Clinical observation of acupuncture combined with sitting-position knee-adjustment manipulations for patellofemoral arthritis / 针灸推拿医学（英文版）

Objective: To observe the efficacy of acupuncture combined with sitting-position knee-adjustment manipulations in treating patellofemoral osteoarthritis. Methods: Ninety-two patients with patellofemoral osteoarthritis were randomized into an observation group and a medication group, with 46 cases in each group. The observation group received acupuncture and sitting-position knee-adjustment manipulations, and the medication group received oral celecoxib capsules. After 8-week treatment, changes in the short-form McGill pain questionnaire (SF-MPQ) and Lysholm knee scoring scale (LKSS) scores were observed, and the clinical efficacy was compared.Results: The total effective rate was 87.0％ in the observation group and 63.0％ in the control group; the between- group difference was statistically significant. Before treatment, there were no significant differences in the SF-MPQ score or LKSS score (P>0.05). After 8-week treatment, the SF-MPQ [including pain rating index (PRI), visual analog scale (VAS), and present pain intensity (PPI)] and LKSS scores showed notable changes in both groups (P<0.05); the SF-MPQ and LKSS scores in the observation group were significantly different from those in the control group (P<0.05).Conclusion: Combining acupuncture and sitting-position knee-adjustment manipulations can reduce pain and ameliorate joint function in patients with patellofemoral osteoarthritis, producing more significant efficacy than oral celecoxib capsules.

Severity of patellofemoral osteoarthritis does not affect the prognosis of total knee arthroplasty with patella retention / 中国组织工程研究

BACKGROUND: There is no uniform standard on whether the patella is replaced in total knee arthroplasty. There are many control studies on patella replacement versus non-replacement, but few studies compare the prognosis of non-replacement patella according to the severity grade of patellofemoral arthritis. OBJECTIVE: To compare the effects of patellofemoral arthritis on prognosis of total knee arthroplasty with patella retention according to the severity of patellofemoral arthritis, METHODS: One hundred and ninety-two cases of total knee arthroplasty who received patella retention with Depuy Synthes prosthesis in the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2017 were retrospectively analyzed, and the follow-up time was more than 2 years. According to the Lwano classification system, the imaging severity of patellofemoral arthritis was graded into mild group (0-I period, n-83) and severe group (phase II—IV, n=109). All patients signed the informed consents and the study was approved by the hospital ethics committee. Clinical prognosis was assessed by Knee Society Score, functional score, Feller score and anterior knee pain score. The imaging prognosis was assessed by patella tilt angle, fit angle, patella displacement distance and patellar ligament ratio. The statistical method of t test was used to analyze the clinical and imaging results before and after surgery. RESULTS AND CONCLUSION: (1) One patient had persistent anterior knee pain, and one patient had wound effusion and secondary healing after debridement. The remaining patients achieved first-stage healing. (2) There were significant differences in the preoperative functional scores and Knee Society Score between mild and severe groups (P 0.05). (3) There was a significant difference between two groups in the patella tilt angle, fit angle and patella displacement distance before surgery (P 0.05). (4) In summary, after at least 2 years of follow-up, the severity of patellofemoral arthritis makes no effect on the clinical and imaging prognosis of patients undergoing total knee arthroplasty with patella retention. Even in patients with severe patellofemoral arthritis, a good prognosis is obtained after total knee arthroplasty with patella retention.

Research progress about influence of patellofemoral osteoarthritis on effectiveness of unicompartmental knee arthroplasty / 中国修复重建外科杂志

Objective: To summarize the current research progress about influence of patellofemoral osteoarthritis on clinical outcome of unicompartmental knee arthroplasty (UKA). Methods: The recent related literature was extensively reviewed and summarized, including pros and cons to regard the patellofemoral osteoarthritis as the contraindication. Results: Previous studies regarded patellofemoral osteoarthritis as the contraindication of UKA. Most of current researches show that the damage to the articular cartilage of the patellofemoral joint to the extent of full-thickness cartilage loss has no influence on outcome of UKA. There is no correlation between preoperative anterior knee pain or medial patellofemoral joint degeneration and the clinical outcome. However, lateral subluxation of the patella has an adverse impact on postoperative curative effect. Degeneration of the lateral patellofemoral joint may be a risk factor of the outcome. Conclusion: Patellofemoral osteoarthritis should not be the absolute contraindication of UKA. The effect of degeneration of the lateral patellofemoral joint is not clear at present, and still needs further studies in the future.

Prevalence and Predictors of Patellofemoral Osteoarthritis after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft

BACKGROUND: The present study aimed to evaluate the prevalence of patellofemoral osteoarthritis (PFOA) and identify the factors that affect PFOA development after single-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. We hypothesized that detecting these factors could be helpful in establishment of a rehabilitation strategy to focus on the modifiable factors. METHODS: Of the 324 patients who underwent primary ACL reconstruction between January 2010 and June 2013, 92 patients who were available for follow-up for a minimum of 36 months after the surgery and underwent second-look arthroscopy were enrolled. Subjective assessments and clinical outcome evaluation were conducted. Arthroscopic cartilage evaluation was done using the Outerbridge classification. Univariable and multivariable logistic regression analyses were used. RESULTS: Ninety-two patients were evaluated at an average of 38.9 ± 5.4 months of follow-up. PFOA above grade 2 was observed in 19 patients (20.7%) at the second-look arthroscopy. Of them, three patients with pre-existing PFOA (3.3%) showed progression of the Outerbridge grade, and 16 (17.4%) had newly developed PFOA. According to the multivariable logistic regression analysis, isokinetic extensor deficit at 60°/sec at the last follow-up (odds ratio [OR], 2.193; 95% confidence interval [CI], 1.081 to 12.439; p = 0.031), age at primary surgery (OR, 1.118; 95% CI, 1.019 to 1.227; p = 0.018), and concurrent meniscectomy at primary surgery (OR, 0.091; 95% CI, 1.012 to 1.177; p = 0.023) were the significant predictors of PFOA development. CONCLUSIONS: Significant predictors of PFOA after ACL reconstruction with hamstring autograft were decreased quadriceps strength at last follow-up, increased age, and concurrent meniscectomy at primary surgery. Quadriceps weakness as a modifiable factor should be considered in the establishment of a rehabilitation strategy to prevent PFOA after ACL reconstruction, especially in older age.

Manipulation Treatment Strategy of Patellofemoral Osteoarthritis Based on Stability of Patella / 中国中医药信息杂志

Patellofemoral arthritis is a clinical common type of knee osteoarthritis distinguished by its pain and anatomical position. The stability of patella is crucial to the stability of the patellofemoral joint and is related to the occurrence and development of osteoarthritis. Patella stability depends on the structural geometry of patellofemoral condyle, the static mechanics of the surrounding joint capsule, tendon, fascia, ligament and patellar ligament and the dynamic mechanics of the quadriceps. Therefore, manipulation therapy should be based on the considerations on the stability of the patella as well as TCM theory. Starting from maintaining the balance of the dynamic and static mechanical system and focusing on the restoration of the stability of patella, the ultimate goal of the treatment is to restore the stability of patellofemoral joint. The main aspects of manipulation treatment strategy include the balancing of dynamic and static mechanical system, the idea of holism treatment, differentiation treatment based on tendons injury identification, fundamental principle of softening tendons, cooperation between doctors and patients, and combination of therapy and convalesce.

Clinical Effect of Arthroscopic Circumpatellar Denervation in Anterior Knee Pain of Patellofemoral Osteoarthritis and its Correlation with Cartilage Degeneration / 医学研究杂志

Objective To explore clinical effect of arthroscopic circumpatellar denervation in anterior knee pain of patellofemoral osteoarthritis and its correlation with cartilage degeneration.Methods Totally 104 patients with anterior knee pain of patellofemoral osteoarthritis were randomly divided into two groups.Patients in control group(n =52) were treated with arthroscopic debridement,and those in combined group(n =52) were treated with arthroscopic debridement plus circumpatellar denervation.All the patients were followed-up for 6 months.The WOMAC scores,knee function recovery were compared between two groups,and the changes of WOMAC score among different degrees of cartilage degeneration were analyzed.Results The WOMAC score of pain,morning stiffness and joint function were significantly improved in combined group than those in control group at 6 months after surgery(P ＜ 0.05).At 6 months after surgery,the score of range of activity and walking distance in both groups were all increased,and combined group had more remarkable increase than that of control group(P ＜ 0.05).Compared with before surgery,the total WOMAC score in patients with grade Ⅰ-m at 6 months after surgery significantly decreased (P ＜ 0.05),while there was no significant difference in patients with grade Ⅳ level between before surgery and 6 months after surgery (P ＞ 0.05).Conclusion Arthroscopic debridement plus circumpatellar denervation for anterior knee pain of patellofemoral osteoarthritis can effectively relieve pain symptom,promote the recovery of knee joint function,especially suitable for patients with cartilage degeneration of Ⅰ ～ Ⅲ.

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)

Nondrug noninvasive treatment in the management of patellofemoral osteoarthritis.

Background: Patellofemoral osteoarthritis is a chronic joint disease affecting one-third of elderly people. The disease impacts upon activities of daily living (e.g. walking, stair-climbing, and housekeeping), ultimately leading to a loss of functional independence and quality of life. Purpose: The main purpose of this study was to assess the results of nondrug noninvasive treatment in the management of patellofemoral osteoarthritis. Materials and Methods: This study was conducted in the department of Orthopaedics in M. M. Medical College, Mullana, Ambala, Haryana, India from June 2005 to June 2010. Two hundred fifty-one out patients of patellofemoral arthritis with a mean age of 45 years were studied. They were managed with noninvasive treatment and were followed for 24 months. Results: At 30 to 40 years of age it was good to excellent, respectively. More than 40 years it was good. The patients global evaluation of condition were found very good up to the age of 30 years at 2 years of follow up, good to very good between 30 to 40 years, respectively, and over the age of 40 years it was good. Conclusion: Nondrug noninvasive interventions can reduce pain and improve function in patellofemoral osteoarthritis.

Intra-Osseous Venography in Patellofemoral Disorders: Clinical Significance / 대한정형외과학회잡지

We performed intra-osseous venography in 16 patients with chondromalacia patellae or patellofemoral osteoarthritis. Of 16 patients, eight patients had chondromalacia patellae and 6 patellofemoral osteoarthritis. Two patients with normal patellae who underwent meniscectomy were used as controls. The results obtained were as follows: 1. Dye congested in the normal patella was disappeared within 2 minutes after injection and extra-osseous drainage pattern disappeared within 1 minute. 2. in chondromaiacia patellae, large amount of dye was spread throughout the entire patella and remained till 10 minutes, while extra-osseous drainage pattern disappeared at about 5 minutes. 3. In patellefemoral osteoarthritis, venous engorgment in patella was similar to that of chondromalacia patellae and extra-osseous drainage pattern disappeared at about 10 minutes. Conclusively, authors thought the patella I.O.V. was one of the significant clinical methods to define the etiological factors of the various patellofemoral disorders such as patellofemoral osteoarthritis and chondromalacia patellae.