Clinical trial of manual therapy in the treatment of chondromalacia patellae.

BACKGROUND: Chondromalacia patellae (CP) is a common and main cause of knee pain, the prevalence of the disease in the general population is as high as 36.2%, especially in middle-aged patients aged between 30 and 40 years (up to 50%). The use of manual therapy (MT) to dredge the meridians and muscles around the knee joint and stimulate the relevant acupoints can play vital roles in relieving pain and improving function. The purpose of this study is to assess the effectiveness, safety and further comprehensively, completely and multi-dimensionally explain the mechanism and treatment advantages of MT for CP. METHODS: A prospective randomized controlled clinical trial design was used to study the efficacy and safety of MT in the treatment of CP. One hundred and twenty cases of CP patients will be recruited and randomly divided into experimental group and control group according to 1:1. The control group: sodium hyaluronate; experimental group: MT added on the basis of the control group. Both groups will receive standard treatment for 4 weeks and followed up for 3 months. And at the same time, pay attention to its efficacy and safety indicators. Observation indicators include: the visual analogue scale pain score; the Western Ontario and McMaster Universities Arthritis Index scores; the Lysholm scores, and Bristol scores, adverse reactions, etc. Data analysis was performed using SPSS 25.0 software. DISCUSSION: This study will precisely evaluate the effectiveness and safety of MT in the treatment of CP. The results of this experiment will provide more reliable clinical basis for the selection of MT for patients with CP.

Chondromalacia patellae: current options and emerging cell therapies.

Chondromalacia patellae (CMP), also known as runner's knee, typically occurs in young patients, which is characterized by anterior knee pain (AKP) that is associated with visible changes in patellar cartilage. The initial pathological changes include cartilage softening, swelling, and edema. CMP is caused by several factors, including trauma, increased cartilage vulnerability, patellofemoral instability, bony anatomic variations, abnormal patellar kinematics, and occupation hazards. CMP may be reversible or may progress to develop patellofemoral osteoarthritis. Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications. Additionally, radiological examinations are also necessary for diagnosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic method, which holds a promise in having the unique ability to potentially identify cartilage lesions. Modalities are conventionally proposed to treat cartilage lesions in the PF joint, but none have emerged as a gold standard, neither to alleviated symptoms and function nor to prevent OA degeneration. Recently, researchers have been focused on cartilage-targeted therapy. Various efforts including cell therapy and tissue emerge for cartilage regeneration exhibit as the promising regime, especially in the application of mesenchymal stem cells (MSCs). Intra-articular injections of variously sourced MSC are found safe and beneficial for treating CMP with improved clinical parameters, less invasiveness, symptomatic relief, and reduced inflammation. The mechanism of MSC injection remains further clinical investigation and is tremendously promising for CMP treatment. In this short review, etiology, MRI diagnosis, and treatment in CMP, especially the treatment of the cell-based therapies, are reviewed.

Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae.

OBJECTIVE: To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation (TCSOM) in treating chondromalacia patellae (CP). METHODS: Sixty cases of CP patients were randomly assigned to a TCSOM group and a Celecoxib group according to the random number table method. All patients in the TCSOM group were treated with a maximum of 10 spinal manipulations and rehabilitation training of quadriceps femoris. The symptoms before and after treatment were assessed with visual analog scale (VAS) and Kujala functional knee scoring system (KFKSS). A symptom improvement rate (SIR) was implemented in order to evaluate the effects of the treatments. RESULTS: The symptoms of 16 patients in the TCSOM group quickly resolved after the first spinal manipulation and 8 cases were significantly improved. The VAS scores in the TCSOM group after 4 weeks of treatment were significantly lower than those in the Celecoxib group. The KFKSS scores in the TCSOM group after 4 weeks of treatment were significantly higher than those in the Celecoxib group. Side effects of the treatment were not reported. Symptom improvement rate based on the VAS in the TCSOM group indicated more significant improvements than the Celecoxib group. CONCLUSION: TCSOM has greater efficacy than Celecoxib capsules for relief of the symptoms of CP.

[Efficacy observation on chrondromalacia patellae treated with fire needling technique at high stress points].

OBJECTIVE: To compare the clinical efficacy differences between fire needling technique of filiform needle at high stress points and regular acupuncture on chrondromalacia patellae so as to provide the better therapy for the treatment of this disease. METHODS: Sixty cases of chrondromalacia patellae were randomized into a fire needling group (28 cases) and a routine acupuncture group (32 cases). In the fire needling group, 5 to 6 high stress points were localized according to the symptoms, palpation and imaging condition and were stimulated with fire needling technique of filiform needle. The treatment was given once every two days, 5 treatments made one session. In the routine acupuncture group, the regular acupuncture was applied at Dubi (ST 35), Xiguan (LR 7), Yanglingquan (GB 34), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, 5 treatments made one session. Lysholm score, VSA score, patella title angle (PTA) and lateral patella angle (LPA) of the affected knees before and after treatment, as well as the clinical efficacy after treatment were observed in the two groups. RESULTS: After treatment, Lysholm score, VSA score, PTA and LPA were all improved apparently in the two groups (all P < 0.01). After the treatments, the improvements in Lysholm score, VSA score, PTA and LPA in the fire needling group were more obvious than those in the routine acupuncture group (all P < 0.05). The effective rate was 92.9% (26/28) in the fire needling group, better than 87.5% (28/32) in the routine acupuncture group (P < 0.01). CONCLUSION: The fire needling technique of filiform needle at the high stress points relieves the clinical symptoms of chrondromalacia patellae and recovers the biodynamical structure of patellae.

Evaluating anterior knee pain.

Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider. There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition as well as key points.

Incidencia de las disfunciones rotatorias de la tibia en las condropatias rotulianas / Incidence of rotary disfunctions of the tibia in patellar chondropathy

Objetivos: Observar la relación entre degeneración del cartílago fémoro-rotuliano y la disfunción rotatoria tibial, en pacientes afectos de condropatía rotuliana unilateral. Material y Métodos: De una muestra de 133 sujetos se seleccionaron 50 sujetos, a los que se les aplicaron evaluaciones manuales y radiológicas (medición goniométrica en rotación tibial y radiología) para observación del posicionamiento rotuliano, mediante la medición del ángulo de congruencia y el desplazamiento transversal de la rotula. Resultados: Se observan diferencias significativas entre la rodilla afectada y la rodilla sana, tanto al comparar la rotación interna tibial, como la rotación externa tibial (p< 0,0001). En relación a la posición de la rótula, cuando se encuentra afectada la rotación interna, observamos una angulación de la rótula en sentido lateral (con respecto a la rodilla sana). Cuando está afectada la rotación externa o ambas rotaciones conjuntas, la rótula se angula hacia medial (con respecto a la rodilla sana) (p<0,02). En relación al desplazamiento lateral, no observamos resultados significativos. Conclusiones: Los procesos degenerativos del cartílago articular fémoro-rotuliano se asocian con una disfunción rotatoria tibial. Existe un sentido de angulación concreto asociado a cada tipo de afectación de rotación determinada, y tendencia a que la rótula se angule y se desplace de una manera distinta en la rodilla afecta, comparada con la rodilla sana (AU)

Objectives: To observe the relationship between degeneration of the femur-patellar cartilage and the rotating tibial dysfunction, in patients suffering from unilateral patellar chondropathy. Material and methods: From a sample of 133 subjects, 50 subjects were selected, to whom manual and radiological tests were applied (goniometric measurement in tibial and radiological rotation) for observation of patellar positioning by the measurement of the angle of congruence and lateral displacement of the patella. Results: Significant differences are observed between the affected knee and the healthy knee, both when comparing internal tibial rotation and external tibial rotation (p <0.0001). In connection with the patella position, when internal rotation is affected, we observe a lateral angulation of the patella (with regard to the healthy knee). When external rotation or both joint rotations are affected, the patella is angled inward (with respect to the healthy knee) (p <0.02). With regard to lateral displacement, we observed no significant results. Conclusions: The degenerative processes of the femur-patellar joint cartilage are associated with rotational or tibial dysfunction. There is a sense of concrete angulation associated with each type of affectation of determined rotation, and a tendency for the patella to angulate and move differently to the affected knee when compared to the healthy knee (AU)

A novel biological approach to treat chondromalacia patellae.

Mesenchymal stem cells from several sources (bone marrow, synovial tissue, cord blood, and adipose tissue) can differentiate into variable parts (bones, cartilage, muscle, and adipose tissue), representing a promising new therapy in regenerative medicine. In animal models, mesenchymal stem cells have been used successfully to regenerate cartilage and bones. However, there have been no follow-up studies on humans treated with adipose-tissue-derived stem cells (ADSCs) for the chondromalacia patellae. To obtain ADSCs, lipoaspirates were obtained from lower abdominal subcutaneous adipose tissue. The stromal vascular fraction was separated from the lipoaspirates by centrifugation after treatment with collagenase. The stem-cell-containing stromal vascular fraction was mixed with calcium chloride-activated platelet rich plasma and hyaluronic acid, and this ADSCs mixture was then injected under ultrasonic guidance into the retro-patellar joints of all three patients. Patients were subjected to pre- and post-treatment magnetic resonance imaging (MRI) scans. Pre- and post-treatment subjective pain scores and physical therapy assessments measured clinical changes. One month after the injection of autologous ADSCs, each patient's pain improved 50-70%. Three months after the treatment, the patients' pain improved 80-90%. The pain improvement persisted over 1 year, confirmed by telephone follow ups. Also, all three patients did not report any serious side effects. The repeated magnetic resonance imaging scans at three months showed improvement of the damaged tissues (softened cartilages) on the patellae-femoral joints. In patients with chondromalacia patellae who have continuous anterior knee pain, percutaneous injection of autologous ADSCs may play an important role in the restoration of the damaged tissues (softened cartilages). Thus, ADSCs treatment presents a glimpse of a new promising, effective, safe, and non-surgical method of treatment for chondromalacia patellae.

[Unsatisfactory long-term prognosis of conservative treatment of patellofemoral pain syndrome]. / Utilfredsstillende langtidsresultater efter konservativ behandling af patellofemoralt smertesyndrom.

This review overviews the long-term prognosis of conservatively treated patients with patellofemoral pain syndrome (PFPS). Median values of the 16 included studies show that 29% of soldiers, 27.8% of sports active and 24,7% of the general public will become pain free after they are diagnosed with PFPS. 21.5% of sports active and 23% of the general public diagnosed with PFPS will stop participating in sports because of knee pain. There is an indication that around one third diagnosed with PFPS will become pain free and one fourth will stop participating in sports because of knee pain.

Chondromalacia patellae treated by warming needle and rehabilitation training.

OBJECTIVE: To observe the effect of warming needle combined with rehabilitation training on chondromalacia patellae in a randomized controlled trial. METHODS: The 92 cases were randomly divided into a treatment group treated by warming needle plus rehabilitation training (47 cases) and a control group treated by medication plus rehabilitation training (45 cases), and the therapeutic effect was compared after 20 sessions. RESULTS: The pain was relieved more obviously in the treatment group than in the control group (P < 0.05), and the total effective rate was 91.8% and 71.1% respectively (P < 0.01). CONCLUSION: Warming needle plus rehabilitation training was superior in the therapeutic effect and duration of producing relief of pain to medication plus rehabilitation training in treating chondromalacia patellae.

Ressonância magnética no diagnóstico da condromalácia de patela: [revisão] / Use of magnetic resonance imaging in the diagnosis of chondromalacia patella: [revision]

As lesões da cartilagem articular da patela são bastante comuns, e em virtude da dissociação entre os sintomas e sinais e o estágio das lesões condrais o exame de escolha inicial é a ressonância magnética, sendo importante para o radiologista estar habituado às alterações condrais nesta doença para o correto diagnóstico.

Patellar articular cartilage lesions are very common and due to the dissociation between signs and symptoms and the stage of the chondral lesions the diagnostic method of choice is magnetic resonance imaging. Therefore, radiologists shold be familiar with chondral abnormalities in order to correctly diagnose this condition.

Regional musculoskeletal pain. The knee.

Chronic knee pain is common at all ages, particularly in the elderly, among whom it has its greatest impact. Chronic knee pain is often ascribed to osteoarthritis in adults and to chondromalacia patellae in children and adolescents. Pathological findings in both these conditions correlate poorly, however, with the severity of knee pain and disability. Psychometric variables correlate better with the impact of knee osteoarthritis, suggesting that this disorder has characteristics of a regional pain syndrome. This perception may reflect our lack of understanding of the biological mechanisms in these disorders. This possibility has been highlighted by the advent of magnetic resonance imaging, and by recent studies of muscle function, reflex quadriceps inhibition and proprioception in people with knee osteoarthritis. Established risk factors for knee osteoarthritis include increased body weight, knee injury and aspects of occupational activity. Recent studies have also suggested a possible role for oestrogens and vitamins C and D in the secondary prevention of this disorder. The emergence of 'nutraceuticals' such as glucosamine as treatments for osteoarthritis has captured the public imagination and merits further study.