Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study

Abstract BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

Isokinetic muscle strength of knee for patients with chondromalacia patellae / 中国康复理论与实践

@#Objective To analyze the characteristics of the muscle strength around the knee joint of chondromalacia patellae patients, and to explore the difference with normal people.Methods In March, 2021, 70 knee-onset chondromalacia patellae patients (experimental group) and 35 normal people (control group) were measured isokinetic muscle strength of flexion and extension of knee in angular velocities of 60°/s and 180°/s.Results At 60°/s and 180°/s, the peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles on the affected side in the experimental group were lower than that of the control group (U > 1097.0, P<0.001). The peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles at 60°/s and extensor muscles at 180°/s were lower on the affected side than on the healthy side in the experimental group (|Z| > 2.121, P<0.05). The peak torque ratios at 60°/s and 180°/s were more in the affected knees than in the healthy knees of experimental group and in the control group (U > 1810.0, |Z| >3.691, P<0.01).Conclusion The explosive force and endurance of the knee flexor and extensor has weakened in patients with chondromalacia patellae, and there is imbalance in knee joint muscle strength.

Therapeutic effect of two muscle strengthening programs in patients with patellofemoral pain syndrome. A randomized controlled clinical trial / Efecto terapéutico de dos programas de fortalecimiento muscular en pacientes con síndrome de dolor pátelofemoral. Ensayo clínico controlado aleatorizado

Abstract Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients. ClinicalTrials.gov Identifier: NCT04011436

Resumen Introducción. El síndrome de dolor pátelofemoral (SPF) es una de las alteraciones musculoesqueléticas más frecuentes que afectan la articulación de la rodilla. El tratamiento conservador reduce el dolor y mejora la capacidad funcional en el corto y mediano plazo. Objetivo. Establecer el efecto terapéutico de dos programas de ejercicios de fortalecimiento muscular en pacientes con SPF de Bogotá, Colombia, con edades entre 15 y 40 años. Materiales y métodos. Ensayo clínico controlado aleatorio experimental realizado en 40 pacientes con SPF de Bogotá, Colombia, con edades entre los 15 y 40 años, con nivel de actividad física leve a moderada y que fueron distribuidos de forma aleatoria en 2 grupos de intervención: Grupo A: programa de ejercicios de fortalecimiento de los músculos del core, la cadera y la rodilla con una duración de 8 semanas; Grupo B: programa de ejercicios de fortalecimiento de los músculos de la cadera y la rodilla con la misma duración. El nivel de dolor se midió a través de la Escala Visual Analógica y de la Escala de Kujala para dolor patelofemoral. Resultados. La adición de ejercicios de fortalecimiento de los músculos del core al tratamiento tradicional mejoró la calidad de vida de los participantes en el grupo de intervención A, donde se observó una reducción significativa del dolor con una diferencia estadísticamente significativa en la puntuación total de la escala Kujala (p=0.025). Conclusiones. Incluir ejercicios de fortalecimiento de los músculos del core al manejo conservador del SPF aumenta su efectividad para reducir el dolor y mejorar la calidad de vida de estos pacientes. ClinicalTrials.gov Identifier: NCT04011436

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.

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for chondromalacia patellae / 针灸推拿医学（英文版）

Objective: To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid. Methods: Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group, with 34 cases in each group. The control group was treated with intra-articular injection of sodium hyaluronate, while the observation group was given additional warm needling moxibustion treatment. Before and after treatment, the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analog scale (VAS), examined by magnetic resonance imaging (MRI) and determined for the levels of nuclear factor-κB (NF-κB), tumor necrosis factor (TNF)-α and interleukin (IL)-1β in knee joint fluid. Clinical efficacy was estimated after treatment. Results: The effective rate was higher in the observation group than in the control group (P<0.05). After treatment, the scores of pain, stiffness and daily activities, as well as the general score of WOMAC declined significantly in both groups (all P<0.05), and were lower in the observation group than in the control group (all P<0.05); the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups (all P<0.05), and were shorter or lower in the observation group than in the control group (both P<0.05); the MRI grading showed no significant change in the control group after intervention (P>0.05), while the grading in the observation group showed notable improvement (P<0.05), and was better than that in the control group (P<0.05); the levels of NF-κB and IL-1β in knee joint fluid dropped significantly in the control group after treatment (both P<0.05), while the levels of NF-κB, TNF-α and IL-1β in knee joint fluid all decreased significantly in the observation group (all P<0.05) and were lower than those in the control group (all P<0.05). Conclusion: Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae; it can mitigate the clinical symptoms, improve the lesion extent of chondromalacia and down-regulate the levels of NF-κB, TNF-α and IL-1β in knee joint fluid.

Prevalence of patellar chondropathy on 3.0 T magnetic resonance imaging / Prevalência de condropatia patelar na ressonância magnética de 3,0 T

Abstract Objective: To establish the prevalence of patellar chondropathy using 3T magnetic resonance imaging (MRI) and to correlate the findings with individual features such as gender, age, and body mass index. Materials and Methods: Data consisted of collecting 3T MRIs of patients' knees obtained between October 2016 and September 2017, comprising a period of 12 months. These MRIs were assessed by an experienced musculoskeletal radiologist who confirmed the presence of patellar chondropathy and, when present, rated the finding into the four grades ascribed by the International Cartilage Repair Society. Results: A total number of 291 patients were assessed during the period with 389 MRI scans. Of those patients, 308 (79.2%) were diagnosed with patellar chondropathy, while 81 (20.8%) were not. Chondropathy was more prevalent in the female gender, in subjects above 40 years of age, and in obese patients. When the results were weighed in International Cartilage Repair Society classification, the milder grades (1 and 2) were seen in younger men (< 30 years of age), while the more severe grades (3 and 4) were mostly present in females, those above 40 years of age, and in obese patients. Conclusion: There was a high prevalence of patellar chondropathy in patients who had undergone high-field knee MRIs (79.2%), being highest in the female gender and in subjects above 40 years of age. The most prevalent group was graded as 4 by the International Cartilage Repair Society classification.

Resumo Objetivo: Estabelecer a prevalência de condropatia patelar em exames de ressonância magnética (RM) em campo de 3,0 T e associar os achados com características como gênero, idade e índice de massa corporal. Materiais e Métodos: Foram coletados exames de RM de joelho em campo magnético de 3.0 T no período de outubro de 2016 a setembro de 2017. Os exames foram analisados por radiologista com experiência em radiologia musculoesquelética, que verificou a presença de condropatia patelar e a classificou entre os quatro graus, de acordo com a classificação da International Cartilage Repair Society. Resultados: Foram avaliados 291 pacientes, com a realização de 389 exames de RM. Destes exames, 308 (79,2%) apresentavam condropatia patelar e apenas 81 (20,8%) não a apresentavam. A doença foi vista mais frequentemente nas mulheres, em indivíduos acima de 40 anos e em obesos. Quando classificada por graus, os mais leves (graus 1 e 2) foram mais observados em homens e jovens (< 30 anos) e os mais severos (graus 3 e 4) no sexo feminino, nos acima de 40 anos e nos obesos. Conclusão: A prevalência de condropatia patelar nos pacientes que realizaram RM foi elevada (79,2%), sendo maior no sexo feminino e nos indivíduos acima de 40 anos. Dentro da classificação da International Cartilage Repair Society, o grupo mais prevalente foi o grau 4.

A study on anterior cruciate ligament injury and knee stability with a silicon mesh brace / 中国组织工程研究

BACKGROUND: Knee braces have been shown to improve knee mechanics in the case of slow walking, but most studies lack the data regarding the effects of a brace on knee injury in the case of lack of movement. OBJECTIVE: Jumping, emergency stop, rotation which easily induce knee joint injury during the rapid exercise were simulated to investigate whether silicon mesh braces can provide stable support for the knee joint and provide data support for the protection against anterior cruciate ligament injury. METHODS: Twelve healthy subjects were selected to perform three movements: Squatting, one-leg jump and steering jump respectively with and without a brace. Reflection markers were placed on the feet, calves, thighs, and pelvis of the subjects. A Qualisys motion capture system was used to obtain kinematic data of the knee joints. Knee joint motion was compared between with and without a brace. This study was performed by Medical Ethics Committee of Guizhou College of Traditional Chinese Medicine on August 8, 2018 (approval No. 2018661). RESULTS AND CONCLUSION: There were significant differences in the angle and angular velocity of the knee joint among sagittal plane, coronal plane, and horizontal plane. The knee joint valgus and internal rotation angle were reduced when wearing a brace in particular in one-leg jump and steering jump. The angular velocity of horizontal surface rotation also decreased obviously when wearing a brace. These findings suggest that wearing a brace can affect the motion mechanics of the knee joint in the coronal and horizontal planes. This suggests that knee joint can effectively control the stability when wearing a brace in the process of dynamic movement, and wearing a brace can improve the control of knee peak valgus angular velocity and external rotation angular velocity, which can help effectively prevent anterior cruciate ligament injury of patients with anterior cruciate ligament defects.

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.

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.

Abordagens fisioterapêuticas na síndrome da dor patelofemoral: revisão de literatura / Physiotherapeutic approaches in patellofemoral pain syndrome: literature review

Introdução: Síndrome da dor patelofemoral (SDPF) é um termo comumente usado para descrever dor anterior de joelho, com gênese devido a diversos fatores, sendo agravada em movimentos de subir e descer escadas, permanecer sentado por muito tempo. Objetivo: Revisar na literatura as abordagens fisioterapêuticas utilizadas no tratamento da síndrome da dor femoropatelar, ressaltando os mais recentes protocolos de tratamento, analisar os efeitos dessas técnicas à patologia, avaliar e discutir a viabilidade desses tratamentos. Métodos: Realizou-se uma busca na literatura, nas bases de dados Lilacs, Medline e PubMed, utilizando palavras-chave dos Descritores em Ciências da Saúde (DECS), nos idiomas português, inglês e espanhol. Para a seleção dos artigos, foi usada a escala metodológica de Jadad. Resultados: Foram selecionados 12 estudos, incluindo 930 pacientes em diversos protocolos de tratamento da patologia estudada. Conclusão: Identificaram-se estudos com novos tratamentos para dor femoropatelar, aumentando, assim, a gama de protocolos para essa doença.

Introduction: Patellofemoral Pain Syndrome is a term commonly used to describe anterior knee pain – arising due to several factors – and is aggravated on moving up and down stairs or sitting for long period of time. Objective: To review in the literature physiotherapy resources used in the treatment of patellofemoral pain syndrome, highlighting the newest treatment protocols, analyzing the effect of these resources to pathology, evaluate and discuss the feasibility of such treatments. Methods: A literature search was performed in Lilacs, Medline and PubMed databases using MeSH keywords – Health Sciences Descriptors in Portuguese, English and Spanish languages. For the selection of articles was used methodological Jadad scale. Results: Twelve studies were selected including, 930 patients undergoing various treatment protocols for the pathology under study. Conclusion: Studies of new treatments for patellofemoral pain were identified, thus increasing the range of the protocols for this disease.

Osteochondral Lesion of Humeral Head Associated with Shoulder Internal Impingement: Report of Three Cases / 대한스포츠의학회지

Internal impingement syndrome is characterized by the posterior shoulder pain when the arm is abducted and external rotated, and articular partial rotator cuff tear with posterosuperior labral fraying in throwing athletes. Osteochondral lesion of humeral head as an associated lesion is reported in some cases but, not considered to be a main origin of the symptoms. We found the similar features of osteochondral lesion on humeral head in three cases of internal impingement syndrome irrespective of conservative treatment for over three months and report good results obtained from arthroscopic debridement and microfracturing for these lesions with a review of the literatures.

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.

Inibição muscular dos extensores do joelho em sujeitos acometidos por condromalácia patelar e osteoartrite do joelho - um estudo de revisão sistemática / Knee extensor muscle inhibition in subjects with chondromalacia patellae and knee osteoarthritis - a systematic review

A inibição muscular (IM) tem sido reportada como um dos fatores associados à fraqueza muscular presente na osteoartrite (OA) e condromalácia patelar (CP), sendo inclusive associada com a etiologia e a progressão. Entretanto, parece existir uma lacuna na literatura em relação a estudos de revisão que avaliaram o grau de IM de sujeitos acometidos por CP e OA. O objetivo do estudo foi reunir os resultados de estudos que investigaram o grau de IM na OA e CP e identificar possíveis diferenças na IM que estejam associadas aos estágios do processo degenerativo. Foram incluídos nesta revisão sistemática estudos transversais e/ou experimentais publicados nas bases de dados PubMed, Scopus, SciELO e Cochrane entre 1990 e 2010 que avaliaram a IM por meio da técnica de interpolação de abalo publicados. Os dados referentes à população, protocolo de IM, qualidade dos estudos e resultados de IM foram sumariados e apresentados em Tabelas. Para análise da qualidade, utilizou-se a escala de PEDro. Após a aplicação dos critérios de inclusão, 13 artigos foram incluídos na revisão sistemática (OA=9 e CP=4). A partir da análise dos dados, observou-se uma IM maior na CP em comparação à OA. Contudo, a variabilidade metodológica e a falta de informações sobre os protocolos de IM indicam a necessidade de novos estudos experimentais a fim de que se possa determinar com maior precisão a relação entre a IM e as doenças degenerativas articulares.

Muscle inhibition (MI) has been reported as one of the factors associated with muscle weakness present in osteoarthritis (OA) and chondromalacia patellae (CP), including being associated with the etiology and progression. However, there seems to be a gap in the literature regarding the review studies that assessed the degree of IM subjects affected by CP and OA. The main objective of study was bringing together the results of studies that investigated the degree of OA in the MI and CP and to identify possible differences in IM which are linked to stages of the degenerative process. We included cross-sectional and/or experimental studies published in the databases PubMed, Scopus, SciELO and Cochrane between 1990 and 2010 that evaluated the MI through interpolation twitch techniques. Data on population characteristics, MI protocol, quality of studies and MI results were summarized and presented in Tables. For quality analysis, it was used the scale PEDro. After applying the inclusion criteria, 13 articles were included in the systematic review (OA=9 and CP=4). Based on the analysis of the data, there MI>CP compared to OA. However, the variability of protocols, as well as the lack of information about the IM protocols, indicates the need for further experimental studies in order that we can determine more precisely the relationship between IM and degenerative joint diseases.

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.

Mid-long term efficacy of osteo-periosteal turned over orthotopically for chondromalacia patellae / 中华骨科杂志

ObjectiveTo investigate the method of osteo-periosteal turned over orthotopically for treating chondromalacia patellae disease and observe the mid-long term efficacy postoperatively.Methods From April 1996 to June 2000,21 patients with chondromalacia patellae were treated in our hospital.Amone them,13 cases were performed osteo-periosteal turned over orthotopically,including 3 males,10 females; with the mean age of 59 years(range,47-65 years).HSS and Lysholm knee rating scale were employed to analysis the results.ResultsThe patients were followed up from 114 to 162 months(mean,133.2 months).One of the patients lost follow-up due to death.Before operation the HSS knee score was 20-58 (34.2±3.8),and 1 year,3 year,5 year,7 year,and 9 year after operation the HSS knee score were 55-70(60.0±7.0),55-82 (64.1±5.9),60-90 (70.1±3.2),50-85 (63.1±4.1),and 50-75 (57.3±2.9) respectively.And Lysholm knee rating scale also showed similar results.The chondromalacia patellae patients before and after operation were significant different.Bone periosteum transplant tissue and surrounding defective tissue healed perfectly,functions recovered perfectly.ConclusionThe method of osteo-periosteal turned over orthotopically has the capabilities to form cartilage.The therapeutic effect and facies articularis patellar is satisfactory.But it only can restore articular cartilage of patellar and does not help for genual malformation.

The MRI study of correlation between patella location and chondromalacia / 中华放射学杂志

ObjectiveTo discuss the relationship between patella location and chondromalacia patella,explore its mechanism and clinical significance.Methods Knee joint MRI was performed in 1052 patients (506 men and 546 female).Among them,there were 299 patients( 100 men and 199 female)with chondromalacia patella.They were divide into the group of 1-19,the group of 20-39,the group of 40-59 years old and the group of older than 60 years to compute the positive rate respectively.Insall-Salvati method was used to measure the length of chondromalacia ligaments(L) and the length of chondromalacia path(P).The relationship between patella location and chondromalacia was tested by using t test and x2 test.ResultsThe total positive rate of chondromalacia patella was 28.4％ (299/1052).In female it was 36.4％ (199/546) and in men was 19.8％ (100/506).The group of 1-19 years old had 16 patients ( 16.8％,16/95).The group of 20-39 years old had 71 patients( 17.9％,71/396).The group of 40-59 years old had 116 patients ( 33.2％,116/349 ).The group of older than 60 years had 96 patients (45.3％,96/212).The positive rate of chondromalacia patella increased with age.The L/P value of normal group and chondromalacia patella group were 1.15 ±0.15 and 1.24 ±0.17 respectively.The L/P value of normal group of men and women were 1.13 ± 0.15 and 1.17 ± 0.14 respectively.The L/P value of chondromalacia patella group of men and women were 1.20 ±0.17 and 1.26 ±0.16 respectively.The InsallSalvati index of age groups showed significant differences.The L/P value of pathological changes group and normal group of 1-19 years old were 1.38 ± 0.25 and 1.24 ± 0.16 respectively.The L/P value of pathological changes group and normal group of 20-39 years old were 1.24 ± 0.17 and 1.15 ± 0.16 respectively.The L/P value of pathological changes group and normal group of 40-59 years old were 1.24 ±0.16 and 1.12 ±0.12 respectively.The L/p value of pathological changes group and normal group of older than 60 years were 1.21 ±0.16 and 1.12 ±0.12 respectively.All of them had significant differences (P ＜ 0.01 ).ConclusionsThe positive rate of chondromalacia patella for female is higher than that for men,which also increases with age.High patella location is relevant to chondromalacia patella.

Arthroscopy-assisted minimally invasive treatment of chondromalacia patella / 中国医师杂志

Objective To study the arthroscopy-assisted minimally invasive treatment of chondromalacia patella. Methods The clinical data of 140 patients with chondromalacia patella, with a mean age of 51.9 ± 5.71 years ( range, 41 to 62 years), undergoing surgical or Non-surgical treatment in our hospital from June 2005 to December 2008 were analyzed. In non-surgical group, 72 cases (96 knees) underwent intra-articular injection of sodium hyaluronate and other non-surgical treatment. In surgical group, 68 cases (84 knees) underwent variorus Arthroscopy-Assisted minimally invasive surgery, according to the extent of the patella cartilage injury and the situation of the patellofemoral joint. Joint functional exercise were carried out after operations. Regular follow-up were done after leaving hospital. Lysholm scoring system was used to evaluate the clinical effects. Judet's evaluation criteria was used to evaluate the improvement of range of motion. Results In non-surgical group, the knee function have been improved 24. 82%. In surgical group the knee function have been improved 35.37%. At the postoperative and final follow-up, the effect in surgery group was significantly better than non-surgical group. Conclusion For the chondromalacia patella with Ⅱ, Ⅲ class cartilage injury, minimally invasive arthroscopic surgery is a good treatment method, which can reduce pain, improve function, slow down the progress of the disease, and improve the quality of life of patients.

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.

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