Patellofemoral Arthritis Research Articles

Patellofemoral joint disorders

Background: Patellofemoral joint problems refer to a spectrum of conditions affecting the patellofemoral joint, which is the joint between the patella and femur. These conditions can cause pain and instability in the knee and affect an individual’s ability to perform daily activities. Patellofemoral joint problems commonly cause knee pain, particularly among young athletes and physically active individuals. This review article discusses current patellofemoral joint problems, including their epidemiology, pathophysiology, diagnosis, and management.Current Concepts: Patellofemoral joint problems are presented as clinical symptoms of pain and instability. Dividing the diagnostic criteria into anterior knee pain, patella instability, and patellofemoral arthritis is useful. Anterior knee pain is diagnosed after excluding possible causes. Patellar instability is classified into recurrent dislocation, habitual dislocation (extension and flexion types), and permanent dislocation. Moreover, patellar instability can progress to the final stage of patellofemoral arthritis. Thus, patellar instability should be treated according to the Dejour criterion, and patellofemoral arthritis treatment requires artificial joint replacement surgery.Discussion and Conclusion: The pathological mechanism of patellofemoral joint problems still needs to be properly established, and multifactorial causes make it difficult to treat patellofemoral joint problems. Accurate diagnosis is considered an essential factor for successful treatment.

Effect of Tan Tui combined with kinesio taping on the posture control of patients with PFPS: protocol for a randomized controlled trial

BackgroundPatellofemoral pain syndrome (PFPS) is a chronic disease. Its early symptoms are mild and can be relieved by rest after the pain. If there is no effective rehabilitation, it may develop into patellofemoral arthritis. Physiotherapy and appropriate exercise intervention can improve PFPS and postural control during exercise. Tan Tui (TT) is an effective means to improve postural control. Whether combined kinesio taping (KT) can be used as an effective treatment for PFPS patients’ recovery has not yet been confirmed.Methods/designSeventy-two eligible patients with early-stage PFPS will be recruited and randomized into 4 groups: TT + KT group (n = 18), TT + KTp group (n = 18), KT group (n = 18), and CON group (n = 18). The TT + KT group was treated with TT combined with KT intervention; the TT + KTp group was treated with TT and KT placebo technical intervention; the KT group was treated with KT intervention alone; the CON group was treated with routine activities. All 4 groups received 30 min, three times a week, for a total of 6 weeks of intervention training. Measurements will be performed at baseline, mid-intervention (4 weeks), and post-intervention (6 weeks) with visual analog scale/score, (VAS), Knee joint Lysholm function score (Lysholm), UniPedal Stance Test (UST), Star Excursion Balance Test ( SEBT), Relative Peak Torque, (RPT), and Knee joint Position PercePtion (KJPP), to check the maintenance of the effect of any intervention.DiscussionFor the first time in this trial, the impact will be evaluated. If the results are the same as expected, they will provide evidence that TT combined with KT sticking intervention can promote the posture control of patients with early PFPS.Trial registrationChinese Clinical Trial Registry ChiCTR2100051166. Registered on 15 September 2021.

Predilection of Patellofemoral Cartilage Lesions in Patients with Posterior Medial Meniscal Root Lesions.

The present study aims to compare the presence and severity of patellofemoral osteoarthritis between patients with root lesions and non-root lesions. A total of 102 patients were included in this study (51 root lesions and 51 non-root lesions). The root lesion cohort was matched to a non-root lesion cohort based on sex, body mass index, and age at the time of surgery. Radiographic evaluation with modified Outerbridge scoring of MRI of the knee was performed to determine the severity of degeneration of the knee joint preoperatively. Mann-Whitney and Independent t tests were used to compare the groups. The root lesion group had statistically greater Outerbridge patella scores (M = 2.45 ± 1.12) and trochlear scores (M = 2.27 ± 1.37) than the non-root lesion patients (M = 1.78 ± 1.30, P = 0.006, and M = 1.55 ± 1.40, P = 0.010, respectively). When using a new scale for grading patellofemoral arthritis, the root lesion group had statistically greater scores (M = 8.33 ± 3.38) than the non-root lesion patients (M = 5.67 ± 3.07) (P < 0.001). Patients with root lesions have a greater degree of patellofemoral cartilage lesions than patients without root lesions. The presence of cartilage lesions preoperatively in root lesion patients has presented the question of whether repair is worthwhile or if one should delay surgery until arthroplasty is indicated. Future research should be carried out on outcomes of root repair surgery in patients with patellofemoral cartilage lesions, in addition to considering the patient's age, activity level, and other risk factors.

What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study

BackgroundInfluences on anterior knee pain, stair climbing limitations, and function such as rising from sitting are poorly understood in unicompartmental knee arthroplasty (UKA). Original indications for UKA excluded patients who had patello-femoral disease, while more recent studies have expanded the indications to include these patients. This study examined the influence of the patello-femoral joint degeneration on patient-reported outcome measures relating to anterior knee pain and function after UKA. MethodsBetween October 2017 and August 2021, Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR) patient-reported outcome measures were collected preoperatively and at 12 months of follow-up for 678 medial UKAs. Patello-femoral joint status was visually graded intraoperatively. Radiographic or intraoperative medial patellar facet and trochlear patello-femoral arthritis and preoperative anterior knee pain were not considered contraindications for UKA, while grade IV lateral patello-femoral arthritis was considered a contraindication for UKA. Multivariable ordinal logistic regressions were performed, using the KOOS, JR questionnaire assessing pain during stair climbing, standing upright, and function during rising from sitting. Independent regressions were performed for each targeted KOOS, JR question, with adjustments for age at surgery, sex, and baseline pain and function scores. ResultsNo association was observed between 12-month postoperative anterior knee pain (P = .575) and function (P = .854) with patellar osteoarthritis grading after UKA. When comparing fixed and mobile-bearing UKA designs, no association was observed between bearing type and pain (P = .663) or functional outcomes (P = .758). ConclusionPain and function improved significantly following medial UKA and was independent of medial patellar and trochlear degenerative status.

Severe patellofemoral arthritis does not compromise 6-month post-operative range of motion or function following unicondylar knee arthroplasty.

The presence of significant patellofemoral arthritis (PFA) is still considered a contraindication for unicondylar knee arthroplasty (UKA) by many surgeons. The purpose of this study was to determine if the presence of severe PFA at the time of UKA compromised early (< 6months) post-operative knee range of motion or functional outcomes. This retrospective review evaluated unilateral and bilateral UKA (323 patients; 418 knees) between 2015 and 2019. Procedures were grouped by degree of PFA present at the time of surgery, including mild PFA (Group 1; N = 266), moderate to severe PFA (Group 2; N = 101), and severe PFA with lateral compartment bone-on-bone contact (Group 3; N = 51). Knee range of motion and Knee Society Knee (KSS-K) and Function (KSS-F) scores were collected both before and at 6months following surgery. Group differences were evaluated with Kruskal-Wallis and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariable logistic regressions were performed to determine influential variables associated with post-operative knee flexion being ≤ 120° and presented as odds ratios (OR) and 95% confidence intervals (CI). Pre-operative flexion was lowest in Group 3 (p = 0.010) with 17.6% of knees having flexion ≤ 120°. Post-operative flexion was lowest in Group 3 (119.1° ± 8.4°, p = 0.003) with 19.6% knees having flexion ≤ 120° compared to 9.8% and 8.9% in Groups 1 and 2, respectively. No significant difference in KSS-F following surgery was found; all three groups demonstrated similar clinical improvement. Increased age (OR 1.089, CI 1.036-1.144; p = 0.001) and body mass index (OR 1.082, CI 1.006-1.163; p = 0.034) were found to be associated with post-operative knee flexion ≤ 120°, while high pre-operative flexion (OR 0.949, CI 0.921-0.978; p = 0.001) was found to be inversely associated with poor knee flexion following surgery. Patients with severe PFA demonstrate similar clinical improvement following UKA at 6months as patients with less severe PFA.

Poster 300: A Novel Magnetic Resonance Imaging (MRI) Scoring System to Evaluate Patellofemoral Osteoarthritis

Objectives: Knee osteoarthritis (OA) is a common degenerative or post-traumatic condition, and may affect one or more compartments, including the medial and lateral tibiofemoral or patellofemoral articulations. Isolated patellofemoral osteoarthritis (PFOA) has been reported in 24% of women and 11% of men aged &gt; 55 years presenting for evaluation of knee pain. PFOA is a result of abnormal mechanical loading across the patellofemoral joint, often related to prior instability, trauma, malalignment or post- surgical changes. Treatment of PFOA typically includes a trial of conservative management, including physical therapy, injections and activity modification. Operative treatment involves joint preservation (i.e., cartilage restoration procedures, tibial tubercle osteotomy, or lateral lengthening) and joint replacement (patellofemoral arthroplasty) procedures. In contrast to the tibiofemoral compartments, the current literature lacks a reliable magnetic resonance imaging (MRI) scoring system to quantitatively evaluate patellofemoral cartilage degeneration. The present study aims to describe, apply and assess the inter-observer reliability of a novel MRI scoring system for assessment of the patellofemoral cartilage. Methods: We conducted a query of an institutional database to identify all patients who underwent patellofemoral arthroplasty by the senior surgeon (S.M.S.) between January 2012 and December 2021. Patients with poor quality or lacking preoperative knee MRI were excluded. MRI scans were performed on 1.5 or 3.0-Tesla magnets utilizing dedicated extremity coils and standardized clinical imaging protocols consistent with International Cartilage Regeneration and Joint Preservation Society (ICRS) guidelines for the assessment of articular cartilage. Preoperative MRI scans were reviewed and patellofemoral cartilage was scored by a fellowship-trained musculoskeletal radiologist and a fellowship- trained orthopedic knee surgeon using our novel MRI scoring system. The novel semi-quantitative MRI patellofemoral scoring system includes assessment of patellar and trochlear cartilage, bony architecture, patellofemoral alignment, and synovitis (Table 1). For statistical analysis, inter-observer agreement was assessed using Cohen-Kappa coefficient for categorical variables, and intraclass correlation coefficient (ICC) for the total score. The measurement agreement for reach variable and total score was interpreted according to the Landis and Koch criteria: 0 - 0.2, slight; 0.21 - 0.4, fair; 0.41 - 0.6, moderate; 0.61 - 0.80, substantial; 0.81 - 1.0, almost perfect. Results: A total of 72 patients were included in the final analysis. The mean (± standard deviation) age and body mass index (BMI) of all patients was 53.30±7.72 years and 27.3±5.37 kg/m, respectively. Patellar bone edema and patellar cysts demonstrated moderate inter-observer agreement. All cartilage features, trochlear bone edema and cysts, osteophytes, subchondral remodeling, patellar height, and synovitis demonstrated substantial inter-observer agreement. Patellofemoral alignment and total score demonstrated almost perfect inter-observer agreement (Table 2 and Figure 1). Conclusions: The novel MRI scoring system for PFOA proposed by the authors is an attempt to develop a comprehensive method to assess patellofemoral joint cartilage degeneration, including evaluation of patellar and trochlear cartilage changes, bony architecture, patellofemoral alignment, and synovitis. Importantly, all features of the scoring system demonstrated at least moderate inter-observer agreement, with the majority of variables and total score demonstrating substantial to near perfect agreement. Future studies should aim to validate this scoring system in patients with and without patellofemoral arthritis and attempt to correlate scores with clinical outcomes. [Table: see text][Table: see text]

Poster 312: Graft harvest for ACL reconstruction from the contralateral knee does not increase patellofemoral arthritis rates versus a normal knee

Objectives: Previous outcome studies after anterior cruciate ligament (ACL) reconstruction have suggested a link between patella tendon (PT) graft harvest and increased incidence of patellofemoral (PF) degenerative changes. However, with the graft harvest on the same knee as the ACL reconstruction, it is difficult to specifically elucidate whether this association is directly from the graft harvest itself as opposed to other factors. Knowledge of the incidence of PF osteoarthritis (OA) after graft harvest from the contralateral knee may provide insight into this relationship. The purpose of this study was to compare PF OA rates between contralateral versus ipsilateral graft harvest for ACL reconstruction. Methods: A database of long-term follow up of ACL reconstruction patients done by a single surgeon was queried to find surgeries done between minimum 15 years and maximum 25 years ago. Patients were included if they had long term radiographs within this window for evaluation of PF OA. Exclusion criteria included revision ACL reconstruction, bilateral ACL involvement, subsequent graft retear, contralateral ACL tear, PF chondral wear seen at the time of surgery, preoperative or subsequent surgeries to either knee, or the presence of preoperative PF OA. Once patients met inclusion criteria, they were separated into groups based on ipsilateral or contralateral PT graft harvest. Standard Merchant’s radiographs were taken by the same technicians with the assistance of a Merchant’s board. Radiographs were graded by the physical therapist that saw the patient back for their long term research visit, each individually trained to grade the images based on the set criteria. Radiographs were graded as none, mild, moderate, or severe PF OA based on joint space narrowing of none, &lt;50%, &gt;50% but &lt;100%, and complete, respectively. Patellofemoral OA rates were then statistically compared utilizing chi-squared analysis or Fisher’s exact test. These criteria produced an ipsilateral group with 95 patients and a contralateral group with 98 patients. Mean ages at time of surgery, height, weight, and sex distribution were not statistically different between groups. The ipsilateral group had a slightly, but statistically significantly, longer mean follow up interval (20.0 vs. 17.4 years, p&lt;.001). Results: In the ipsilateral graft group, PF OA of any grade was present in 20.0% of the involved ACL reconstructed knees and 9.5% of the uninvolved normal knees, which was a statistically significant difference ( p=.041, OR 2.4). In the contralateral graft group, PF OA was present in 10.2% of the ACL reconstructed knees and 13.3% of the contralateral graft donor knees ( p=.506). Patellofemoral OA of any grade was present in 14.7% of all knees in the ipsilateral group and 11.7% of all knees in the contralateral group ( p=.348). When comparing the uninvolved normal knee from the ipsilateral group to the contralateral graft donor knee of the contralateral group, there was no statistical difference in PF OA rates of any grade (9.5% vs. 13.3% p=.407). The ACL reconstructed knee in the ipsilateral group exhibited PF OA in 20.0% and 10.2% in the contralateral group ( p=.057). With regard to moderate or severe PF OA in either knee, the rates were not statistically significant between the ipsilateral and contralateral groups. When comparing the ipsilateral group normal knee to the contralateral group donor knee, the rates of moderate or severe PF OA were 1.1% and 2.0% respectively, which was not statistically significantly different. Conclusions: Previous studies suggest that patella tendon grafts are associated with higher rates of PF OA after ACL reconstruction. Our study reveals that PF OA rates are not statistically increased when a patella tendon graft alone is taken from the knee, when compared to a normal control knee. However, when ACL reconstruction and PT graft are combined in the same knee, there is a statistically significant increase in PF OA versus the uninvolved normal knee, with the ACL reconstructed knee with ipsilateral graft being 2.4 times more likely to experience PF OA than the uninvolved knee. Furthermore, harvesting the ACL graft from the contralateral knee trends toward decreased PF OA rates in the ACL reconstructed knee, though this is not statistically significant. We conclude that the PT graft itself does not increase PF OA rates and that contralateral PT graft harvest may provide advantages to ipsilateral graft harvest with regard to PF OA.

Patellofemoral Arthroplasty.

Patellofemoral arthroplasty (PFA) as a treatment option for isolated patellofemoral disease continues to evolve. Enhancement in patient selection, surgical technique, implant design, and technology has led to improved short-term and midterm outcomes. Furthermore, in the setting of a younger patient with isolated patellofemoral arthritis, PFA represents an option for improved function with faster recovery times, bone preservation, maintenance of ligamentous proprioception, and the ability to delay total knee arthroplasty (TKA). The most common reason for revising PFA to a TKA is progression of tibiofemoral arthritis. In general, conversion of PFA to TKA leads to successful outcomes with minimal bone loss and the ability to use primary TKA implants and instrumentation. PFA seems to be a cost-effective alternative to TKA in appropriately selected patients with 5-, 10-PFA survivorships of 91.7% and 83.3%, respectively, and an annual revision rate of 2.18%; however, more long-term clinical studies are needed to determine how new designs and technologies affect patient outcomes and implant performance.

Short-Term Outcomes of Concomitant Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction to Treat Concurrent Patellofemoral Arthritis and Patellar Instability.

The purpose of this study was to evaluate the efficacy of combined patellofemoral arthroplasty (PFA) and medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral arthritis in the setting of concomitant patellar instability. Patients who underwent single-stage, combined PFA and MPFL reconstruction by a single surgeon at a tertiary-care orthopaedic center between 2016 and 2021 were identified. Postoperative radiographic and clinical outcomes at a minimum of 6 months were recorded using patient-reported outcome measures, including International Knee Documentation Committee (IKDC), Kujala, and VR-12. Early complications and rates of recurrent instability were also recorded. Of the 16 patients who met inclusion and exclusion criteria, 13 patients were available for final follow-up (81%; 51.7 ± 7.2 years, 11 females, 2 males) with a mean clinical follow-up of 1.3 ± 0.5 years (range: 0.5-2.3 years). Patients experienced significant improvements in patellar tilt and multiple patient-reported outcome metrics postoperatively, including IKDC, Kujala, VR-12 Mental Health, and VR-12 Physical Health. At the time of the most recent follow-up, no patient had experienced a postoperative dislocation or subluxation event. The findings suggest that concurrent PFA and MPFL reconstruction are associated with significant improvements in multiple patient-reported outcomes. Further studies are needed to evaluate the duration of clinical benefits achieved with this combined intervention.

Lateral Retinacular Release During Medial Unicompartmental Knee Arthroplasty in the Presence of Patello-Femoral Joint Arthritis Relieves Patello-Femoral Joint Pressure and Improves Associated Symptoms

BackgroundThis study evaluated the effects of concomitant lateral patellar retinacular release (LPRR) during medial unicompartmental knee arthroplasty (UKA). MethodsWe retrospectively analyzed 100 patients who had patello-femoral joint (PFJ) arthritis who underwent medial UKA with (n = 50) and without (n = 50) LPRR who had ≥2 years follow-up. Radiological parameters associated with lateral retinacular tightness, including patellar tilt angle (PTA), lateral patello-femoral angle (LPFA), and congruence angle, were measured. Functional evaluation was performed using the Knee Society Pain Score, Knee Society Function Score (KSFS), Kujala Score, and the Western Ontario McMaster Universities Osteoarthritis Index score. Intraoperative patello-femoral pressure evaluation was performed on 10 knees to evaluate the pressure changes before and after LPRR. Mann–Whitney U-tests were used for statistical analyses. ResultsDemographic data did not differ between the LPRR(+) and LPRR(−) groups. A decrease in PTA and an increase in LPFA were observed in the LPRR(+) group compared to those in the LPRR(−) group (PTA; −0.54 versus −1.74, P = .002, LPFA; 0.51 versus 2.01, P = .010). The LPRR(+) group showed significantly better KSFS and Kujala scores than the LPRR(−) group (KSFS: 90 versus 80, P = .017; Kujala score: 86 versus 79, P = .009). Intraoperative patello-femoral pressure analysis showed a 22.6% reduction in the PFJ contact pressure and an 18.7% reduction in PFJ peak pressure after LPRR. (P = .0015, P < .0001, respectively) ConclusionA LPRR during UKA may be a simple and useful adjunct procedure to relieve PFJ symptoms with concomitant PFJOA.

Etiology and Exercise Treatment of Patellofemoral Pain Syndrome

Objective: As a result of peripatellar pain or anatomical or biomechanical anomalies in the anterior knee, patellofemoral pain syndrome (PFPS) is a knee injury that can be made worse by weight-bearing activities like climbing and descending stairs. According to long-term follow-up studies, patellofemoral arthritis may eventually develop in 45% of PFPS patients who do not receive prompt and efficient treatment in the early stages, causing irreparable harm that may significantly impair the patient's quality of life. In order to prevent injuries, enhance daily life activities and athletes' sporting performance, it is important that we understand the mechanism and exercise treatment of PFPS. Methods: We reviewed the China Knowledge Network (CNKI) and PubMed life science database, searched for the terms "patellofemoral pain syndrome," "patellar tenderness," "running knee," and "anterior knee pain," and summarized the pertinent research. Results: Its cause is still unknown, and its etiology is complicated, with the main contributing factors being poor lower extremity function, decreased muscle strength, lack of flexibility, and impaired neuromuscular control. The majority of exercise therapy currently performed includes training the hip, knee, core, retraining the gait, and blood flow restriction training. The impact of the condition may depend on quick and efficient interventions. Conclusion: Exercise therapy had the strongest evidence base, particularly for the positive effects of either single hip or knee muscle strength training or a combination of the two, according to systematic evaluations that came to conclusions about the effectiveness of interventions. However, there was insufficient evidence to determine the ideal form of training and long-term effects. Contrarily, there is still scant evidence to support interventions such as gait retraining, blood flow restriction training, and core stability training. When it comes to selecting a course of treatment, a combination of treatments is typically advised and chosen in accordance with the precise evaluation of the patient's condition.

Varus osteotomy as a salvage procedure for young patients with symptomatic patellofemoral arthritis and valgus malalignment at short- to mid-term follow-up

Constrained primary total knee arthroplasty (TKA) can provide stability in the face of incompetent collateral structures or irreconcilable flexion–extension imbalances. However, little is known about its effect on overall knee range of motion (ROM). This study determines whether TKA with increased constraint affects postoperative ROM.Patients undergoing primary TKA using either posterior stabilized (PS) or constrained condylar knee (CCK) inserts were match-paired based on body mass index, preoperative ROM, and direction and severity of the coronal deformity, yielding 68 pairs. ROM and Knee Society Score (KSS) were obtained preoperatively and at 6 weeks, 4 months, and 1 year.When the 68 matched pairs were considered, all outcome variables related to ROM between the PS and CCK groups at each of the postoperative intervals were similar. Additionally, both the individual items and combined scores of the KSS were similar between groups at all time points.We demonstrate that the use of increased constraint does not affect ROM, relief of pain, or function after TKA.Level III (retrospective case-controlled study, based on prospectively collected data).

Effect of open-wedge high tibial osteotomy and lateral patellofemoral retinacular release on patellar position: an X-ray imaging-based comparative study.

Open-wedge high tibial osteotomy (OWHTO) may cause adverse changes in the mechanical environment of the patellofemoral joint. For patients with lateral patellar compression syndrome or patellofemoral arthritis, intraoperative management is still challenging. The effect of lateral retinacular release (LRR) on patellofemoral joint mechanics after OWHTO remains unclear. Our study aimed to evaluate the effect of OWHTO and LRR on the patellar position based on lateral and axial radiographs of the knee joint. The study comprised 101 knees (OWHTO group) undergoing OWHTO alone and 30 knees (LRR group) undergoing OWHTO and concomitant LRR. The following radiological parameters were statistically analyzed preoperatively and postoperatively: femoral tibial angle (FTA), medial proximal tibial angle (MPTA), weight-bearing line percentage (WBLP), Caton-Deschamps index (CDI), Insall-Salvati index (ISI), lateral patellar tilt angle (LPTA), and lateral patellar shift (LPS). The follow-up duration ranged from 6 to 38 months, with a mean of 13.51±6.84 months in the OWHTO group and 12.47±7.81 months in the LRR group. The Kellgren-Lawrence (KL) grading system was used to evaluate changes in patellofemoral osteoarthritis (OA). Regarding the patellar height, preliminary analysis demonstrated a statistically significant decrease in the CDI and ISI in both groups (P<0.05). However, there was no significant difference in changes in CDI or ISI between the groups (P>0.05). In the OWHTO group, although there was a significant increase in the LPTA (P=0.033), the postoperative decrease in the LPS was not significant (P=0.981). In the LRR group, both the LPTA and LPS significantly decreased postoperatively (P=0.000). The mean changes in LPS were 0.03 mm in the OWHTO group and 1.44 mm in the LRR group, indicating a significant change in LPS (P=0.000). However, there was no significant difference in changes in LPTA between the groups, which was contrary to our expectations. Imaging showed no change in patellofemoral OA in the LRR group and progressive changes (from KL grade I to II) in patellofemoral OA in 2 (1.98%) patients in the OWHTO group. OWHTO can cause a significant decrease in patellar height and an increase in lateral tilt. LRR can significantly improve the lateral tilt and shift of the patella. The concomitant arthroscopic LRR should be considered for the treatment of patients with lateral patellar compression syndrome or patellofemoral arthritis.

A PROSPECTIVE STUDY TO EVALUATE EFFECTIVENESS OF KINESIO TAPING IN NON-TRAUMATIC CHRONIC KNEE PAIN

Background: Kinesio tape has multiple benefits including decreasing pain, increasing proprioception, increasing quadriceps muscle strength, and improving lymphaticcirculation at the knee joint. To evaluate the effectiveness of kinesiotape innon traumatic chronic knee pain. Material and Methods: Aprospective study was done from august 2020 to January 2022 in nscb medical college jabalpur on 80 patients with patello femoral arthritis of knee joint and early grade medial joint line arthritis of knee joint(kellgenlawrencegrading) in which kinesio tape was applied over knee for 6 days by an orthopaedicsurgeonand followed up at end of 1st , 2nd , 3rd , 4th week and outcomes were measured using WOMAC(western Ontario and mcmaster university arthritis index) and Vas(visual analogue scale) scores. Results: VAS score(pre application:7.12, after 4 weeks:4.68)and WOMAC score( pre application:46.18, after 4 weeks:35.65)showed a statistically decrease in scores in cases of patellofemoral arthritis and early grade medial joint line arthritis of knee joint.(p value &lt;0.001) Conclusion: Kinesio tape appears to beaneffective,easy and cheap method in early symptomaticpatello femoralosteoarthritis and early grade medial joint line arthritis of knee joint.

Effect of kinetic exercises versus isometric exercises among patellofemoral arthritis patients: An experimental study

Introduction and Aim: Patellofemoral arthritis (PFOA) is one of the most common causes of anterior knee pain in adults and is more common in women than men. The aim of the study was to investigate the effect of kinetic chain exercises versus isometric exercises and to reduce the pain and improve the quality of Life. Materials and Methods: The present study was conducted in a physiotherapy clinic. For the comparative experimental study, 30 subjects were taken in each group and the total duration of the study was 6 weeks (30 minutes duration /once a day /5 day a week) from June 2022 to mid-August 2022. Method of sampling was a purposive sampling technique. Results: Numerical pain rating scale (NPRS) Kujala Scoring Questionnaire (Anterior knee pain scale). Conclusion: From the data obtained it was evident that the kinetic chain exercise group patients showed marked improvement than group B.

Development and Preliminary Evaluation of the CHARUSAT Patellofemoral Arthritis Questionnaire

Background: Knee osteoarthritis is one of the leading causes of the increasing global burden of musculoskeletal disorders. The prevalence rate of patellofemoral arthritis is 39% in South Asia in &gt;40 years of age. The census on early osteoarthritis recommends focusing on the prediagnostic stage. However, none of the tools is available to screen the early symptoms of patellofemoral arthritis. Purpose of the Study: The purpose of this study was to develop and evaluate the psychometric properties of the CHARUSAT Patellofemoral Arthritis Questionnaire. Methods: The questionnaire was developed using a mixed method stepwise approach. The participant with early patellofemoral arthritis (n = 14) was interviewed. We conducted scoping review and in-depth interviews to develop a conceptual framework. Initial content validation was completed through community consultation and expert opinion. Final psychometric validation was conducted on n = 310 individuals with early patellofemoral arthritis. Participants were recruited from tertiary hospitals' outpatient units and regional communities in India. Results: Conceptual framework was developed based on the current literature review, and qualitative data obtained from participants finalized the 4 domains and 12 content versions: crepitus (2 items), stiffness (2 items), pain (2 items), and difficulty in functional activity (6 items). The psychometric measurement demonstrated good internal consistency, Cronbach's alpha α was 0.90 and an acceptable level of inter-item redundancy. The intraclass correlation coefficient (ICC) value for the test and retest assessment was 0.93 (ICC:2,1; 95% confidence interval = 0.880–0.936; P &lt; 0.000). Principal component analysis demonstrates a four-factor solution with 56.83% total variance. Conclusions: It is an acceptable, reliable, and valid self-administered questionnaire that can identify the early symptoms of patellofemoral arthritis. The questionnaire provides an excellent opportunity for self-analysis of the symptoms at the community level.

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

Objectives: To compare the outcomes of patellar replacement and patellar neurectomy in Patients undergoing Total Knee Replacement . Materials &amp; Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. Total 30 Patients were enrolled in this study and they were divided into two groups. Group A constitutes of 15 Patients underwent Post tibial neurectomy. And Group B consisting of 15 Patients went through Tibial Resection. All the patients have been assessed through the Tinel test on the painful area and self-administered Patient-Reported Outcome Measurements (PROMs): Patellar replacement also known as patellofemoral arthroplasty, is a surgical procedure that is performed in conjunction with total knee replacement (TKR) to relieve pain in the knee joint caused by patellofemoral arthritis or other conditions affecting the patella. All the patients of Group B were given anesthesia to numb the area. An incision was made in front of the knee to expose the patella and surrounding structures. Removal of the patella: The patella was carefully removed from the knee joint. The underside of the patella was reshaped to fit a prosthetic component that was implanted in its place. The patellar component was attached to the reshaped surface of the patella using bone cement. The patella was repositioned in the knee joint and attached to the femur using sutures. The incision was closed using sutures or staples. The goal of patellar replacement is to reduce pain and improve function in the knee joint. All the group A participants went through Patellar neurectomy. Patellar neurectomy is a surgical procedure that involves cutting or removing the nerve endings that supply sensation to the patella. Results: Total 30 Patients participated in this study. In Group A =15 Patients who underwent patellar Neurectomy and 15 Patients in Group B who experienced Tibia Resection. Total 5 months follow up was done. Group B participants showed excellent Results. NRS score decreased to 0 in Group B. While in patellar Neurectomy group A two patients experienced still moderate pain, Remaining 13 patients although did not experienced pain but felt numbness on limbs. Practical Implication: Patellar neurectomy involves cutting or removing the nerve endings that supply sensation to the patella, interrupting the transmission of pain signals from the patella to the brain. Although it is less time consuming but can cause numbness or altered sensation in the skin over the patella, which may affect the patient's quality of life Does not address underlying patellar instability or misalignment, which can still cause pain and functional limitations Can be associated with a risk of complications such as neuroma, infection, stiffness. Conclusion: Patellar Resection with TKA has better outcomes than Patellar Neurectomy. Patellar denervation with electrocautery is effective in reducing pain and opioid consumption after total knee replacement. Postoperative range of motion is significantly better in patellar denervation group, which means that patellar denervation significantly improves clinical outcome Keywords: Total Knee Replacement, Patellar Replacement, Neurectomy, Neurectomy, Tibia Resection, Pain, Prosthesis

Study on the correlation between the severity of patellofemoral arthritis and the morphology of the distal femur

PurposeDistal femoral torsion is a key factor for poor alignment of patellofemoral joint. This study aims to evaluate the correlation between distal femoral torsion and the severity of patellofemoral arthritis, and to analyze the correlation between distal femoral torsion and the morphology of femoral condyle.MethodsA retrospective analysis was performed on 125 patients awaiting surgical treatment for knee osteoarthritis from January 2021 to March 2022(79 females, 46 males, average age: 65.78 years, SD 6.61). All patients underwent knee joint radiography, lower-limb digital radiography, and knee joint CT scans. The ratio of length of each distal femoral condyle, TT-TG, patellar tilt, DFL-PCL, DFL-TEA, TEA-PCL and TEA-ACL were measured. The Pearson correlation coefficient was used to evaluate the correlation between distal femoral torsion and ratio of distal femoral condyle, TT-TG and patellar tilt. Logistic regression was used to evaluate the correlation between each parameter and the severity of PFOA.ResultsWith the increased severity of PFOA, TT-TG, patellar tilt, DFL-PCL, DFL-TEA and PCA all tended to increase. Patellar tilt was correlated with DFL-PCL (r = 0.243) and TEA-PCL(r = 0.201), but TT-TG had no evident correlation with distal femoral torsion. Compared with Grade I patients of PFOA, DFL-PCL, DFL-TEA, and TEA-PCL were risk factors for increased severity of patellofemoral arthritis in Grade III patients of PFOA, but there was no significant statistic difference in Grade II patients of PFOA.ConclusionsDistal femoral torsion correlates with the severity of patellofemoral arthritis. Variation of the femoral transepicondylar axis caused by the change of ratio of the femoral condyle is particularly important in the distal femoral torsion. In patients with severe PFOA, abnormal variation of the femoral condyle axis should be not ignored.

Tibial tubercle osteotomy to unload the patellofemoral joint

The tibial tubercle osteotomy (TTO) is a versatile tool for unloading patellar and trochlear focal chondral defects as well as treating patellofemoral arthritis with or without patellofemoral instability. The TTO indirectly functions to address chondral defects in the patellofemoral joint (PFJ) by unloading compressive forces in the affected area and preventing further chondral deterioration and pain. Since its inception, the TTO technique has undergone iterative modification and refinement. The Fulkerson anteromedialization has persisted as the workhorse of modern TTO procedures with good surgical results, though it is not without limitations. Recently, the use of novel surgical systems such as the multidirectional tibial tubercle transfer as well as concomitant soft tissue balancing procedures have been implemented to address challenges posed by the classic Fulkerson technique and improve TTO customizability and reproducibility. In addition, TTO has increasingly been used in conjunction with concomitant procedures such as autologous chondrocyte implantation and osteochondral allograft transfer in the PFJ, to protect the restored cartilage from repeat injury. Though the anteriorization TTO has long been supported to help alleviate pathologic joint compression, recent advancements in surgical guides as well as combined procedures involving multiplane TTO, cartilage restoration, and soft tissue balancing allow for customization of treatment that more thoroughly addresses the complex anatomy and pathology in the PFJ. This article aims to provide an overview of the rationale and recent advancements in the use of TTO to unload and treat chondral defects in the PFJ.

Complications and costs of patellofemoral arthroplasty versus total knee arthroplasty

BackgroundPatellofemoral arthroplasty (PFA) is an alternative to total knee arthroplasty (TKA) for the treatment of patellofemoral arthritis. Although PFA may preserve native kinematics and accelerate recovery, it has been associated with higher revision rates. The purpose of this study is to compare complication rates and costs between PFA and TKA. MethodsUsing the PearlDiver database, 6,179 patients with isolated patellofemoral arthritis treated with PFA or TKA from 2010-2015 were retrospectively reviewed with 5-year follow up. PFA and TKA patients were matched by age, sex, and Elixhauser Comorbidity Index via a 1:1 stepwise algorithm. Five-year costs and complications were compared between matched cohorts. The lifetime costs of PFA and TKA were evaluated with Markov decision modeling. ResultsCompared to TKA, PFA was associated with fewer Emergency Department (ED) visits (6.1% vs 3.9%, p = 0.004) but a higher 5-year revision rate (9.9% vs 4.2%, p < 0.001). After multivariate regression, PFA was independently more likely to require revision (odds ratio 2.60, 95% confidence interval 1.32–4.71, p = 0.003). PFA was associated with lower total healthcare costs at every time point between 3 months ($18,014 vs $26,473, p < 0.001) and 5 years ($20,837 vs $27,942, p < 0.001). On average, the lifetime cost of PFA per patient was $5,235 less than for TKA ($26,343 vs $31,578). ConclusionsPFA is a less expensive alternative to TKA with a similar risk of medical complications but is associated with a significantly higher 5-year revision rate. Future studies should examine the reasons for PFA failure and methods to mitigate this risk.