Role of magnetic resonance imaging evaluation of anterior knee pain

Background: the term "anterior knee pain" is often used interchangeably with "Patellofemoral pain syndrome PFPS" or "runner's knee". PFPS can be defined as anterior knee pain involving the patella and retinaculum

Aim of the Work: to highlight the role of magnetic resonance imaging [MRI] in the diagnosis and grading of the most common causes of anterior knee pain

Patients and Methods: this study included fifty patients, their ages range between 10-60 years [average age 27 years]. All presented with anterior knee pain [AKP] and were referred to the Radiology Department of El-Demerdash Hospital for MRI examination after orthopedic consultation

Results: the role of MRI in the diagnosis and grading of the most common causes of anterior knee pain have been shown in this study. These causes have been classified in to five disease categories; Patellar abnormalities represented most of them [64% of the sample size] and they included chondromalacia patella, patellar instability, transient patellar dislocation and painful bipartite patella. Hoffa's diseases represented 12% of the sample size and they included Hoffa impingement syndrome and Hoffa fibrotic bands. Patellar tendon disorders represented 6 % of the sample size and they included Patellar Tendinopathy and Osgood Schlatter Disease. Quadriceps tendon disorders represented 4% of the sample size and they included Quadriceps Tendinopathy. Other causes represented 14% of the sample size and they included torn anterior horn of the lateral meniscus and cartilage injuries

Conclusion: many factors may cause anterior knee pain. MRI is generally safe, non-ionizing, non-invasive and valuable imaging technique which has been proven to be the modality of choice for establishing an accurate diagnosis of different knee pathologies that cause anterior knee pain in different age groups. It also allows to know the extent, severity, grades and types of the lesions, what will be necessary to decide appropriate treatment

Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work

Radiofrecuencia pulsada para el tratamiento del síndrome de dolor patelofemoral postraumático / Pulsed radiofrequency for treatment of post-traumatic patellofemoral pain syndrome

El síndrome de dolor patelofemoral puede ser definido como dolor retropatelar o peripatelar resultante de cambios físicos y bioquímicos en la articulación patelofemoral. En ortopedia, las causas más comunes serían el sobreuso, el mal alineamiento patelofemoral y el trauma. Presentamos un caso del uso de radiofrecuencia pulsada selectiva de los nervios patelares, medial y lateral, para el tratamiento del dolor patelofemoral postraumático crónico. La radiofrecuencia pulsada puede ser una opción mínimamente invasiva para el tratamiento del síndrome de dolor patelofemoral postraumático...

Patellofemoral pain syndrome can be defined as retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. In orthopaedics, the most common causes include overuse, patellofemoral malalignment, and trauma. The case is reported of chronic post-traumatic patellofemoral pain syndrome treated with pulsed radiofrequency of both the medial and lateral patellar nerves. Pulsed radiofrequency might be a minimally invasive option for treatment of post-traumatic patellofemoral pain syndrome...

Avaliação isocinética, dor e funcionalidade de sujeitos com síndrome da dor patelofemoral / Isokinetic evaluation, pain and functionalidad of subjects with patellofemoral pain syndrome / Evaluación isocinética, dolor y funcionalidad de sujetos con síndrome de dolor patelofemoral

Este estudo visou determinar a influência da Síndrome da Dor Patelofemoral (SDPF) sobre o pico de torque e trabalho da musculatura flexora e extensora do joelho, além de avaliar a dor e funcionalidade de sujeitos com a disfunção. Participaram 52 sujeitos do gênero feminino, 23 com SDPF e 29 clinicamente saudáveis similares em idade, estatura e massa corporal. A avaliação isocinética foi realizada no modo concêntrico para os flexores e extensores do joelho nas velocidades de 60 e 180°/s. Também foi aplicada a Escala Visual Numérica antes e após cada velocidade do teste isocinético e o questionário de Kujala. Os dados foram analisados pela estatística descritiva e inferencial (testes U de Mann-Whitney, Wilcoxon e t independente) com nível de significância de α=0,05. O Grupo com Síndrome da Dor Patelofemoral (GSDPF) apresentou menor pontuação (p=0,01) no questionário de Kujala (75,7±12,3 pontos) em relação ao Grupo Controle (GC) (100±0,0 pontos), além de menor pico de torque, tanto em 60 como 180°/s, dos flexores (0,82±0,24 Nm/kg; 0,51±0,22 Nm/kg) e extensores (1,85±0,48 Nm/kg; 1,13±0,44 Nm/kg) do joelho, bem como menor trabalho total dos extensores do joelho a 180°/s (6,46±2,54 J/kg) e 60°/s (9,42±3,27 J/kg). Além disso, foi observado aumento da dor do GSDPF após a avaliação isocinética a 180°/s (0,9 cm) e 60°/s (2,3 cm). Os resultados evidenciaram que sujeitos com SDPF possuem menor capacidade funcional e menor pico de torque e trabalho dos flexores e extensores do joelho, sugerindo que o fortalecimento desta musculatura deve ser considerado na reabilitação destes sujeitos...

The aim of this study was to determine the influence of Patellofemoral Pain Syndrome (PFPS) on peak torque and work in knee flexor and extensor muscles. In addition to evaluate pain and function of subjects with the disfunction. Fifty two females subjects, 23 with diagnosis of PFPS and 29 control subjects, similar for age, height and body mass, participated in this study. The isokinetic evaluation was performed in concentric mode for knee flexors and extensors at speeds of 60 and 180°/s. In addition, was applied to Visual Numerical Scale before and after each velocity of isokinetic testing and Kujala questionnaire. Data were analyzed by descriptive and inferential statistics (U Mann-Whitney, Wilcoxon and t independent tests) with alpha level at α=0.05. The Patellofemoral Pain Syndrome Group (PFPSG) had lower scores (p=0.01) on Kujala questionnaire (75.7±12.3 points) in relation to Control Group (CG) (100±0.0 points), and lower peak torque of knee flexors (0.82±0.24 Nm/kg; 0.51±0.22 Nm/kg) and extensors (1.85±0.48 Nm/kg; 1.13±0.44 Nm/kg) in 60 and 180°/s and lower total work of knee extensors at 180°/s (6.46±2.54 J/kg) and 60°/s (9.42±3.27 J/kg). In addition, there was exacerbation of pain in PFPSG after the isokinetic evaluation at 180°/s (0.9 cm) and 60°/s (2.3 cm). The results showed that individuals with PFPS have lower functional capacity and lower peak torque and work flexors and knee extensors, suggesting that strengthening these muscles must be considered in the rehabilitation of these subjects...

Este estudio tiene como objetivo determinar la influencia del Síndrome de Dolor Patelofemoral (SDPF) sobre el peak de torque y el trabajo de la musculatura flexora y extensora de la rodilla, además de evaluar el dolor y la funcionalidad de sujetos con esta disfunción. Participaron 52 sujetos de género femenino, 23 con SDPF (GSDPF) y 29 clínicamente saludables (GC) similares en edad, estatura y masa corporal. La evaluación isocinética fue realizada en el modo concéntrico para los flexores y extensores de rodilla en las velocidades de 60 y 180°/s. También fue aplicada la Escala Visual Numérica antes y después de cada velocidad del test isocinético y el Cuestionario de Kujala. Los datos fueron analizados por estadística descriptiva e inferencial (Tests U de Mann-Whitney, Wilcoxon y T independiente) con un nivel de significancia de α=0,05. El GSDPF presentó menor puntuación (p=0,01) en el Cuestionario de Kujala (75,7±12,3 puntos) en relación al GC (100±0,0 puntos), además presentó un menor peak de torque, tanto en 180°/s y 60°/s. Los resultados evidencian que sujetos con SDPF poseen menor capacidad funcional y peak de torque de trabajo de los flexores y extensores de rodilla, sugiriendo que el fortalecimiento de esta musculatura debe ser considerada en la rehabilitación de estos sujetos...

Clinical rearfoot and knee static alignment measurements are not associated with patellofemoral pain syndrome / Medidas clínicas estáticas do retropé e joelho não estão associadas à síndrome da dor patelofemoral

The aim of the present study was to investigate the association between the patellofemoral pain syndrome and the clinical static measurements: the rearfoot and the Q angles. The design was a cross-sectional, observational, case-control study. We evaluated 77 adults (both genders), 30 participants with patellofemoral pain syndrome, and 47 controls. We measured the rearfoot and Q angles by photogrammetry. Independent t-tests were used to compare outcome continuous measures between groups. Outcome continuous data were also transformed into categorical clinical classifications, in order to verify their statistical association with the dysfunction, and χ2 tests for multiple responses were used. There were no differences between groups for rearfoot angle [mean differences: 0.2º (95%CI -1.4-1.8)] and Q angle [mean differences: -0.3º (95%CI -3.0-2.4). No associations were found between increased rearfoot valgus [Odds Ratio: 1.29 (95%CI 0.51-3.25)], as well as increased Q angle [Odds Ratio: 0.77 (95%CI 0.31-1.93)] and the patellofemoral pain syndrome occurrence. Although widely used in clinical practice and theoretically thought, it cannot be affirmed that increased rearfoot valgus and increased Q angle, when statically measured in relaxed stance, are associated with patellofemoral pain syndrome (PFPS). These measures may have limited applicability in screening of the PFPS development.

O objetivo deste estudo foi investigar se existe associação entre a síndrome da dor patelofemoral e as medidas clínicas estáticas: os ângulos do retropé e Q. Foi realizado um estudo observacional, transversal, caso-controle, no qual foram avaliados 77 adultos (ambos os sexos), 30 participantes com síndrome da dor patelofemoral e 47 controles. Foram medidos os ângulos do retropé e Q, por meio da fotogrametria. Testes t para amostras independentes foram usados para comparações dos resultados das variáveis contínuas entre os grupos. Os resultados das variáveis contínuas foram transformados em classificações clínicas categóricas, para verificar a associação estatística com a disfunção, e o teste do χ2 para respostas múltiplas também foi utilizado. Não houve diferença entre os grupos para o ângulo do retropé [média da diferença: 0,2º (IC95% -1,4-1,8)] e ângulo Q [média da diferença: -0,3º (IC95%-3,0-2,4). Não houve associação entre o ângulo do retropé [Odds Ratio: 1,29 (IC95% 0,51-3,25)], assim como entre o ângulo Q [Odds Ratio: 0.77 (IC95% 0,31-1,93)] e a ocorrência da síndrome da dor patelofemoral. Apesar de serem teoricamente justificadas e amplamente utilizadas na prática clínica fisioterapêutica, não pode-se afirmar que as medidas dos ângulos do retropé e Q, quando mensuradas em posição ortostática, estão associadas com a ocorrência da síndrome da dor patelofemoral. Essas medidas podem ter aplicabilidade limitada na triagem desta disfunção.