Evaluating the Impact of Flossing Band Integration in Conventional Physiotherapy for Patellofemoral Pain Syndrome.

Background/Objectives: Patellofemoral Pain Syndrome (PFPS) is prevalent among physically active individuals, highlighting the need for innovative treatment strategies beyond conventional physiotherapy. This study investigates the effectiveness of integrating flossing band therapy with standard physiotherapy, anticipating improved outcomes in pain reduction, functional ability, and patient satisfaction. Methods: A double-blinded randomized controlled trial involved 50 PFPS-diagnosed participants. They were divided into two groups: Standard Physiotherapy Group (SPG) and Flossing Band and Physiotherapy Group (FBPG), each undergoing an 8-week intervention focusing on resistance training supplemented by respective therapies. Assessment metrics included pain (VAS), strength (Dynamometry), lower limb function (LEFS), and PFPS function (AKPS) measured before and after the intervention. Results: Significant enhancements in all outcome measures were noted for both groups, yet the FBPG exhibited notably superior improvements in pain, knee functionality, muscle strength, and lower extremity function. The FBPG demonstrated statistically significant greater efficacy in pain alleviation and strength enhancement. Conclusions: The addition of flossing band therapy to conventional physiotherapy presents a more effective treatment modality for PFPS, suggesting its potential to redefine therapeutic standards. Future studies should delve into the long-term impacts and mechanistic underpinnings of floss band therapy in PFPS management.

Anatomical Variation of Infrapatellar Innervation Determines Clinical Risk of Infrapatellar Neuropathy.

BACKGROUND: Infrapatellar neuropathy arises from traumatic, iatrogenic, or compression injury to the infrapatellar branch (IB) of the saphenous nerve. The risk of infrapatellar neuropathy has been shown to depend on the IB's anatomical course. The infrapatellar branch of the saphenous nerve (ISBN) has been discovered to take varying courses, and the IB can emerge directly from the femoral nerve. The variety of the IBSN's courses and the prevalence of cases involving the infrapatellar branch of the femoral nerve (IBFN) call the uniform IB course described in textbooks into question. OBJECTIVES: In this study, we aim to identify sites of IB emergence and their anatomical relations and evaluate them for their risk of neuropathy. STUDY DESIGN: The study is an anatomical prospective pilot study. SETTING: The setting is a single-center cadaveric study performed at the anatomical institute of the Medical University of Vienna. METHODS: Twenty-two anatomical specimens were evaluated for the relationship of their IBs to anatomical risk sites. The subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle were assessed. The measurements and relations of the IB were determined with callipers and assessed by computational modelling. RESULTS: Nine IBs originated from the saphenous nerve, 11 originated from the femoral nerve, and 2 originated from both. The subsartorial course was most frequent in IBs of saphenous origin. Penetrating and profound distal sartorial relations correlated moderately with emergence type and were highest in the saphenous group. The crossing of the medial femoral epicondyle was the most common relation of IBs that emerged femorally. LIMITATIONS: The study's limitations were the low number of cadavers to examine and the confining of the exploration of knee extension to anatomical specimens that restricted an inferential analysis. CONCLUSION: Infrapatellar innervation can emerge from the saphenous nerve, the femoral nerve, or a combination of both, and the origin of the innervation determines the clinical risk for infrapatellar neuropathy. While innervation from the IBSN may lead to compression at the subsartorial course, distal sartorial penetration, and the crossing of the medial femoral epicondyle, innervation from the IBFN carries reduced anatomical risk for infrapatellar neuropathy.

Dynamic soft tissue mobilization versus proprioceptive neuromuscular facilitation in reducing hamstring muscle tightness in patients with knee osteoarthritis: a randomized control trial.

BACKGROUND: Knee osteoarthritis (KOA) considered as one of the most common degenerative diseases of synovial joint. KOA is mostly managed by physical therapy, focused on pain management, the range of motion and muscle strengthening but muscle flexibility is usually neglected. A study was conducted to evaluate the effectiveness of dynamic soft tissue mobilization (DSTM) in comparison with the proprioceptive neuromuscular facilitation (PNF) stretching in the management of hamstring tightness, reduction of pain intensity and improvement of physical functionality in KOA. METHODS: Forty eight patients with KOA were randomly allocated to group A receiving DTSM and group B receiving PNF stretching. The cryotherapy and isometric strengthening exercises were also given to both groups. Total treatment duration consisted of 4 weeks, 3 sessions per week and total 12 sessions per patient. Each treatment session comprised of 30 min. At baseline and post treatment, Active knee extension test(AKET), Visual analogue scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess hamstring flexibility, pain intensity level and physical functional capability respectively. The continuous variables were shown as mean and standard deviations. For the comparison of outcome within and between groups, paired sample and independent t-test was applied. Considerable p value was less than 0.05. RESULTS: The between group analysis of VAS, right AKE test, and left AKE test showed non-significant (p > 0.05) mean difference as 0.2 (95% CI= -0.29, 0.70), 1.79 (95% CI= -1.84, 4.59), 1.78 (95% CI= -1.6, 5.19) respectively. KOOS domains of symptom, pain, ADLs, sports and recreational, and quality of life had also non-significant (p > 0.05) mean difference as 1.12 (95% CI= -4.05, 6.3), -5.12 (95% CI= -12.71, 2.46), -2.55 (95% CI= -7.47, 2.38), -2.7 (95% CI= -9.72, 4.3), and - 0.68 (95% CI= -7.69, 6.36) respectively. Significant (p < 0.001) improvement was shown in both groups for all outcome measures after 12 sessions. CONCLUSION: DSTM and PNF stretching, both treatments are equally beneficial in KOA for hamstring flexibility, pain reduction and functional mobility in terms of AKET, VAS, and KOOS respectively. TRIAL REGISTRATION: ClincalTrials.Gov with ID: NCT04925895, 14/06/2021, retrospectively registered.

Relationship between kinesiophobia, isometric hip and knee torques to pelvic, hip and knee motion during the single-leg drop jump in women with patellofemoral pain: A cross-sectional study.

BACKGROUND: Individuals with patellofemoral pain (PFP) have kinesiophobia and hip and knee strength deficits. These factors may be related to kinematic alterations of pelvic, hip and knee during a more demanding functional activity, such as jumping landing. The aim was to investigate the relationships between kinesiophobia and hip/knee torque to pelvic/hip/knee kinematics during the single-leg drop vertical jump in women with PFP. METHOD: Thirty women with PFP were assessed with Tampa Scale for Kinesiophobia; isokinetic dynamometry of the hip extensor, hip abductor, and knee extensor; and three-dimensional motion analysis system during the single-leg drop vertical jump. A Pearson correlation matrix was used to investigate relationship among variables. RESULTS: Fair correlations were found between increased kinesiophobia and increased peak hip internal rotation angle (r = 0.43; p = 0.018) as well as between greater peak knee extensor torque and greater peak knee flexion (r = 0.41; p = 0.022). Moderate to good correlation was found between increased peak hip abductor torque and increased peak contralateral pelvic drop (r = 0.52; p = 0.003). No other significant correlations were found between variables. CONCLUSIONS: Kinesiophobia is associated with hip kinematics, but not with knee kinematics, during the single-leg vertical drop jump in women with PFP. The greater hip abductor torque is associated with greater contralateral pelvic drop. The positive relationship between knee extensor torque and knee flexion indicates that rehabilitation programs involving quadriceps muscle strengthening may assist women with PFP in control knee flexion and improve load absorption during jumping landing.

Effect of hip abductors and lateral rotators' muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis.

BACKGROUND: Even though literature indicates presence of weak hip abductors and lateral rotators' in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited. OBJECTIVE: This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions. METHOD: Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration's 'Risk of bias' quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs. RESULTS: All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function. CONCLUSION: In adult patients with PFP, strengthening hip abductors and lateral rotators' have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.

Comparative Study of the Efficacy of Hyaluronic Acid, Dry Needling and Combined Treatment in Patellar Osteoarthritis-Single-Blind Randomized Clinical Trial.

Background: Osteoarthritis of the knee is one of the most common ailments worldwide, and pain management of this condition is critical. Methods: A multicentre randomized controlled trial RCT with three months of follow-up, conducted in parallel groups: hyaluronic acid (HA), dry needling (DN) and ultrasound (US) and isometrics of quadriceps. 60 participants took part in the RCT who were diagnosed with osteoarthritis (Grade 3) of the knee by MRI and active adults (age: 23.41 ± 1.68 years; height: 1.79 ± 0.08 m; body mass: 78.33 ± 9.03 kg; body mass index (BMI): 24.14 ± 1.45 kg/m2). After the assigned intervention, VAS, WOMAC, IPAQ and the Star Excursion Balance test were measured at baseline. At 24 h, 15 days, 30 days, 90 days and 180 days follow-up, all variables were measured again. Results: Comparing statistically significant differences between groups, VAS scores were significant at post-test measurement (HA vs. US + isometric and DN vs. US + isometric) at 24 h (HA vs. DN), at 15 days (HA vs. US + isometric and DN vs. US + isometric) and at 1 month (US + isometric vs. HA and US + isometric vs. DN). Conclusions: There is an improvement in pain intensity in knee osteoarthritis in the short term in patients undergoing DN and conventional US + isometric treatment, but in the long term the HA group shows an improvement in pain intensity. There is also a significant difference in the improvement of knee function at different phases of the study in the various intervention groups. The combination of DN and HA in clinical practice is the best option for the treatment of osteoarthritis.

Comparison of Patellofemoral Outcomes between Attune and PFC Sigma Designs: A Prospective Matched-Pair Analysis.

BACKGROUD: Attune (DePuy Synthes) prosthesis was designed to overcome patellofemoral complications associated with PFC Sigma (DePuy Synthes) prosthesis. The aim of our study was to compare the incidence of anterior knee pain (AKP), patellofemoral crepitus (PCr), and functional outcome between them. METHODS: This prospective matched-pair study was conducted between January 2014 and June 2015, during which 75 consecutive Attune total knee arthroplasties (TKAs) were matched with 75 PFC Sigma TKAs based on age, sex, body mass index, pathology, and deformity. A single surgeon performed all the operations with aid of computer navigation, using a posterior-stabilized prosthesis with patellar resurfacing. Outcome was assessed by new Knee Society Score (NKSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. AKP and PCr were assessed by a patient-administered questionnaire till 2 years of follow-up. Three pairs were lost to follow-up and finally 72 pairs were analyzed. RESULTS: One patient in each group reported AKP and 1 patient from each group had PCr at 2 years postoperatively. None of these patients required additional surgery. The incidence of lateral retinacular release was higher with PFC Sigma (5/72) than Attune (2/72); however, this was statistically not significant (p = 0.4). The Attune group had a significantly greater range of motion (ROM) at 3 months postoperatively (p = 0.049). At final follow-up, ROM was comparable between two prosthesis designs. NKSS and WOMAC scores were also comparable between the groups. CONCLUSIONS: We observed that both Attune and PFC Sigma had a low and comparable incidence of AKP and PCr up to 2 years of follow-up. The Attune group achieved a significantly greater ROM at 3 months postoperatively. At 2 years of follow-up, both prostheses had excellent and comparable clinical and functional results.

Comparison of mobilization with movement and Mulligan knee taping on Patellofemoral pain syndrome.

OBJECTIVE: To compare the effect of mobilisation with movement and Mulligan knee taping on anterior knee pain, hamstring flexibility and physical performance of the lower limb. METHODS: The randomised controlled trial was conducted from July to December, 2019, at the physical therapy department of Sahat Clinic, Rawalpindi, Pakistan, and comprise participants of both genders having patellofemoral pain who were randomised into mobilisation with movement group A and Mulligan knee taping group B. Both the groups were treated for 2 days per week for 2 consecutive weeks. Outcome was measured using the numeric pain rating scale, the Kujala pain rating scale, the active knee extension test and the time-up-and-go test. Assessments were taken at baseline, and at 2nd and 6th weeks post intervention. Data was analysed using SPSS 21. RESULTS: Of the 34 participants, there were 17(50%) in each of the two groups. Overall, there were 6(17.6%) males and 28(82.4%) females with a mean age of 31.17±7.22 years. Group A showed significant improvement (p<0.0001) in terms of pain, while group B had better hamstring flexibility (p<0.0001). Both the groups showed a significant difference (p<0.0001) for all outcome variables post-intervention. CONCLUSIONS: Mobilisation with movement was found to be more effective in the treatment of patellofemoral pain and associated knee functional performance.

Immediate Effect of Ankle Mobilization on Range of Motion, Dynamic Knee Valgus, and Knee Pain in Women With Patellofemoral Pain and Ankle Dorsiflexion Restriction: A Randomized Controlled Trial With 48-Hour Follow-Up.

CONTEXT: Restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. This, in turn, has been correlated with knee pain in women with patellofemoral pain. OBJECTIVES: To investigate the immediate effect of 3 ankle mobilization techniques on dorsiflexion ROM, dynamic knee valgus, knee pain, and patient perceptions of improvement in women with patellofemoral pain and ankle dorsiflexion restriction. DESIGN: Randomized controlled trial with 3 arms. SETTING: Biomechanics laboratory. PARTICIPANTS: A total of 117 women with patellofemoral pain who display ankle dorsiflexion restriction were divided into 3 groups: ankle mobilization with anterior tibia glide (n = 39), ankle mobilization with posterior tibia glide (n = 39), and ankle mobilization with anterior and posterior tibia glide (n = 39). INTERVENTION(S): The participants received a single session of ankle mobilization with movement technique. MAIN OUTCOME MEASURES: Dorsiflexion ROM (weight-bearing lunge test), dynamic knee valgus (frontal plane projection angle), knee pain (numeric pain rating scale), and patient perceptions of improvement (global perceived effect scale). The outcome measures were collected at the baseline, immediate postintervention (immediate reassessment), and 48 hours postintervention (48 h reassessment). RESULTS: There were no significant differences between the 3 treatment groups regarding dorsiflexion ROM and patient perceptions of improvement. Compared with mobilization with anterior and posterior tibia glide, mobilization with anterior tibia glide promoted greater increase in dynamic knee valgus (P = .02) and greater knee pain reduction (P = .02) at immediate reassessment. Also compared with mobilization with anterior and posterior tibia glide, mobilization with posterior tibia glide promoted greater knee pain reduction (P < .01) at immediate reassessment. CONCLUSION: In our sample, the direction of the tibia glide in ankle mobilization accounted for significant changes only in dynamic knee valgus and knee pain in the immediate reassessment.

Patellar denervation does not reduce post-operative anterior knee pain after primary total knee arthroplasty with patellar resurfacing.

PURPOSE: Anterior knee pain (AKP) is a frequent symptom after a total knee arthroplasty (TKA). Patellar denervation (PD) has been put forth as a technique to reduce this pain; however, its effects have not been assessed in combination with patellar resurfacing. The aim of this study is to evaluate the effect of PD on AKP and functional outcomes after TKA with patellar resurfacing. METHODS: A prospective study was designed that included patients scheduled for TKA with patellar resurfacing. The 202 recruited patients were randomized into either the PD group or the non-denervation group [mean age 72.7 years (SD 8.2); 119 (70.4%) women and 50 (29.6%) men; average body mass index 31.4 kg/m2 (SD 4.9)]. Pressure pain threshold (PPT) assessed by pressure algometry (PA), visual analogue scale(VAS), patellofemoral Feller score and the Knee Society Scores (KSS) were recorded preoperatively and at the 1-year follow-up. RESULTS: 169 patients were included in data analysis. At the 1-year follow-up, there were mild differences between denervation and non-denervation group in PPT value (494.4 kPa vs. 552.3 kPa, p = 0.047) and in VAS at stairs (2.9 vs. 1.5, p = 0.003) in favour of the non-denervation group. There was no difference in the improvement between groups in patellofemoral Feller score and KSS, but slightly higher improvement in non-denervation group in PPT (94.1 kPa vs. 160 kPa, p = 0.047), VAS walking (5.3 vs. 6.2, p = 0.041) and VAS at stairs (4.6 vs. 5.7, p = 0.022). CONCLUSION: Patellar denervation does not improve AKP and clinical outcomes in primary TKA with patellar resurfacing compared to patellar replacement without denervation. PD cannot be recommended when patellar replacement is performed in TKA. LEVEL OF EVIDENCE: II.

Dynamic knee valgus kinematics and their relationship to pain in women with patellofemoral pain compared to women with chronic hip joint pain.

BACKGROUND: Dynamic knee valgus (DKV) is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing. Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment. Using a secondary analysis of exiting data sets, we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain, and the relationship between joint-specific kinematics and pain in these 2 pain populations. METHODS: In the original studies, 3-dimensional hip and knee kinematics during a single leg squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV. Pain intensity during the squat was assessed in both groups. For the secondary analysis, kinematic data were compared between pain groups using their respective control groups as a reference. Within each pain group, correlation coefficients were used to determine the relationship between kinematics and pain during the squat. RESULTS: Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain (effect sizes ≥ 0.40). Greater knee external rotation (r=0.47, p=0.04) was correlated with greater knee pain in those with patellofemoral pain, while greater hip adduction (r =0.53, p =0.05) and greater hip internal rotation (r =0.55, p =0.04) were correlated with greater hip pain in those with chronic hip joint pain. CONCLUSION: Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain. In both groups, greater abnormal movement at the respective joint (e.g. knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group) was associated with greater pain at that joint during a single leg squat.

Effect of Intravenous Corticosteroids on Pain Management and Early Rehabilitation in Patients Undergoing Total Knee or Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Corticosteroids are frequently used for the treatment of postoperative nausea and vomiting, and have also been reported to have an effect on postoperative analgesia. This study was conducted to assess the pain management effect of perioperative intravenous corticosteroids in patients undergoing total knee or hip arthroplasty and evaluate their early rehabilitation. METHOD: Randomized controlled trials (RCTs) were searched from electronic databases, including PubMed, Web of Science, Embase (Ovid interface), and the Cochrane Library (Ovid interface). Among 932 records identified, 14 RCTs involving 1,023 patients were eligible for data extraction and meta-analysis. RESULTS: The use of intravenous steroids was associated with reduced pain at rest and with activity during the first 24 hours after operation (P < 0.05). Patient steroid groups had less opioid consumption (P < 0.05). Additionally, patients using intravenous corticosteroids had better outcomes, in terms of nausea and vomiting (both P < 0.05). Moreover, corticosteroids were effective in decreasing the inflammatory marker interleukin-6 (P < 0.05). Complications such as deep infection and pruritus showed similar occurrence in both the corticosteroid groups and control groups (P > 0.05), while the occurrence of venous thromboembolism was lower in the corticosteroid groups, with a marginally significant difference. In addition, no significant difference in length of hospital stay was observed, irrespective of whether patients received intravenous corticosteroids (P > 0.05). CONCLUSION: Our results show that intravenous corticosteroids have good efficacy and safety when used perioperatively in total knee or hip arthroplasty.

Evaluation and management of knee pain in young athletes: overuse injuries of the knee.

Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idiopathic anterior knee pain. Although, numerous anatomical and biomechanical factors have been postulated to contribute the knee pain in young athletes, the most common underlying reason is overuse injury. In this paper, we have reviewed selected conditions that case knee pain in athletes, including anterior knee pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johanssen syndrome, juvenile osteochondritis dissecans (JOCD), bipartite patella, plica syndrome, and tendonitis around the knee.

Customized footwear for motion control to treat anterior knee pain among runners / Calçado personalizado para controle de movimento para tratar a dor anterior do joelho entre os corredores

BACKGROUND: Street running is extremely popular worldwide. Despite its benefits, there is evidence that stressful physical activity contributes to the development of lesions on the patellofemoral joint, leading, to anterior knee pain. As an attempt to attain pain control and to improve performance, specific footwear is being developed, aiming to suit particular types of foot strike, and therefore to reduce the risk of injury. OBJECTIVE: To evaluate the effectiveness of the use of customized shoes, based on baropodometric test, for the remission of anterior knee pain among amateur street runners. METHODS: This is a cross-sectional study, using questionnaires based on anthropometric and anatomical data of the runner, type of training, individualized footwear based on baropodometric test and diagnosis of anterior knee pain. In total, 40 athletes were studied, which were divided into two groups: Group 1, with 19 athletes who wore specific shoes for their activity, according to the type of foot strike, and, Group 2, with 21 athletes who used neutral shoes, not prescribed by healthcare professionals. All athletes practiced at the same running field. RESULTS: Most of the athletes were female (70%), The pain remission had no overall statistically significant difference between the two groups. However, significant differences were found between groups A and B regarding the time of occurrence and the extent of AKP. CONCLUSION: The data analysis showed that the use of customized running shoes, based exclusively on baropodometric exams, does not reduce anterior knee pain in amateur street runners, which is consistent with current literature. The improvement of pain with customized shoes, when present, appeared to have a short duration of around three month.

FUNDAMENTO: Corrida de rua é extremamente popular em todo o mundo. Apesar dos seus benefícios, há evidências de que o estresse dessa atividade física contribui para o desenvolvimento de lesões da articulação patelofemoral, levando, à dor anterior do joelho. Como uma tentativa de alcançar o controle da dor e para melhorar o desempenho, calçados específicos foram desenvolvidos, visando adequar determinados tipos de impacto do pé, e, por conseguinte, para reduzir o risco de lesões. OBJETIVO: Avaliar a eficácia do uso de sapatos personalizados, com base no teste de baropodometria, para a remissão de dor anterior do joelho entre os corredores de rua amadores. MÉTODOS: Este é um estudo transversal, por meio de questionários com base nos dados antropométricos e anatômicas do corredor, tipo de treinamento, calçado individualizado com base no teste de baropodometria e diagnóstico da dor anterior do joelho. No total, 40 atletas foram estudados, divididos em dois grupos: Grupo 1, com 19 atletas que usavam sapatos específicos para a sua atividade, de acordo com o tipo de ataque de movimento do pé, e, Grupo 2, com 21 atletas que usaram sapatos neutros, não prescritos por profissionais de saúde. Todos os atletas treinaram em um mesmo campo. RESULTADOS: A maioria dos atletas eram do sexo feminino (70%); não houve diferença estatisticamente significativa entre os dois grupos em termos de remissão da dor. CONCLUSÃO: A análise dos dados mostrou que o uso de tênis personalizados, com base exclusivamente em exames baropodométricos, dor anterior do joelho não reduz a dor os corredores de rua amadores, o que é consistente com a literatura atual. A melhora da dor com sapatos personalizados parece ter uma curta duração de cerca de três meses.

Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome.

OBJECTIVE: To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). DESIGN: Sensitivity and specificity analysis. SETTING: Physical rehabilitation center and laboratory of biomechanics and motor control. PARTICIPANTS: Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The diagnostic accuracy was calculated for sEMG parameters' reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. RESULTS: The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80-.90), precise (SEM=2.71-3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). CONCLUSIONS: The results provide evidence to support the use of EMG signals (B2-frequency band of 45-96 Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.