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

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

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

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

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

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

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

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

Efficacy observation on chrondromalacia patellae treated with fire needling technique at high stress points / 中国针灸

<p><b>OBJECTIVE</b>To compare the clinical efficacy differences between fire needling technique of filiform needle at high stress points and regular acupuncture on chrondromalacia patellae so as to provide the better therapy for the treatment of this disease.</p><p><b>METHODS</b>Sixty cases of chrondromalacia patellae were randomized into a fire needling group (28 cases) and a routine acupuncture group (32 cases). In the fire needling group, 5 to 6 high stress points were localized according to the symptoms, palpation and imaging condition and were stimulated with fire needling technique of filiform needle. The treatment was given once every two days, 5 treatments made one session. In the routine acupuncture group, the regular acupuncture was applied at Dubi (ST 35), Xiguan (LR 7), Yanglingquan (GB 34), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, 5 treatments made one session. Lysholm score, VSA score, patella title angle (PTA) and lateral patella angle (LPA) of the affected knees before and after treatment, as well as the clinical efficacy after treatment were observed in the two groups.</p><p><b>RESULTS</b>After treatment, Lysholm score, VSA score, PTA and LPA were all improved apparently in the two groups (all P < 0.01). After the treatments, the improvements in Lysholm score, VSA score, PTA and LPA in the fire needling group were more obvious than those in the routine acupuncture group (all P < 0.05). The effective rate was 92.9% (26/28) in the fire needling group, better than 87.5% (28/32) in the routine acupuncture group (P < 0.01).</p><p><b>CONCLUSION</b>The fire needling technique of filiform needle at the high stress points relieves the clinical symptoms of chrondromalacia patellae and recovers the biodynamical structure of patellae.</p>

Artrosis patelofemoral / Arthrose fémoro-patellaire / Patellofemoral osteoarthritis

Introducción: la artrosis del compartimento patelofemoral es observada con frecuencia en pacientes con gonartrosis, entre sus síntomas y signos destacan el dolor y la sensación de inestabilidad. Objetivo: actualizar y profundizar en el conocimiento de aspectos esenciales como: epidemiología, factores predisponentes, imagenología, diagnóstico diferencial y tratamiento en pacientes con artrosis patelofemoral. Mètodos: se revisaron 200 artículos publicados en Pubmed, Hinari y Medline mediante el localizador de información Endnote con la palabra clave patellofemoral osteoarthritis, se utilizaron 52 citas, 46 de ellas de los últimos cinco años. Resultados: se abordan aspectos de gran interés desde el punto de vista epidemiológico acerca de la frecuencia con que se afecta el compartimento patelofemoral y la diferencias entre la condromalacia de rótula y la artrosis patelofemoral. Se describen los factores predisponentes entre los que se destaca, la displasia patelofemoral. Los exámenes imagenológicos se describen en detalle, en especial los relacionados con las vistas axiales de rótula y se menciona la importancia de la gammagrafía ósea. Se nombran las modalidades más usadas y sus principales indicaciones. Conclusiones: la presente revisión aporta elementos actuales para el tratamiento de enfermos con artrosis patelofemoral y aclara las diferencias entre dos entidades que se confunden con frecuencia en la práctica médica(AU)

Introduction: arthritis of the patellofemoral compartment is frequent in patients with gonarthrosis. Its signs and symptoms include pain and a feeling of instability. Objective: update and broaden knowledge on essential aspects such as epidemiology, predisposing factors, imaging, differential diagnosis and treatment of patients with patellofemoral osteoarthritis. Methods: a review was conducted of 200 papers published by Pubmed, Hinari and Medline using the information locator EndNote with the key term "patellofemoral osteoarthritis". Fifty-three citations were used, 46 of them from the last five years. Results: a discussion is provided of topics of great epidemiological interest, such as the frequency with which the patellofemoral compartment is involved, and the differences between patellar chondromalacia and patellofemoral osteoarthritis. A description is included of predisposing factors, among them patellofemoral dysplasia. Imaging studies, especially those based on axial patellar views, are described in detail. Reference is made to the importance of bone scintigraphy. A description is presented of the most common treatment modes and their main indications. Conclusions: the present review provides updated information about the treatment of patients with patellofemoral osteoarthritis, and sheds light on the differences between two conditions which are often confused in medical practice(AU)

Introduction: on trouve d'habitude une arthrose du compartiment fémoro-patellaire chez les patients atteints de gonarthrose. Les symptômes et signes comprennent la douleur et la sensation d'instabilité. Objectif: le but de cette révision est d'actualiser et d'approfondir les connaissances sur des aspects essentiels tels que l'épidémiologie, les facteurs de prédisposition, l'imagerie, le diagnostic différentiel et le traitement de l'arthrose fémoro-patellaire. Méthodes: On fait une révision de 200 articles publiés à Pubmed, Hinari et Medline, en utilisant le localisateur d'information Endnote avec le mot clé patellofemoral osteoarthritis. Cinquante-trois, dont 46 ont été publiés dans ces derniers cinq ans, sont cités. Résultats: On aborde des aspects très intéressants du point de vue épidémiologique à propos de la fréquence dans laquelle le compartiment fémoro-patellaire est touché, des différences entre la chondromalacie de la rotule et l'arthrose fémoro-patellaire. Les facteurs de prédisposition, tels que la dysplasie fémoro-patellaire, sont décrits. Les examens d'imagerie sont décrits en détail, notamment ceux qui sont en rapport avec les vues axiales de la rotule. On fait mention de l'importance de la gammagraphie osseuse. Quant au traitement, les techniques les plus fréquemment utilisées et leurs indications principales sont définies. Conclusions: La présente révision met en relief les éléments actuels sur le traitement des malades atteints d'arthrose fémoro-patellaire, et fait des distinctions entre les deux conditions fréquemment confondues dans la pratique médicale(AU)

Estimulação elétrica neuromuscular na disfunção patelofemoral: revisão de literatura / Neuromuscular electric stimulation in patellofemoral dysfunction: riterature review

A disfunção femoropatelar é uma deficiência bastante comum entre indivíduos jovens que acomete, principalmente, o sexo feminino e pode ser caracterizada por dor, edema e creptação retropatelar. Sistematizar o conhecimento em relação ao aumento da força muscular do quadríceps e alívio de dor em pacientes com disfunção femoropatelar, através da utilização da estimulação elétrica neuromuscular e exercícios resistidos. Trata se de um estudo de revisão narrativa da literatura no período de 2005 a 2011. Os critérios de inclusão foram artigos de intervenção, dos últimos seis anos, nos idiomas inglês, espanhol e português, que utilizaram o fortalecimento muscular e a eletroestimulação neuromuscular para reabilitação obtidos através de buscas nos bancos de dados eletrônicos Medline, Lilacs e na biblioteca Bireme. A busca bibliográfica resultou em 28 referências, destes foram excluídos nove de acordo com os objetivos e critérios de inclusão e foram selecionados 16 artigos para leitura dos resumos e posterior análise. A Estimulação Elétrica Neuromuscular (EENM) de média frequência pode ser utilizada associada a exercícios resistidos como coadjuvante no tratamento da disfunção femoropatelar (DFP), tanto para se obter um reequilíbrio muscular quanto para o alívio da dor.

Patellofemoral dysfunction is a fairly common deficiency among young individuals that primarily affects females and may be characterized by pain, swelling and retropatellar crepitation. The purpose of this review of literature from the period between 2005 and 2011 was to systematize knowledge in relation to the increase in quadriceps muscle strength and pain relief in patients with patellofemoral dysfunction, using neuromuscular electrical stimulation and resistance exercises. The inclusion criteria were intervention articles from the past six years, in English, Spanish and Portuguese, which used muscle strengthening and neuromuscular electrical stimulation for rehabilitation obtained through searches in the electronic databases Medline and Lilacs and in the Bireme library. The bibliographic search yielded 28 references, of which nine were excluded in accordance with the aims and inclusion criteria while 16 articles were selected for reading of the abstracts and subsequent analysis. Mediumfrequency Neuromuscular Electrical Stimulation (NMES) can be used in association with resistance exercises as an adjuvant in the treatment of patellofemoral dysfunction (PFD), both to achieve muscle rebalance and for pain relief.

Análise do conhecimento de profissionais de Educação Física referente à prescrição de exercícios físicos para portadores de condromalácia patelar / Knowledge analysis of physical education professionals regarding exercise prescription for patients with chondromalacia patellae

Este trabalho buscou verificar a conduta profissional que professores de Educação Física (PEFs) possui na utilização do exercício de extensão de joelhos na cadeira extensora e no leg press em pessoas sofrendo de condromalácia da patela. Dois experimentos foram feitos, utilizando questionários aplicados em academias do Rio de Janeiro. O primeiro estudo foi dividido nas seguintes opções: “cadeira extensora”, “leg press”, “ambos” e “nenhum” e foi aplicado em 18 PEFs. O segundo estudo foi relacionado com a utilização de ângulos específicos na máquina de extensão de pernas que foi dividido em: “0°-30°”, “60°-90°”, “ambos” e “nenhum” que foi aplicado em 24 PEFs. Adicionalmente ambos os questionários possuíam seções específicas onde informação complementar poderia ser escrita para justificar as respostas. As justificativas foram nomeadas (JT+) quando satisfatória e (JT-) na ausência de argumentos baseados em dados científicos. A análise estatística foi feita com o teste qui-quadrado e a significância foi considerada quando o valor de p era menor do que 0,05. No primeiro estudo nós observamos que a utilização do leg press foi menor do que as outras opções. Além disso, o percentual de JT+ foi maior nas opções “cadeira extensora”, “leg press” e “nenhum”. No segundo estudo nós observamos que o percentual de PEFs que escolheram a opção “0°-30°” foi maior em relação a opção “ambos”. Quando as justificativas foram analisadas, nós observamos que todas as opções tiveram um maior percentual de JT-, com exceção da opção “ambos” que não mostrou diferenças (p>0,05). Nós concluímos que os PEFs possuem uma adequada conduta quando escolhem os exercícios para pessoas com condromalácia patelar, porém existe uma necessidade de melhor sustentar as argumentações relacionadas com a utilização de ângulos no exercício de cadeira extensora.

This work aimed to verify which professional conduct Physical Education teachers (PETs) have when using knee extension exercise with leg extension machines and leg presses in people suffering from chondromalacia patellae. Two experiments were done using questionnaires applied in Rio de Janeiro gyms. The first study was divided in the following options: “leg extension”, “leg presses”, “both” or “none” and was applied in 18 PETs. The second study was related to the utilization of specific angles in leg extension machines that were divided in: “0°-30°”, “60°-90°”, “both” and “none” that was applied to 24 PETs. Additionally both questionnaires have specific sections where complementary information could be written to justify the answers. The explanations was named (JT+) when satisfactory and (JT-) in the absence of arguments based in scientific data. Statistical analysis was done by chi square test and significance was considered when p value was lower than 0.05. In first study we observed that leg press utilization was lower than the other options. Besides that JT+ percent was higher in options “leg extension”, “leg press” and “none” but had no significant alterations in “both”. In second study we observed that the percent of PETs that chose option “0-30°” was higher in relation to the option “both”. When the explanations were analyzed, we observed that all the options had a higher percentage of JT- with exception of option “both” that showed no differences (p>0.05). We conclude that PETs have an adequate conduct when choosing exercises for people with chondromalacia patellae, however there is a need to better sustain the argumentations relating to angle utilization in leg extension exercises.

Condromalácia patelar: análise de quatro testes clínicos / Chondromalacia patella: analysis of four clinical tests

Introdução: Condromalácia patelar (CP) é a perda da cartilagem de uma ou mais porções da patela, agravada por atividades que aumentam a compressão entre a patela e o fêmur. Objetivo: Analisar quatro testes clínicos para CP em indivíduos com e sem CP. Método: Foram avaliados 52 indivíduos: 28 com condromalácia e 24 sem. O diagnóstico foi determinado por raio-x (22), ressonância magnética (9) e ultrassom (4). Foi feita anamnese e exame físico, onde aplicaram-se os testes de Waldron (TW), apreensão patelar (AP), Sinal de Frund (SF) e Sinal de Clarke (SC). Resultados: SF e SC identificaram o maior número de sujeitos (12) com CP, seguido do TW (10) e o AP (7). Entretanto, os testes também evidenciaram resultados falso-positivos (SC ? 12; SF ? 4; TW ? 2 e AP -1) Conclusão: Os testes clínicos utilizados nesse estudo foram inconsistentes, evidenciando resultados falso-positivos, sugerindo cautela na sua utilização como indicadores da CP.

Introduction: chondromalacia patella (CP) is the loss of cartilage of one or more portions of the patella, aggravated by activities that increase the compression between the patella and femur. Objective: To assess four clinical trials for lung cancer for individuals with and without CP. Methods: We studied 52 subjects: 28 with and 24 without chondromalacia. The diagnosis was determined by X-ray (22), MRI (9) and ultrasound (4). Was made medical history and physical examination, where we applied tests Waldron (TW), patellar apprehension (AP) Signal Fründe (SF) and Signal Clarke (SC). Results: SF and SC identified the largest number of subjects (12) with CP, followed by TW (10) and AP (7). However, tests also showed false-positive results (SC - 12, SF - 4, TW - 2, AP -1) Conclusion: The clinical tests used in this study were inconsistent, showing false positive results, suggesting caution in its use as Indicators of CP.

Evaluation of the Chondromalacia Patella Using a Microscopy Coil: Comparison of the Two-Dimensional Fast Spin Echo Techniques and the Three-Dimensional Fast Field Echo Techniques

OBJECTIVE: We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. MATERIALS AND METHODS: Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. RESULTS: The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01). CONCLUSION: The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella.

Relação entre o ligamento patelofemoral lateral e a largura da faceta patelar lateral / Relationship between the lateral patellofemoral ligament and the width of the lateral patellar facet

OBJETIVO: Avaliar a relação entre o comprimento e largura do ligamento patelofemoral lateral (LPFL) e a largura da faceta articular patelar lateral (FAPL) em cadáveres. A instabilidade patelofemoral está intimamente relacionada com a morfologia patelar e com a tensão das estruturas retinaculares laterais. Estudos evidenciam que quanto mais larga a faceta patelar lateral e quanto mais tenso o retináculo lateral, maior a propensão do desenvolvimento de uma enfermidade na articulação patelofemoral. MÉTODOS: Foram dissecados 20 joelhos em 20 cadáveres. Identificamos as peças quanto ao gênero, idade, lado dissecado, comprimento e largura do LPFL e a largura da FAPL. Foi utilizado o nível de significância estatística de 5 por cento (0,050) e a aplicação da análise de correlação de Spearman. RESULTADOS: O LPFL apresentou em média 16,05 milímetros de largura (desvio-padrão 2,48) e 42,10 milímetros de comprimento (desvio-padrão 8,84). A largura da FAPL variou de 23 a 37 milímetros (média 28,1). A relação entre a largura da FAPL e a largura do LPFL é estatisticamente não-significante (p=0,271), enquanto que a relação entre a largura FAPL e o comprimento do LPFL é estatisticamente significante (p=0,009). CONCLUSÃO: O comprimento do LPFL e a largura FAPL apresentam valores inversamente proporcionais.

OBJECTIVE: The aim of this study, with cadavers, is to evaluate the relationship between the width and length of the lateral patellofemoral ligament (LPFL) and the size of the lateral patellar articulate facet (LPAF). Patellofemoral instability is closely related to patellar morphology and the lateral retinacular layers. Studies evidence that the wider the lateral patellar facet and the more strained the lateral retinacule, the greater the tendency for development of pathology in the patellofemoral joint. METHODS: 20 knees were dissected in 20 cadavers. The parts were identified according to gender, age, dissected side, length and width of LPFL and width of LPAF. In order to carry out the statistical analysis we adopted the significance level of 5 percent (0.050) and also used Spearman's Coefficient of Rank Correlation. RESULTS: The LPFL presented a mean width of 16.05 millimeters (standard deviation 2.48) and 42.10 millimeters of length (standard deviation 8.84). The width of the LPAF varied from 23 to 37 millimeters (mean 28.1). It was observed that the relationship between the LPAF and LPFL widths is not statistically significant (p=0.271), whereas the relationship between the LPAF width and the LPFL length is statistically significant (p=0.009). CONCLUSION: The shorter the LPFL the greater the width of the LPAF.

[Assessment of realationship between patellar index and anterior knee pain]

Anterior knee pain is one of the most common symptoms for referral reasons to orthopedic clinics specially knee clinic. This type of pain is one of the most common complaints in adolescents and adults, for various. The most common cause is patellar chondromalasia, but in many cases, no definitive cause is found through clinical examinations, paraclinic and imaging procedures. This type of pain has no detectable pathologic factor and is called anterior knee pain syndrome. The aim of this study was to access the relationship between the anterior knee pain and patellar index in patients who were referred to the orthopedic clinic. This case-control study was performed analytically on 44 patients that were selected randomly and were divided equally in two case and control groups. Patients in case group had anterior knee pain and patients in control group had come to the clinic for another reason. In all patients, lateral knee radiography was used to calculate patellar index. In this study, after analyzing the data, we found that there was no significant difference in age factor between the two groups. We found this syndrome to be common in female housekeepers, than in others group. Other notable findings showed there was no significant correlation between BMI and patellar index in females and males. Lastly, we found there is a significant difference regarding patellar index in case group. Presently, despite several studies regarding knee pains, many authors have no common agreement in this field. Many diseases were not detectable in the past and even their etiology was unknown, however, today we know their etiology and even their mechanism in detail. We now understand the pathologic factor of Anterior Knee Pain Syndrome and even its etiology for the future. In this study, we found the relationship between Patellat Index and Anterior Knee Pain Syndrome and a significant difference between the case and control groups

Relación entre la inclinación troclear femoral lateral y la condromalacia patelar evaluada con imágenes de resonancia magnética y artroscopia / Relationship between the inclination and lateral femoral trochlear chondromalacia patella evaluated with magnetic resonance imaging and arthroscopy

La condromalacia patelar está asociada a inestabilidad rotuliana. La inclinación troclear femoral lateral se ha vinculado a inestabilidad patelar, pero no se conoce su asociación con la condromalacia patelar. Se incluyeron 39 pacientes, ambos sexos, edades de 13-74 años, a quienes se realizó resonancia magnética y artroscopia de la rodilla. La sensibilidad y especificidad de la resonancia magnética para la condromalacia patelar fue 84 por ciento y 71,4 por ciento. El grado leve de condromalacia patelar afectó más a hombres y pacientes más jóvenes, mientras que los grados moderado y severo afectaron más al sexo femenino y pacientes de más edad. No hubo diferencias significativas entre los valores de inclinación troclear femoral lateral de los pacientes con y sin condromalacia patelar. Sin embargo, en la condromalacia patelar severa la inclinación troclear femoral lateral fue menor, particularmente en comparación a los casos moderados (17,6º vs. 21,8º, P=0,06). La inclinación troclear femoral lateral y la inestabilidad patelar podrían estar asociadas a condromalacia patelar severa, pudiendo condicionar progresión de la enfermedad

The patellar chondromalacia is associated to rotulian instability. The lateral femoral troclear inclination is linked to patellar inestabily; however, there are not studies about linking it to patellar chondromalacia. 39 patients of both genders were included; age range between 13-74 years, who underwent magnetic resonance and arthroscopy of the knee. The sensitivity and specificity of the magnetic resonance for patellar chondromalacia were 84 percent and 71.4 percent. Mild cases were more frequents in men and younger subjects. Moderate and severe grades were more frequents in the femenine gender and affect older patients. There were not significant differences between the values of lateral femoral troclear inclination of the patients with and without chondromalacia patellar. However, the lateral femoral troclear inclination was lower in the severe patellar chondromalacia, particularly in comparison to moderate cases (17.6º vs. 21.8º, P=0.06). The lateral femoral troclear inclination and patellar instability could be associated to severe patellar chondromalacia; They may be according the progression of the disease

Comparación de hallazgos quirúrgicos de lesiones meniscales con hallazgos imagenológicos de RMN tratados a través de cirugía artroscopica: en IVSS Hospital Dr. Juan Montezuma Ginnari durante el período 2003-2006 / Comparison of surgical findings of meniscal injuries with RMN imaging findings of treated through arthroscopic surgery: in IVSS Hospital Dr. Juan Montezuma Ginnari during the period 2003-2006

Los meniscos son estructuras indispensables para la función normal de la rodilla, su afectación puede ser degenerativa o traumática. Se realizó un estudio retrospectivo, descriptivo y analítico que reunió 69 pacientes con meniscopatía, tratados a trevés de la cirugía Atroscópica. Se encontró relación entre hallazgos imagenológicos y quirúrgicos en cuanto a la frecuencia de lesiones del lado derecho del menisco, siendo mayormente afectado el menisco medial con 61,40 por ciento por hallazgos quirúrgicos en comparación al 51,51 por ciento de frecuencia del menisco lateral según la Resonancia magnética.

Exercícios terapêuticos na prevenção da condromalácia patelofemoral em atletas / Therapeutic exercises at prevention of patellar chondromalacia in athletes

A patela tem como uma das funções, aumentar o braço de alavanca e o trabalho biomecânico do quadríceps. Alterações no alinhamento patelofemoral são fatores que propiciam mudanças na estrutura da cartilagem articular do joelho, levando a um quadro de condromalácia. A proposta deste artigo de revisão é investigar os efeitos da fisioterapia no monitoramento de praticantes de atividades físicas, visando à diminuição dos riscos de lesão na cartilagem articular do joelho; analisar os efeitos do trabalho de força muscular para prevenir ou diminuir o desgaste cartilaginoso; e enfatizar a fisioterapia preventiva no desempenho do atleta durante sua vida profissional.

The patella’s function is to increase the level arm and the biomechanical work of the quadriceps muscle. Alterations in the patellofemoral alignment are factors that provide changes in the knee articular cartilage structure, leading to a chondromalacia condition. The purpose of this literature review is to investigate the effect of physical therapy in the athlete’s preparation, aiming at reducing the risks of knee articular cartilage injury; to analyze the effect of muscle strength in order to prevent or decrease the articular cartilage and; to target the effect of preventive physical therapy in improving athletes’ performance during their professional life.

Avaliação quantitativa das forças laterais da patela: ressonância magnética estática e cinemática / Quantitative evaluation of lateral forces on the patella: static and kinematic magnetic resonance imaging

OBJETIVO: Avaliar a validade da ressonância magnética cinemática combinada com a ressonância magnética estática no estudo da articulação femoropatelar. MATERIAIS E MÉTODOS: Foram realizadas ressonância magnética estática e ressonância magnética cinemática em 20 voluntários assintomáticos (40 joelhos) e em 23 pacientes (43 joelhos), em aparelho de configuração fechada de 1,5 tesla de campo. Os indivíduos foram posicionados na extremidade da mesa, em 30° de flexão. A translação patelar foi avaliada medindo-se o desvio da bissetriz, o deslocamento lateral da patela e o ângulo de inclinação da patela. Para a comparação entre os estudos estático e cinemático, foi utilizado o teste não-paramétrico de Wilcoxon. Para a comparação entre os voluntários e os pacientes, foi utilizado o teste de Mann-Whitney. RESULTADOS: Houve diferenças significantes entre a ressonância magnética estática e a ressonância magnética cinemática (p < 0,05) nos três parâmetros utilizados. No grupo dos pacientes, as diferenças entre a ressonância magnética estática e a ressonância magnética cinemática foram maiores que nos voluntários a 20° e a 30° de flexão, com o desvio da bissetriz e com o deslocamento lateral da patela. CONCLUSÃO: A combinação da ressonância magnética estática e ressonância magnética cinemática evidenciou que a força resultante lateral é maior na faixa de 20° e 30° de flexão, especialmente nos indivíduos sintomáticos, para a instabilidade femoropatelar.

OBJECTIVE: To evaluate the usefulness of combining static and kinematic magnetic resonance imaging in the evaluation of the femoropatellar joint. MATERIALS AND METHODS: Twenty healthy volunteers (40 knees) and 23 patients (43 knees) were submitted to both static and kinematic magnetic resonance imaging on a 1.5 tesla whole-body magnetic resonance scanner. The knees were positioned at 30° flexion with the quadrature knee coil at the inner end of the examination table. The patellar translation was evaluated by measurements of bisect offset, lateral patellar displacement and patellar tilt angle. The nonparametric Wilcoxon test was utilized for statistical analysis of data resulting from the static and kinematic studies in both groups. Nonparametric Mann-Whitney test was utilized in the comparison between healthy volunteers and patients. RESULTS: Statistical analysis demonstrated significant differences (p < 0.05) between static and kinematic magnetic resonance imaging for the three parameters evaluated in both groups. Among the patients the differences between static and kinematic measurements were greater than those found in the volunteers, at 30° and 20° flexion, with bisect offset and lateral patellar displacement. CONCLUSION: Static and kinematic magnetic resonance imaging, when performed in association, demonstrated that the lateral forces being exerted on the patella are higher at a knee flexion at the range between 20° and 30°, particularly in individuals symptomatic for femoropatellar instability.

Condromalácia de patela: comparação entre os achados em aparelhos de RM de alto e baixo campo magnético / Chondromalacia patellae: comparison of high-field strength versus low-field strength magnetic resonance imaging findings

OBJETIVO: Comparar os aparelhos de ressonância magnética de baixo campo e de alto campo para estudo da cartilagem articular da patela. MATERIAIS E MÉTODOS: Foi realizado estudo usando as seqüências GRE 2D, GRE 3D, FSE T2 e STIR (baixo campo) e TSE T2 SPIR. Cada seqüência foi analisada separadamente para o estudo da cartilagem, sem o conhecimento dos dados do paciente e do resultado das outras seqüências, sendo atribuído grau de lesão de 0 a 3 e descrita a sua localização. Os resultados de concordância e discordância foram analisados pelos testes de Kappa e McNemar. RESULTADOS: Na faceta medial houve baixas concordâncias e as discordâncias mostraram significativa superestimação. Na faceta lateral houve boas concordâncias e as discordâncias não foram significativas. No ápice houve boas concordâncias e as discordâncias mostraram significativa subestimação. CONCLUSÃO: A seqüência STIR teve a melhor concordância com a seqüência TSE T2 SPIR. Lesões de alto grau são mais bem caracterizadas pelas seqüências do aparelho de baixo campo. Areas de aumento de sinal dificultam o estudo da cartilagem da faceta medial da patela no aparelho de baixo campo.

OBJECTIVE: To compare the performance of low-field-strength and high-field-strength magnetic resonance imaging equipments for evaluation of the patella articular cartilage. MATERIALS AND METHODS: The study was developed using GRE 2D, GRE 3D, FSE T2, STIR sequences (low-field) and TSE T2 SPIR sequence. Each sequence has been separately analyzed for evaluation of the cartilage without knowledge of other sequences results or any patients data; the lesion was assigned a grade from 0 to 3 and had its location defined. Agreement and disagreement results were analyzed by Kappa and McNemar tests. RESULTS: Medial facet has presented low agreement index and disagreements showed to be significantly overestimated. Lateral facet has presented a reasonable agreement index and disagreement index was not significant. Medial ridge has presented a reasonable agreement index and disagreement index has showed to be underestimated. CONCLUSION: The STIR sequence versus TSE T2 SPIR sequence has presented the higher agreement index. High grade lesions are better characterized by low-field-strength magnetic resonance imaging equipment sequences. Areas of increased signal intensity make difficult the study of the patella medial facet cartilage in low-field-strength equipment.

Ressonância magnética no diagnóstico da condromalácia de patela: [revisão] / Use of magnetic resonance imaging in the diagnosis of chondromalacia patella: [revision]

As lesões da cartilagem articular da patela são bastante comuns, e em virtude da dissociação entre os sintomas e sinais e o estágio das lesões condrais o exame de escolha inicial é a ressonância magnética, sendo importante para o radiologista estar habituado às alterações condrais nesta doença para o correto diagnóstico.

Patellar articular cartilage lesions are very common and due to the dissociation between signs and symptoms and the stage of the chondral lesions the diagnostic method of choice is magnetic resonance imaging. Therefore, radiologists shold be familiar with chondral abnormalities in order to correctly diagnose this condition.

Preliminary study on treating patellar instability guided by arthroscopy / 中南大学学报(医学版)

OBJECTIVE@#To explore the operation method in treating patellar instability guided by arthroscopy and to evaluate its therapeutic effects.@*METHODS@#Thirty-two patients (34 knees) with patellar instability including 2 patellar tilt (2 knees), 26 (27 knees) patellar subluxation, and 4 (5 knees) patellar dislocation, diagnosed by clinical and arthroscopical standard, were treated with anterior transfer of the gracilis or medial transfer of the tibial tuberosity based on the lateral retinacular release and medial tightening.@*RESULTS@#Twenty-eight patients were followed up for 5-87 (mean 36.6) months. The excellence rates was 92.8%.@*CONCLUSION@#The patellofemoral alignment can be seen directly and dynamically under the arthroscopy. The combinational treatment including anterior transfer of the gracilis in repairing patellar instability can avoid the recurrence effectively and get satisfactory results.

Avaliação do ângulo de congruência da patela em pacientes com diagnóstico de condromalácea / Evaluation of knee congruence angle in patients with chondromalacia

O joelho é uma articulação sujeita a um maior número de patologias de origem mecânica, das quais mais comuns são femoropatelares, dentre elas a condromálacea. A condromalácea patelar é definida como o amolecimeto da cartilagem articular da patela por desgastes de origem diversas. O desgaste cartilaginoso produzido pelo desgaste diário afeta secundariamente as superfícies cartilaginosas e sinovial na articulação do joelho, produzindo alterações osteoartríticas disseminadas. O ângulo de congruência é um bom indicador para mensurar o alinhamento patelar. Em estudos realizados o valor normal da congruência é de -6º com o joelho em 45º. Esse estudo objetivou avaliar o ângulo de congruência da patela de pacientes com diagnóstico de condromalácea com os achados na bibliografia. Os valores que encontramos sugerem a existência de aumento do ângulo de congruência e mau alinhamento patelar associados à patologia.

The knee is a joint that commonly presents pathologies from mechanical origins. One of the most common is the patellofemoral syndrome, among them the chondromalacia. The chondromalacia is defined as a patellar articular cartilage softening due to diverse origins. The cartilage lesions produced by the daily activity, secondary affects the cartilage and synovial surfaces in the knee joint, and spread osteoartritic alterations. The congruence angle is a good pointer to measure the patellar alignment. In several studies the normal value of the congruence is of -6º, with the knee in 45º. The objective of this study was to compare the patellar congruence angle in patients with diagnosis of chondromalacia in the literature. The values that we found suggest the existence of an increase in the congruence angle and bad patellar alignment associated with the pathology.