structures of the patellofemoral joint [43]. This overload may cause anterior knee pain.…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral pain syndrome

Petersen

Ellermann

Gösele-Koppenburg³

et al. 2013

Knee Surg Sports Traumatol Arthrosc

227

181

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The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear-foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non-operative therapy concept with short-term use of NSAIDs, short-term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non-operative and should address the functional causes.Level of evidence V.

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“…In contrast to adults, for whom PFP is often assumed to be a kinematic problem, overuse is most often cited as the etiology of pain for adolescent patients. 28, 44, 46, 47, 52 There are a plethora of analyses 6, 9, 12, 24, 37, 50 on patellar tracking and alignment patterns in adults with PFP. Yet, an extensive search of the literature revealed no studies on patellar tracking and just two studies 17, 33 on patellar alignment in adolescents with PFP.…”

Section: Introductionmentioning

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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Patellofemoral Joint Kinematics in Individuals with and without Patellofemoral Pain Syndrome

Cited by 132 publications

References 23 publications

Inter- and intra-rater reliability of patellofemoral kinematic and contact area quantification by fast spin echo MRI and correlation with cartilage health by quantitative T1ρ MRI

Inter- and intra-rater reliability of patellofemoral kinematic and contact area quantification by fast spin echo MRI and correlation with cartilage health by quantitative T1ρ MRI

Patellofemoral pain syndrome

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

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