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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-four patients who had undergone the Elmslie-Trillat procedure from 1985 to 1989 were examined in order to evaluate the effectiveness of this operation in the treatment of recurrent subluxation of the patella. The result of an increased Q angle accompanied by patella alta, femoral sulcus dysplasia, or vastus medialus obliquus dysplasia was also studied. Only those patients with recurrent subluxation of the patella took part in this study; cases of habitual or permanent dislocation, potential instability, traumatic dislocation, and degenerative arthritis were excluded. The patients were reviewed both clinically and radiographically, and the A.R.P.E.G.E. scoring system was used to evaluate the results. The follow-up period ranged from 1 year to 5 years and 4 months, with an average of 3 years. The overall results were excellent or good in 77% of the cases, as was the subjective knee stability rating in 87% of the cases and the pain rating in 82% of the cases. Recurrence of the subluxation was observed in only one instance. The results were not significantly different when the groups of patients with patella alta and type 1 femoral sulcus dysplasia were considered separately. The results were also excellent in the patients who underwent the Elmslie-Trillat procedure with reconstruction of the vastus medialis obliquus. In conclusion, surgical realignment of the anterior tibial tubercle confirmed its reliability in the treatment of recurrent subluxation of the patella. In cases of patella alta, the authors recommend lowering the anterior tibial tubercle only when the Insall-Burstein index is greater than 1.3. Femoral sulcus-plasty should be performed in cases of type 3 sulcus dysplasia.
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PMID:The Elmslie-Trillat procedure for recurrent subluxation of the patella. One to five year follow-up. 130 79

The influence of a physical therapy program on pain and patellar tracking was investigated clinically and radiologically with tangential views in 51 knees with lateral patellar compression syndrome. A pretest-posttest design was used to evaluate physical measurements of patellar alignment in subjects who had had patellofemoral pain for a minimum of 6 weeks. Eighty-four percent of the subjects were pain-free after an average of 8 weeks of rehabilitation or 11 physical therapy visits, with a mean quadriceps strength to total body weight ratio of 61% in women and 86% in men. The pretest-posttest difference in Merchant's congruence angle was significant at a probability of 0.0066 in the patients who were pain-free after exercise, demonstrating less lateral patellar tracking. The pretest-posttest difference in iliotibial band flexibility was significant at a probability of 0.0017, with the patients who were pain-free after exercise becoming more flexible. No significant differences were observed from before to after exercise in the patellofemoral index, Q angle, hamstring flexibility, thigh measurement, sclerotic subchondral bone, or sulcus angle. We were unable to predict which subjects would become pain-free with exercise by patellar position because the group that improved began more laterally tilted. The results of this study indicate that patellar tracking is improved with vastus medialis oblique strengthening, iliotibial band stretching, and joint mobility exercise in the majority of subjects with lateral patellar compression syndrome.
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PMID:The effect of exercise on patellar tracking in lateral patellar compression syndrome. 141 87

To elucidate and attempt to dissociate the two mechanisms, neuromuscular and mechanical, underlying patellofemoral pain syndrome, 18 subjects, divided into two groups based on a diagnosis of patellofemoral pain syndrome and the knee Q angle, were studied. The control group was asymptomatic and exhibited a normal Q angle (mean, 8.25 degrees), whereas the other group, diagnosed as patellofemoral pain syndrome patients, reported knee pain and had an above-normal Q angle (mean, 21.05 degrees). All subjects were tested for isometric maximum knee extension at 90 degrees, 30 degrees, and 15 degrees of knee flexion while they were seated in a special restraining chair. During testing, surface electromyography at the oblique and long fibers of the vastus medialis, and at the vastus lateralis were recorded along with the knee moment of force. The integrated electromyographic signals associated with the peak torque for all of the vastus muscles, along with the vastus medialis obliquus:vastus lateralis and vastus medialis longus:vastus lateralis activity ratios showed no significant differences between groups nor between the three angles, suggesting that all vasti measured were consistently active throughout the studied range of motion. This suggests that the neural drive was not affected in the patellofemoral pain syndrome patients. However, when the five patients showing the largest Q angles were isolated, they revealed a significantly smaller vastus medialis obliquus:vastus lateralis ratio when compared to the other group. The same ratio was also significantly smaller at 15 degrees compared to 90 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Quadriceps femoris muscle activity in patellofemoral pain syndrome. 144 19

The purpose of this study was to extend our knowledge of running related injuries by determining whether relationships exist between selected anthropometric, biomechanical, muscular strength and endurance, and training variables and runners afflicted with patellofemoral pain (PFP). Specifically, the objectives of this study were to examine differences in selected measures between a non-injured control group (C) of runners (N = 20) and a group of injured runners (INJ) diagnosed by an orthopedic surgeon as having PFP (N = 16). High speed photography, a force platform, and isokinetic dynamometry were used to determine rearfoot motion, ground reaction forces, and knee muscular strength and endurance. Stepwise discriminant function analyses were performed on the anthropometric, biomechanical, and muscular strength and endurance variables. Q angle was a significant discriminator (P less than 0.01) between the INJ and C groups. The muscular endurance data revealed several significant discriminators with the INJ subjects being weaker in knee extension endurance. Kinetic analysis revealed several significant discriminators whereas rearfoot movement variables were not good discriminators between the groups. The training data revealed that the INJ group ran significantly less (P less than 0.01) miles.wk-1 than the C group. Our results suggest that Q angle is a strong discriminator between runners afflicted with PFP and non-injured runners. In addition, several muscular endurance and kinetic variables may also be important components of the etiology of PFP.
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PMID:Etiologic factors associated with patellofemoral pain in runners. 194 20

A technique for utilizing a modified superomedial portal, 6 cm proximal to and in line with the medial edge of the patella, is described for observing patellar tracking and performing a lateral retinacular release. The lateral release is performed without tourniquet using electrosurgery, and the knee is positioned in 90 degree flexion for two days postoperatively. The technique was used in 53 patients with lateral patellar and soft tissue tenderness and pain, 31 of whom had lateral patellar subluxation documented on 45 degrees Merchant x-ray views. Patients with a history of dislocation or a Q angle of more than 18 degrees were excluded. Conservative treatment averaged seven months pre-operatively. Results in 75% of the patients (37 knees) were rated good or excellent at an average follow-up of 20 months. One postoperative hemarthrosis occurred. This technique facilitates patellar evaluation and lateral release under direct vision using the same portal, as well as permitting early range of motion postoperatively.
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PMID:Arthroscopic lateral retinacular release using a modified superomedial portal, electrosurgery, and postoperative positioning in flexion. 340 24

The clinical histories of 50 young athletes who complained of patellar instability or pain were analyzed, and their physical findings were compared to those of 50 controls. The patients were divided into three groups, based on their symptoms. Analysis of their physical findings confirmed the validity of these divisions. Those who complained of frank dislocation of the patella exhibited the most pronounced stigmata of quadriceps dysplasia, including vastus medialis deficiency and infrapatellar fat pad enlargement, and had increased general ligamentous laxity, increased mean patellar mobility, and out-facing patellae with concomitantly decreased Q angles in chronic, recurrent cases. Patients who complained of the classic patellar pain pattern, often called "chondromalacia patella," but who denied swelling were designated CMP. They had normal mean ligamentous laxity and mean patellar mobility, an increased incidence of in-facing patellae with concomitantly increased mean Q angle, and frequently palpable lateral patellofemoral bands. Patients who complained of pain and swelling had physical findings intermediate to the other two groups, and generally correspond to what is usually termed subluxation of the patella. They exhibited normal general laxity but increased mean patellar mobility, normal mean Q angle but an increased incidence of patellar infacing, and fat pad enlargement.
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PMID:Clinical characteristics of patellar disorders in young athletes. 725 73

The purpose of this study was to evaluate the significance of the Q angle with respect to the patella position. Fifty-six knee joints of 34 patients (15 bilateral) with chronic patellofemoral pain were prospectively evaluated. All patients were examined by the same orthopaedic surgeon (R.M.B.) and the Q angle measured clinically and using long radiographs. Additionally, axial computed tomography (CT) scans were obtained through the center of the patellar articular cartilage in 0 degrees of flexion. Three different patellofemoral indices were measured by the second author (K.W.), who was not involved in the clinical examination: lateral patellar displacement (LPD), lateral patellar tilt (LPT), and patella-lateral condyle index (PLCI). These results were compared with the values of the measured Q angle. For statistical analysis, the Pearson correlation coefficient was calculated and the Statistical Package for Social Science (SPSS) used. A pvalue < 0.05 was considered significant. We could not find a significant correlation between the Q angle values and the patellofemoral indices in all patients (bilateral or only right/left). Within the patients with bilateral patellofemoral pain (n = 15), there was a significant correlation between LPD and PLCI (p = 0.015), LPT and PLCI (p = 0.024) left and LPD and LPT(p = 0.011) right. Similar results were found in patients with pain only on one side. In conclusion, there is no significance between the Q angle and the position of patella. The diagnostic relevance of the Q angle could not be established.
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PMID:Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. 1148 69

Foot orthoses often are prescribed for patients with patellofemoral pain. The purpose of this clinical commentary is to review the theoretical and research basis that might support this intervention and to provide our own clinical experience in providing foot orthoses for these patients. Literature is reviewed regarding (1) the effects of foot orthoses on pain and function, (2) the relationship between foot and lower-extremity/patellofemoral joint mechanics, (3) the effects of foot orthoses on lower-extremity mechanics, and (4) the effects of foot orthoses on patellofemoral joint position. The literature and our own clinical experience suggest that patients with patellofemoral pain may benefit from foot orthoses if they also demonstrate signs of excessive foot pronation and/or a lower-extremity alignment profile that includes excessive lower-extremity internal rotation during weight bearing and increased Q angle. The mechanism for foot orthoses having a positive effect on pain and function for these patients may include (1) a reduction in internal rotation of the lower extremity; (2) a reduction in Q angle; (3) reduced laterally-directed soft tissue forces from the patellar tendon, the quadriceps tendon, and the iliotibial band; and (4) reduced patellofemoral contact pressures and altered patellofemoral contact pressure mapping. Foot orthoses may be a valuable adjunct to other intervention strategies for patients who present with the previously stated structural alignment profile.
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PMID:The role of foot orthoses as an intervention for patellofemoral pain. 1466 61

Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders. However, no consensus on the definition, classification, assessment, diagnosis, or management has been reached. We evaluated symptoms and clinical findings in subgroups of individuals with PFPS, classified on the basis of the findings in radiological examinations and compared the findings with knee-healthy subjects. An orthopedic surgeon and a physical therapist consecutively examined 80 patients clinically diagnosed as having PFPS and referred for physical therapy. The examination consisted of taking a case history and clinical tests. Radiography revealed pathology in 15 patients, and scintigraphic examination revealed focal uptake in 2 patients indicating pathology (group C). Diffusely increased uptake was present in 29 patients (group B). In the remaining 29 patients radiographic and scintigraphic examinations were normal (group A). Knee-healthy controls (group D) reported no clinical symptoms. No symptom could be statistically demonstrated to differ between the three patient groups. Knee-healthy subjects differed significantly from the three patient groups in all clinical tests measuring pain in response to the provocations; compression test, medial and lateral tenderness, passive gliding of the patella, but they also differed in Q angle. Differences in clinical tests between the patient groups were nonsignificant. The main finding in our study on patients clinically diagnosed with PFPS is that possible pathologies cannot be detected from the patient's history or from commonly used clinical tests.
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PMID:Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain. 1684 49

The patellofemoral articulation has been frequently overlooked as a significant contributor to the success of primary total knee arthroplasty. Neglecting the patellofemoral articulation frequently leads to abnormal patellofemoral tracking. To understand the concept of patellofemoral maltracking, the importance of the Q angle, mechanical alignment, femoral component rotation, tibial component positioning, patellar component positioning, patellar height, and patellar resurfacing as factors related to patellofemoral tracking and function must be considered. Greater attention to and understanding of these factors will lead to significant pain relief and overall patient satisfaction.
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PMID:Patellar tracking in primary total knee arthroplasty. 1695 79


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