Characterastics of muscle architectural parameters for early knee osteoarthritis in middle-aged and elderly women / 中国康复理论与实践

ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.

Comparison between the effects of Maitland’s mobilization versus its combination with vastus medialis oblique neuromuscular stimulation on two scales (NPRS & WOMAC) in knee osteoarthritis patients

Background & objectives: Osteoarthritis (OA) is the most common form of arthritis that increases with age affecting the population from the middle age to the elderly. The present study was undertaken to find whether neuromuscular stimulation of vastus medialis oblique (VMO) in combination with Maitland’s mobilization and exercises was more effective as compared to Maitland’s mobilization with exercises alone in patients with knee OA. Methods: Sixty patients with knee OA were purposively selected and randomly distributed to two groups that received an intervention for eight weeks. Group A patients received Maitland’s mobilization in combination with exercises and group B patients received the same intervention as group A in combination with neuromuscular stimulation of VMO muscle. After eight weeks, outcome measures, i.e. Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) index, were reassessed. Results: Both groups showed significant (P<0.05) within-group improvement in the knee pain levels and stiffness as reflected by NPRS and WOMAC index. Interpretation & conclusions: Patients of both the groups (A and B) were found to be improving significantly in pain and disability, group A patients receiving Maitland’s mobilization in combination with exercises were found to get more relief in pain and disability.

Neuromuscular compartmentalization of the vastus medialis muscle: comparison of the activity of the vastus medialis obliquus and the vastus medialis longus by high density electromyography / Compartimentación neuromuscular del músculo vasto medial: comparación de la actividad del vasto medial oblicuo y del vasto medial largo mediante electromiografía de alta densidad

SUMMARY: Anatomical studies describe the vastus medialis (VM) as being subdivided into two morphologically distinct components, the vastus medialis obliquus (VMO) and the vastus medialis longus (VML). However, there are discrepancies regarding the functional differentiation of these components. The aim of this study was to compare the levels of activation of the VMO and the VML by high density surface electromyography. Twelve healthy young women (age: 21.4 ± 2.0 years; weight: 58.1 ± 7.5 kg; height: 1.6 ± 0.1 m), performed an open kinetic chain knee exercise during which the EMG activity of the VMO and the VML was recorded with two- dimensional matrices of 32 surface electrodes. The exercises were performed with three levels of resistance (5, 10 and 15 % of the body weight (BW)), considering three phases: concentric, isometric and excentric. In the isometric phase the VMO had greater activation than the VML with the three levels of resistance (p<0.05). In the excentric phase, the VMO also showed greater activation than the VML with the 10 and 15 % BW resistance levels, while in the concentric phase, the VMO showed greater activity than the VML with only the 15 % BW resistance. The results indicated significant differences in the activation level of the two components of the VM. This bears importance in the development of exercises intended to achieve a greater or more selective activation of the VMO. In the sample subjected to evaluation, the EMG recordings describe a greater activation of the VMO in comparison to the VML, which is more important in the isometric and excentric phases of the flexion/extension of the knee in an open kinetic chain. These findings suggest a functional compartmentalization of the VM.

RESUMEN: Los estudios anatómicos describen que el músculo vasto medial (VM) se subdivide en dos componentes morfológicamente distintos, el vasto medial obliquus (VMO) y el vasto medial largo (VML). Sin embargo, existen discrepancias con respecto a la diferenciación funcional de estos componentes. El objetivo de este estudio fue comparar los niveles de activación del VMO y el VML mediante electromiografía de superficie de alta densidad. Doce mujeres jóvenes sanas (edad: 21,4 ± 2,0 años; peso: 58,1 ± 7,5 kg; altura: 1,6 ± 0,1 m), realizaron un ejercicio de rodilla de cadena cinética abierta durante el cual se registró la actividad EMG de la VMO y la VML con dos matrices dimensionales de 32 electrodos de superficie. Los ejercicios se realizaron con tres niveles de resistencia (5, 10 y 15% del peso corporal (PC)), considerando tres fases: concéntrica, isométrica y excéntrica. En la fase isométrica el VMO tuvo mayor activación que el VML con los tres niveles de resistencia (p <0,05). En la fase excéntrica, el VMO también mostró mayor activación que el VML con los niveles de resistencia de 10 y 15% BW, mientras que en la fase concéntrica, el VMO mostró mayor actividad que el VML con solo el 15 % de resistencia al BW. Los resultados indicaron diferencias significativas en el nivel de activación de los dos componentes de la VM. Esto tiene importancia en el desarrollo de ejercicios destinados a lograr una activación mayor o más selectiva del VMO. En la muestra sometida a evaluación, los registros EMG describen una mayor activación del VMO en comparación con el VML, que es más importante en las fases isométrica y excéntrica de la flexión / extensión de la rodilla en cadena cinética abierta. Estos hallazgos sugieren una compartimentación funcional de la VM.

Heart rate and lower limb muscle activity on cycle ergometer / Frequência cardíaca e atividade muscular dos membros inferiores em cicloergômetro / Frecuencia cardíaca y actividad muscular de los miembros inferiores en cicloergómetro

ABSTRACT Introduction: Muscle activity in the pedal stroke movement on a cycle ergometer can be measured by surface electromyography, as an effective and improved method for studying muscle action and objectively determining the different action potentials of the muscles involved in specific movements. Heart rate behavior is an important factor during exercise with load. Objective: To identify heart rate behavior and pattern of muscle activity of the rectus femoris and vastus medialis in healthy subjects in the pedaling dynamic at different loads, submaximal test, on an instrumented cycle ergometer. Methods: 20 healthy adults were evaluated. Heart rate measurement was performed, together with electromyographic analysis, in the time domain, of the rectus femoris and vastus medialis muscles during incremental exercise of the lower limbs on the cycle ergometer. Results: Heart rate behavior presented significant difference for p≥0.05 in relation to increased loads. The EMG signal intensity from the vastus medialis muscle (normalized RMS value) in each quadrant of the pedaling cycle showed significant difference for p≥0.05 in relation to quadrants I, II and IV and significant difference for p≥0.05 in relation to quadrants III and IV. In the rectus femoris (RF) muscle, there was significant difference for p≥0.05 in relation to quadrants I, II and IV and significant difference for p≥0.05 in relation to quadrants I, II and III. Conclusion: An increase in heart rate proportional to the increase in load was observed, as well as an increase in the amplitude of the electromyographic signal proportional to the increase in load. It was possible to identify the pattern of muscle activation in the studied quadrants during pedal stroke movements, independent of load. Level of evidence III; Study of non-consecutive patients; without uniform application of the "gold" standard reference.

RESUMO Introdução: A atividade muscular no gesto motor da pedalada no cicloergômetro pode ser mensurada por meio da eletromiografia de superfície. A eletromiografia de superfície tem sido um método efetivo e aprimorado para estudar a ação muscular, determinando com objetividade os diferentes potenciais de ação dos músculos empenhados em movimentos específicos. O comportamento da frequência cardíaca tem relação importante durante o exercício com carga. Objetivo: Identificar o comportamento da frequência cardíaca e o padrão da atividade muscular do reto femoral e vasto medial em indivíduos saudáveis na dinâmica da pedalada em diferentes cargas, teste submáximo, no cicloergômetro instrumentado. Métodos: Foram avaliados 20 adultos saudáveis, realizando-se a mensuração da frequência cardíaca e a análise eletromiográfica no domínio do tempo dos músculos reto femoral e vasto medial durante o exercício incremental dos membros inferiores em cicloergômetro. Resultados: O comportamento da frequência cardíaca apresentou diferença significante para p ≥ 0,05 com relação ao incremento das cargas. A intensidade do sinal EMG do músculo vasto medial (valor RMS normalizado) em cada quadrante do ciclo da pedalada mostrou diferença significativa para p ≥ 0,05 com relação aos quadrantes I, II e IV e diferença significativa para p ≥ 0,05 com relação aos quadrantes III e IV. No músculo reto femoral (RF) verificou-se diferença significativa para p ≥ 0,05 com relação aos quadrantes I, II e IV e diferença significativa para p ≥ 0,05 com relação aos quadrantes I, II e III. Conclusão: Constatou-se aumento da frequência cardíaca proporcional ao incremento das diferentes cargas e também se evidenciou um aumento na amplitude do sinal eletromiográfico proporcional ao incremento da carga. Foi possível identificar o padrão da ativação dos músculos com relação ao ciclo da pedalada nos quadrantes estudados, independentemente do nível da carga. Nível de evidência III; Estudo de pacientes não consecutivos; sem padrão de referência "ouro" aplicado uniformemente.

RESUMEN Introducción: La actividad muscular en el gesto motor de la pedaleada en el cicloergómetro se puede medir por medio de la electromiografía de superficie. La electromiografía de superficie ha sido un método efectivo y mejorado para estudiar la acción muscular, determinando con objetividad los diferentes potenciales de acción de los músculos empeñados en movimientos específicos. El comportamiento de la frecuencia cardíaca tiene relación importante durante el ejercicio con carga. Objetivo: Identificar el comportamiento de la frecuencia cardíaca y el patrón de la actividad muscular del recto femoral y vasto medial en individuos en la dinámica de la pedaleada en el cicloergómetro instrumentado. Métodos: Se evaluaron 20 adultos saludables, realizándose la medición de la frecuencia cardíaca y el análisis electromiográfico en el dominio del tiempo de los músculos recto femoral y vasto medial durante el ejercicio incremental de los miembros inferiores en cicloergómetro. Resultados: El comportamiento de la frecuencia cardíaca presentó una diferencia significativa para p ≥ 0,05 con relación al incremento de las cargas. La intensidad de la señal EMG del músculo vasto medial (valor RMS normalizado) en cada cuadrante del ciclo de la pedaleada mostró diferencia significativa para p ≥ 0,05 con relación a los cuadrantes I, II y IV y diferencia significativa para p ≥ 0,05 con relación a los cuadrantes III y IV. En el músculo recto femoral (RF) se verificó diferencia significativa para p ≥ 0,05 con relación a los cuadrantes I, II y IV, y diferencia significativa para p ≥ 0,05 con relación a los cuadrantes I, II y III. Conclusión: Se constató aumento de la frecuencia cardíaca proporcional al incremento de las diferentes cargas y también se evidenció un aumento en la amplitud de la señal electromiográfica proporcional al incremento de la carga. Fue posible identificar el patrón de la activación de los músculos con relación al ciclo de la pedaleada en los cuadrantes estudiados, independientemente del nivel de la carga. Nivel de evidencia III; Estudio de pacientes no consecutivos; sin patrón de referencia "oro" aplicado uniformemente.

Effect Of Functional Stabilization Training On Pain And Muscle Activation Ratio Of Vastus Medialis Obliqus And Vastus Lateralis In Individuals With Patellofemoral Pain: A Randomized Control Trial

Background: Patients with patellofemoral pain(PFP) demonstrate impaired lower-limb and trunk movement control along with hip and trunk muscle weakness. Functional stabilization training (FST) is a treatment focused on hip muscle strengthening and lower-limb and trunk movement control. The objective of the study is to examine the effectiveness of functional stabilization training on pain and electromyographic muscle activation ratio for VMO and VL in individuals with PFP. Methodology: Study has been conducted on 60 patients diagnosed with PFP. Written informed consent was obtained from the patients. All the patients were randomly allocated into two groups for 8 weeks of intervention. Outcome measurements were numeric pain rating scale (NPRS) and electromyographic muscle activation ratio for VMO and VL. Results: The results showed that there is statistically high significant difference(p<0.05) showing improvement in means of NPRS and electromyographic muscle activation ratio for VMO and VL before and after intervention in both the groups but FST group shows more significant improvement in NPRS(p=0.000) and in VMO:VL(p=0.000) compared to CT group. Conclusion: FST group showed more benefits then CT group in individuals with PFP in relieving pain and improving balance in the activity of VMO and VL.

A Study on the Effect of Isometric Quadriceps Activation and Vastus Medialis Obliquus Strengthening in Decreasing Q-Angle among Young Females

Females are more prone for lateral displacement of patella than males due to increased Q-angle (15–18°) in them compared to males (12–15°). In a normal state, lateral displacement is prevented by geometry of the joint and by the passive stabilizers. Even though contraction of the quadriceps tends to displace the patella laterally, vastus medialis oblique (VMO) acts medially and posteriorly as much as it acts proximally, and so its tension helps in resisting the Q angle effect. There are two procedures in common practice to reduce Q-angle and thereby to prevent lateral displacement of patella– either through vastus medialis oblique (VMO) strengthening or by isometric quadriceps activation (quadriceps muscle strengthening). We wanted to compare the effects of isometric quadriceps activation and VMO strengthening in reducing Q angle in a group of young females.METHODSA non-randomized, two group, pre-test, post-test assessment of Q-angle was done. Twenty healthy females of 18-20 age group were selected and randomly divided into two groups. Isometric quadriceps activation and VMO strengthening was done for 4 weeks. Q-angles were measured before and after the strengthening exercise using a long arm goniometer.RESULTSThe mean q angle before treatment was 21. (minimum 20 and maximum 23). While after the treatment, q angles were significantly reduced in both the groups and mean q angle was 16.3.CONCLUSIONSBoth the isometric quadriceps activation and VMO strengthening reduced Q-angle significantly and there was no significant difference between the two procedures. Results of this study help the physiotherapist in choosing the exercise for the management of patellofemoral pain and lateral displacement of patella.

Irreducible Knee Dislocation with Vastus Medialis Muscle Interposition

Knee dislocation is one of the rare orthopedic emergencies that require special management with an annual incidence rate of less than 0.02%. Knee dislocations are classified by Kennedy, according to the direction of tibial dislocation in relation to the femur, as anteromedial, posteromedial, anterolateral, and posterolateral. Operative intervention and multi-ligament reconstruction are usually required in knee dislocation. Interposition of the vastus medialis inside the joint of a dislocated knee is an uncommon scenario where reduction becomes impossible. In this report, we present a case of irreducible knee dislocation with vastus medialis muscle interposition. Before reduction, we performed arthroscopy of the knee and removal of the interposed muscle to prevent extravasation of the fluid by sealing the torn capsular area.

El adelantamiento del vasto medial ofrece buenos resultados clínicos y funcionales para la inestabilidad lateral femororrotuliana / Vastus medialis advancement provides good clinical and functional outcomes for lateral patellofemoral instability

Introducción La inestabilidad lateral femororrotuliana es una patología de etiología multifactorial aunque existen múltiples opciones para su tratamiento. El adelantamiento del vasto medial con liberación retinacular lateral asistida por artroscopia (AVMLRAA) se realiza cuando no hay alteraciones de alineación ni de la estructura ósea. El objetivo del estudio es evaluar los resultados clínicos y funcionales de pacientes con inestabilidad lateral femororrotuliana (ILFR) tratados con AVMLRAA. Material y métodos Estudio descriptivo y transversal realizado entre septiembre de 2014 y enero de 2016. Se incluyó a pacientes con ILFR tratados con AVMLRAA. Se presentan los resultados evaluados por las escalas de Tegner-Lysholm y Kujala antes de la cirugía y 12meses después de operados. Resultados Seis pacientes, 5 mujeres (83,3%) y 1 hombre (16,7%); media de edad al presentar la primera luxación: 15,83 (7-30) ±8,47 años; rodilla afectada: 4 derechas (66,7%) y 2 izquierdas (33,3%); tiempo promedio desde la primera luxación hasta la cirugía: 10,08 (0,5-17) ±5,16 años; las evaluaciones prequirúrgicas y posquirúrgicas de las escalas Tegner-Lyshom y Kujala para el género y lado afectado no mostraron diferencias estadísticamente significativas (p>0,05). La mediana prequirúrgica de la escala Tegner-Lysholm fue 37,50 (6-78) ±26,66; posquirúrgica: 88,17 (77-99) ±7,73 (p = 0,028); mediana de la escala Kujala prequirúrgica: 36,67 (2-77) ±29,703; posquirúrgica: 84,83 (75-100) ±9,368 (p = 0,027). El seguimiento promedio fue 14,0 (12-18) ±2,44 meses; la aprensión posquirúrgica fue 100% negativa. El 100% respondió que se volverían a operar en caso de presentar nuevamente los síntomas. Discusión El AVMLR para el manejo de la ILFR en pacientes sin malformaciones óseas ni mala alineación ofrece buenos resultados clínicos. Nivel de evidencia clínica Nivel IV.

Background Patellofemoral lateral instability is a condition of multifactorial origin, and has multiple options for its treatment. Vastus medialis advancement with arthroscopic assisted lateral retinacle replication (AALRR) is performed when there is no alteration of alignment or bone structure. The purpose of this study is to evaluate the clinical and functional results of patients with patellofemoral lateral instability (PFLI) treated with AALRR. Material and methods A descriptive, cross-sectional study was conducted from September 2014 to January 2016 on patients with PFLI treated with AALRR. The results before surgery and 12months after surgery, were evaluated using the Tegner-Lysholm and Kujala scales. Results The study included 6 patients, 5women (83.3%), and 1man (16.7%). The median age at first dislocation was 15.83 (7-30) ±8.47years. The affected knees were 4right (66.7%) and 2left (33.3%). The mean time from first dislocation to surgery was 10.08 (0.5-17) ±5.16years. The pre- and post-surgical evaluations using the Tegner-Lysholm and Kujala scales for the affected gender and side showed no statistically significant differences (P>.05). The pre-surgical median of the Tegner-Lysholm scale was 37.50 (6-78) ±26.66, and post-surgical, 88.17 (77-99) ±7.73 (P=.028). The pre-surgical and post-surgical median of the Kujala scale was 36.67 (2-77) ±29.703, and 84.83 (75-100) ±9.368, respectively (P=.027). The mean follow-up was 14.0 (12-18) ±2.44months.; Post-surgical apprehension was 100% negative. All patients responded that they would have a further operation in case of presenting with the symptoms again. Discussion The AALRR for the management of PFLI in patients without bone malformations or misalignment offers good clinical results. Evidence level IV.

The MRI study of correlation between medial patellofemoral ligament tear and injury degrees of vastus medialis obliquus after acute patellar dislocation / 中华放射学杂志

Objective To discuss the relationship between the injury patterns of medial patellofemoral ligament(MPFL) and injury degrees of vastus medialis obliquus(VMO) after acute patellar dislocation(PD). Methods Knee joint MRI was performed in 79 patients with acute PD. Images were acquired and evaluated using standardised protocols. Injury patterns of MPFL were grouped by severity (partial tear and complete tear)and location (isolated patellar-side tear (PAT), isolated femoral-side tear (FEM) and combined tear (COM) ) for analysis of the prevalence of VMO injury. The VMO elevation was calculated on sagittal and coronal planes. Results The prevalence rates of MPFL tear and VMO lesion were 96.2%(76/79)and 54.4%(43/79)after acute PD.The prevalence rate of VMO lesion was 40.6%(13/32)and 68.2%(30/44)in the partial and complete MPFL tear subgroups,respectively.Complete MPFL tear subgroup showed higher prevalence rate of VMO lesion when compared with partial tear subgroup(χ2=5.727, P=0.017). The prevalence rates of VMO lesion in the PAT, FEM and COM subgroups were 31.8% (7/22), 67.7% (21/31) and 70% (14/20), respectively. There were statistically significant differences among them(χ2=8.549,P=0.014).About the mean VMO elevation,there were statistically significant differences between the complete and partial MPFL tear subgroups, the FEM and PAT subgroups, and the COM and PAT subgroups (P=0.00). Conclusions Compared with partial MPFL tear, complete tear predisposes to VMO lesion and has a higher elevation of the torn VMO after acute PD.The femoral-sided and combined MPFL tears predispose to VMO lesion and have higher elevations of the torn VMO.

<b>Influence of Acupuncture to SP 3 on the Activity of the Quadriceps Femoris Muscle During Extensor Movement of the Knee Joint</b> / 日本東洋医学雑誌

<p>The aim of this study was to investigate the effects of acupuncture to SP 3 on the quadriceps femoris during knee extension in patients with musculoskeletal diseases by applying the meridian concept.<br>The subjects included 10 healthy individuals with a mean age of 23.1 years, and all of whom provided informed consent for participation. During knee extension, each subject underwent three different types of acupuncture stimuli : 1) stimulation to SP 3, 2) stimulation to SP 4, and 3) no stimulation. For each stimulation,the subjects performed isometric contraction with 40% of maximum voluntary contraction with knee flexion to 60°. Surface electromyography (EMG) of the vastus medialis obliquus, vastus medialis longus, rectus femoris,and the four sites within the vastus lateralis was performed during knee extension before acupuncture stimulation ; immediately after starting stimulation ; and 5, 10, and 15 min after starting stimulation. Relative-integrated EMG data was recorded during and after acupuncture stimulation and compared to data that were recorded before acupuncture as reference values.<br>The results showed that after 15 min of acupuncture stimulation to SP 3, the relative-integrated EMG data on the vastus medialis obliquus was significantly increased compared to the data obtained without stimulation (p < 0.05).<br>Therefore, in conclusion, after 15 min of acupuncture stimulation to SP 3, the relative-integrated EMG data on the vastus medialis obliquus exhibited suppressed muscle function.</p>

Influence of knee extension in sitting position with hip adduction on surface EMG of quadriceps muscles in patients with patellofemoral pain syndrome / 医用生物力学

Objective To investigate the possible effect of fully knee extension in sitting position with or without hip adduction on quadriceps imbalance in patients with patellofemoral pain syndrome (PFPS) by using surface electromyography (sEMG). Methods sEMG signals of vastus lateralis (VL) and vastus medialis oblique (VMO) muscles from 30 patients with PFPS as PFPS group and 30 healthy subjects as control group were collected, during their fully knee extension in sitting position with or without hip adduction. All the EMG data were then analyzed by extracting time domain indexes, namely, the root mean square (RMS) and integrated EMG (IEMG), to compare the balanced relationship between VL and VMO muscles. Results In PFPS group, there were no significant differences in VL time domain indexes during knee extension in sitting position with or without hip adduction, while statistical differences were found in VMO time domain indexes, and values of RMS and IEMG of VMO were higher under hip adduction, which indicated that the VMO muscle recruitment was strengthened. Conclusions Fully knee extension in sitting position with hip adduction can promote EMG activities of VMO muscles in patients with PFPS, which will help to balance the VL and VMO muscles.

Observations on the Efficacy of Vastus Medialis Oblique Enhancement plus Electroacupuncture Intervention in Treating Patellar Chondromalacia / 上海针灸杂志

ObjectiveTo investigate the clinical efficacy of vastus medialisoblique enhancement plus electroacupuncture intervention in treating patellar chondromalacia.MethodFifty-two patients meeting the inclusion criteria were randomly allocated to a treatment group of 32 cases and a control group of 20 cases. The treatmentgroup received vastus medialis oblique enhancement plus electroacupuncture intervention and the control group, electroacupuncture intervention alone. Both groups were treated once daily, 10 times as a course, for four consecutive courses. The Visual Analogue Scale (VAS) score was counted in the two groups before and after treatment. The clinical therapeutic effects were evaluated in the two groups.ResultThe VAS score improved significantly in both groups of patients after treatment compared with before(P<0.05). It improved significantly more in the treatment group than in the control group (P<0.05). The cure rate and the total efficacy rate were 37.5% and 96.9%, respectively, in the treatment group, which were higher than a cure rate of 20.0% and a total efficacy rate of 75.0% in the control group, respectively. ConclusionVastus medialis oblique enhancement plus electroacupuncture intervention can improve the clinical symptom of pain more markedly and heighten the clinical therapeutic effect in patients with patellar chondromalacia. Its effect is better than that of electroacupuncture intervention alone.

Effect of double-leg semi-squats with hip adduction on the vastus medialis oblique of patients with patellofemoral pain syndrome / 中华物理医学与康复杂志

Objective To investigate the possible effect of performing double-leg semi-squats with hip adduction on the imbalance between vastus lateralis (VL) and vastus medialis oblique (VMO) muscles of patients with patellofemoral pain syndrome (PFPS).Methods Thirty patients with PFPS were selected to be in the study group,matched with 30 healthy subjects who were enrolled as the control group.Electromyography was used to record VL and VMO activities while the subjects performed double-leg semi-squats (DSs) and double-leg semi-squats with hip adduction (DSs-HA).Results In the study group,when performing DSs,the average RMS was (103.31 ± 44.54) μV and the IEMG was (8.02 ±3.45) μVs for VL.For VMO the RMS was (85.02 ±41.19) μV and the IEMG was (6.72 ±3.20) μVs.The differences in the time domain indexes (RMS,IEMG) between VL and VMO were both significant during DSs (P ＜ 0.05).There was no significant differences during DSs-HA (P ＞ 0.05).The time domain indexes (RMS,IEMG) of VMO were significantly different in both the DSs and DSs-HA (P ＜ 0.05).Conclusions Stronger sEMG signals were seen from the VMO in the double-leg semi-squats with hip adduction than without hip adduction,which indicates that more selective VMO activation can be obtained in the exercise with hip adduction to help balance the VL and VMO.

The dynamic stability of the patella in persons with patellofemoral pain / 中华物理医学与康复杂志

Objective To analyze the activity of the vastus medialis (VM) and vastus lateralis (VL) muscles in the dynamic stabilization of the patella in patients with patellofemoral pain (PFPS) using standard surface electromyographic (sEMG) tests.Methods This comparative study involved 7 patients with PFPS (13 knees) and 10 healthy subjects (20 knees).They performed weight-bearing squat movements,and sEMG was employed to measure the mean amplitude and the time before peak (TBP) of their VM and VL muscles.Results There was no significant difference between the two groups in the ratio of the mean amplitudes of the VM and VL muscles.However,the ratio in both groups in squatting was significantly higher than when simply standing.In the PFPS group the average TBP delay of the VM relative to the TBP of the VL was significantly longer than in the control group during squat movements.Conclusions The delay in the TBP of the VM relative to the VL during squat movements could serve as a standardized test for assessing treatment effect in patients with local factor PFPS.

Baker's Cyst with Intramuscular Extension into Vastus Medialis Muscle

Baker's cysts are one of the most common cystic lesions around the knee joint and mainly caused by fluid distension of the gastrocnemius-semimembranous bursa that is situated along the medial side of the popliteal fossa. Typically, a Baker's cyst extends along the intermuscular planes around the knee joint and may enlarge any direction. However, it is mostly located in the inferomedial or superficial layers of the knee joint and less commonly extends laterally or proximally. Expansion of the cyst tends to respect the intermuscular planes, and Baker's cysts along the intramuscular route have been rarely reported. Thus, we report a case of Baker's cyst with intramuscular extension into the vastus medialis muscle.

Anatomic study of the portions long and oblique of the vastus lateralis and vastus muscles: review article

Although not mentioned directly in the classical anatomical literature, the vastus lateralis and vastus medialis, which make up the quadriceps femoris muscle, show variations in their anatomical structures due to the presence of long and oblique portions receiving the designation of vastus lateralis longus, vastus lateralis obliques to the vastus lateralis and vastus medialis oblique and vastus long, for the vastus medialis. The aim of this paper is to review the scientific literature regarding the presence of long and oblique portions of the broad medial and lateral portions recognize these as integral parts, anatomically, the quadriceps femoris. To this end, we used published articles in magazines and journals, located through Medline, and Lilacs Excerpa Medica, and the Portal Capes, with the key words: quadriceps, vastus medialis, vastus lateralis, vastus medialis longus, vastus medialis oblique , vastus lateralis longus and vastus lateralis oblique. Used to, still, a master’s thesis, located at Portal Capes, plus textbooks and atlases of anatomy. Among the 27 surveyed, only two do not recognize these portions as independent structures, considering the differences in fiber orientation. Of the 18 studied anatomy books, no mention such parts. However, eight anatomy books describe differences in trajectory of fiber insertions of the vastus lateralis and vastus medialis. Before this study it was concluded that these portions have not only morphological differences but also in other respects proved through scientific studies being published in some of them considered independent muscle suggesting inclusion of muscles in Anatomical Nomina.

Effects of the Off-Loading Brace on the Activation of Femoral Muscles: A Preliminary Study

OBJECTIVE: To provide the off-loading knee brace was designed relief for the pain associated with osteoarthritis by reduce loads on the degenerative compartment of the knee. This study examined the effects of the off-loading knee brace on activation of femoral muscles during squatting, slow and fast walking exercise in healthy young individuals. METHOD: Ten healthy male subjects without a history of knee pain were recruited. Each subject was asked to do squatting, slow and fast walking exercises with a brace secured to the dominant leg. The same exercises were repeated without the brace. Surface electromyographic (sEMG) data was collected from the vastus medialis oblique (VMO), vastus lateralis (VL) and biceps femoris (BF) muscles from the dominant side of the leg. All dynamic root mean squre (RMS) values of sEMG were standardized to static RMS values of the maximal isometric contraction and expressed as a percentage of maximal activity. RESULTS: We found that VMO activity was significantly decreased with application of the off-loading knee brace during squatting and fast walking exercise. However there were no significant differences in VMO activity with application of the off-loading knee brace during slow walking exercise. CONCLUSION: These results suggest that the external moment of the brace which effectively stabilized the patella in the movement in which the knee joints become relatively unstable. The brace could be useful in the short term, but for long-term use, weakening of the VMO is predicted. Therefore the program of selective muscular strength strengthening for the VMO should be emphasized.

Exploratory survey at the mexican marketplace on pork muscles characteristics from USA and Mexico

Trends in variation of physical, chemical and sensory traits due to country of origin (COO) were evaluated for samples from United States of America (U.S.A.) and Mexico of three pork muscles, Rectus femoris (RF, n = 20 from each COO), Vastus medialis (VM, n = 20 from each COO), and Longissimus dorsi (LD, n = 10 from each COO) in two separate, small-scale, exploratory surveys conducted at Mexico City. Compositional, physical and chemical properties and consumer acceptability traits of these Mexican and U.S.A. pork samples were quite similar, though Mexican pork samples generally were more variable. LD samples from U.S.A. had greater (P<0.05) water-holding and emulsifying capacities whereas both RF and LD from U.S.A. required lower shear force (P<0.05) compared to Mexican counterparts. Ratings from consumers did not indicate preference for pork from any of the countries. Because of the limited number of observations for the samples surveyed these results are preliminary and may not adequately characterize the populations of each country, but they did reveal important trends for selected traits of Mexican and U.S.A. pork currently available at the local market.

Se evaluaron tendencias en la variación de características físico-químicas y sensoriales debidas al país de origen (PDO), de muestras mexicanas y estadounidenses (EUA) de tres músculos del cerdo: Rectus femoris (RF, n = 20 por PDO), Vastus medialis (VM, n = 20 por PDO), and Longissimus dorsi (LD, n = 10 por PDO) mediante dos encuestas exploratorias separadas, a baja escala, conducidas en la Ciudad de México. Los resultados mostraron que músculos porcinos de los dos orígenes tienen propiedades físicas, químicas y sensoriales muy similares, aunque las muestras mexicanas mostraron mayor variabilidad. Las muestras de LD de EUA tuvieron mayor (P<0,05) capacidad de retención de agua y emulsificación, y al igual que las de RF, requirieron menos fuerza de corte que las mexicanas (P<0,05). Los consumidores no pudieron detectar diferencias entre muestras de diferente origen. Debido al limitado número de observaciones en las muestras encuestadas, los resultados deben considerarse preliminares y si bien no permiten caracterizar adecuadamente las poblaciones de cada país, las mismas revelan tendencias importantes para los rasgos seleccionados de la carne de cerdo procedente de México y EUA disponibles actualmente en el mercado local.

Irreducible Posterolateral Dislocation of the Knee Joint with Lateral Dislocation of the Patella: A Report of Two Cases

Reduction of the knee is impossible if the medial femoral condyle is caught in the medial soft tissue while posterolateral dislocation of the knee happens. Irreducible posterolateral dislocation with buttonholing of the medial femoral condyle through the torn vastus medialis muscle has rarely been reported. Furthermore, such a case associated with patella lateral dislocation has very seldom been reported. We report here on 2 such cases that were treated with open reduction.

Efeito imediato da estimulação elétrica neuromuscular seletiva na atividade eletromiográfica do músculo vasto medial oblíquo / Immediate effect of selective neuromuscular electrical stimulation on the electromyographic activity of the vastus medialis oblique muscle

A Síndrome da dor patelofemoral (SDPF) é descrita como dor anterior ou retro-patelar do joelho na ausência de outras patologias associadas, sendo freqüentemente associada à disfunção do Vasto Medial Oblíquo (VMO). Entretanto, diversos estudos têm demonstrado a impossibilidade de ativar seletivamente este músculo através de exercícios. O objetivo do presente estudo foi analisar o efeito imediato da estimulação elétrica neuromuscular (EENM) seletiva no músculo VMO por meio do comportamento eletromiográfico dos músculos VMO e vasto lateral (VL). Foram avaliadas 18 mulheres saudáveis, com idade média de 23,2 anos e IMC médio de 20 Kg/m2. Os procedimentos do estudo incluíram uma análise eletromiográfica dos músculos VMO e VL, antes e imediatamente após a EENM do músculo VMO. Durante a análise eletromiográfica, as voluntárias realizaram uma contração isométrica voluntária máxima durante a extensão do joelho a 60° em um dinamômetro isocinético. A estimulação elétrica foi realizada através da corrente Russa. A análise dos dados mostrou um aumento significativo na intensidade de ativação do músculo VMO imediatamente após a estimulação do mesmo (p=0,0125), enquanto que a intensidade de ativação do músculo VL, não mostrou aumento significativo (p=0,924). Além disso, verificou-se também um aumento significativo na relação VMO/VL (p=0,048). No presente estudo, observou-se uma modificação na relação VMO/VL após a EENM, sugerindo que a mesma tem um efeito favorável no fortalecimento seletivo do VMO...

The Patellofemoral pain syndrome (PFPS) is described as an anterior or retropatellar knee pain in the absence of other associated diseases, and has often been associated with dysfunction of the vastus medialis oblique muscle (VMO). However, several studies have demonstrated the impossibility of selectively activating this muscle with exercises. The aim of the present study was to analyze the immediate effect of neuromuscular electrical stimulation of VMO muscle by means of monitoring the electromyographic activity of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles. Eighteen healthy women with a mean age of 23.2 years and mean BMI of 20 Kg/m2 were evaluated. The study protocol included electromyographic analysis of VMO and VL muscles, before and immediately after neuromuscular electrical stimulation of the VMO muscle. During the electromyographic analysis, the volunteers performed maximal voluntary isometric contraction in a 60° knee extension on an isokinetic dynamometer. ôRussian currentõ apparatus was used for electrical stimulation. Results: The data analysis demonstrated a signifi cant increase in VMO activation intensity immediately after it had been electrically stimulated (p=0.0125), whereas VL activation intensity exhibited no signifi cant increase (p=0.924). Moreover, a signifi cant increase in the VMO/VL ratio was also detected (p=0.048). In this study it was observed that electrical stimulation modifi ed the VMO/VL ratio, which suggests electrical stimulation has a benefi cial effect on VMO muscle strength...