Muscle activation, strength, and volume in people with patellofemoral osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: This systematic review investigated whether people with patellofemoral osteoarthritis (PFOA) have muscle strength, volume, and activation around the hip and knee that is different from asymptomatic controls. METHODS: Searches were carried out in five electronic databases, with terms related to PFOA, including muscle strength, volume and activation. Only studies with at least one group with symptomatic PFOA and one asymptomatic group were included. The methodological quality of the studies was assessed using the Downs and Black checklist. Certainty of evidence was assessed using the GRADE methodology. Using the random effects model, a meta-analysis was performed when there were at least two studies reporting the same domain. RESULTS: Eight studies (250 participants) met the inclusion criteria. Subjects with PFOA had weaker hip abduction (SMD -0.96; 95%CI = -1.34 to -0.57), hip external rotation (-0.55;-1.07 to -0.03), hip extension (-0.72;-1.16 to -0.28), and knee extension (-0.97;-1.41 to -0.53) when compared to asymptomatic controls. People with PFOA also presented with smaller volumes of the gluteus medius, gluteus minimus, tensor fascia lata, vastus medialis (VM), vastus lateralis (VL) and rectus femoris when compared to asymptomatic controls. Also, people with PFOA presented with changes in muscle activation for the VL, VM and gluteus maximus (GMax) when compared to asymptomatic controls. CONCLUSION: People with PFOA present with lower strength and volume of the hip and quadriceps muscles and altered muscle activation of the VM, VL and GMax during ascending and descending stairs when compared to asymptomatic controls. However, the certainty of these findings are very low. TRIAL REGISTRATION NUMBER: PROSPERO systematic review protocol (ID = CRD42020197776).

Migration mesh mimicking bladder malignancy after open inguinal hernia repair.

Despite the benefits of using surgical meshes to repair abdominal and inguinal hernias, there are increasing reports of mesh migration into the gastrointestinal and urinary tracts-a complication that cannot be overlooked or neglected. Resolution of such cases can be difficult and depends on the degree of migration and the anatomical site involved. The present paper reports the case of a 68-year-old patient undergoing a trans-ureteral resection of a possible bladder malignancy diagnosed following clinical and radiological evaluation. During the procedure (cytoscopy), it was found that migration of a mesh was mimicking the urological disease initially suspected. A polypropylene mesh had been inserted into the right inguinal region 20 years previously to repair an inguinal hernia. This is one of only a few case reports on mesh migration presenting as a suspected bladder malignancy.