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

Postoperative anterior knee pain was evaluated in a consecutive series of 138 knees in 108 patients with rheumatoid arthritis treated by total knee replacement with Mark I Insall-Burstein prostheses. No knee had primary patellar resurfacing, and in the 119 knees followed up for a mean of 63.9 months, none had secondary resurfacing. Anterior knee pain was absent in 87 knees (73%), mild in 16 (13.5%) and moderate or severe in 16 (13.5%). The height of the patella above the prosthetic joint line was the only variable which was directly related to the incidence of anterior knee pain. The sensitivity and specificity of patellar height measurements for identifying patients with or without pain were derived. From these data, a selective policy of resurfacing the patella in those at risk was adopted. Choosing a patellar height of 15 mm or less, patellar resurfacing could be avoided in 80% of patients likely to have no pain, and the patella could be resurfaced in 65% of those likely to have anterior knee pain.
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PMID:Anterior knee pain in rheumatoid patients after total knee replacement. Possible selection criteria for patellar resurfacing. 2721 2

Anterior knee pain is a frequent musculoskeletal complaint affecting all ages, both sexes, athletes, and nonathletes alike. Numerous theories have been proposed regarding its etiology including patellar malalignment, quadriceps insufficiency, subluxation, quadriceps muscle tightness, and chondral defects. However, the mechanism by which these factors produce this pain is not clear. Knowledge of the distribution of nociceptive nerve fibers around the knee would seem to provide insight in treating these painful conditions. Eleven human patellae--eight specimens from patients with degenerative patellofemoral disease and three normals--were evaluated. Immunohistochemical techniques using monoclonal antibody to substance-P were employed to identify nociceptive fibers. Substance-P is a nociceptive neurotransmitter found in afferent nerve fibers. Substance-P fibers were isolated in the retinaculum, fat pad, periosteum, and subchondral plate of patellae affected with degenerative disease. This study demonstrates that selective tracting of nociceptive pain fibers is possible around the knee both in soft tissue and, in some circumstances, bone. The subchondral plate of normal patellae did not demonstrate erosion channels, but those with chondral defects from degenerative disease did. Nociceptive fibers found in these defects may explain the origin of symptoms in some patients. The distribution of substance-P nerve fibers in the soft tissues around the knee suggests that denervation may be the mechanism by which surgical procedures for anterior knee pain produce favorable results.
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PMID:Innervation of the human knee joint by substance-P fibers. 170 91

Anterior knee pain in adolescents is generally recognised as a common but benign self-limiting condition. Although many operative procedures for its treatment have been proposed, there is little statistical evidence that they are more effective than expectant management. A group of 54 adolescent girls has been followed for two to eight years from presentation with anterior knee pain. Although some pain persisted in the majority, in many the symptoms declined in severity. This study provides a baseline for comparison with the results of operative intervention; it is suggested that surgical treatment is unproven and unnecessary.
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PMID:The natural history of anterior knee pain in adolescents. 396 40

Anterior knee pain in our military population consititutes a diagnostic and therapeutic problem that is not always easily solved. In recent years, a better understanding of the biomechanics of the patello-femoral joint has contributed to the successful classification and treatment of many patients. However, the cause of pain remains elusive in a significant subset of patients who show no clinical or radiographic evidence of patellar malalignment and continue to have persistent pain despite adequate physiotherapy. In this article, the classification and approach to anterior knee pain are reviewed. Emphasis is placed on dividing patients into four subsets namely; normal tracking, patellar tilt, patellar subluxation and extra-articular causes of anterior knee pain. A more rational approach to the problem can then be employed and successful rehabilitation and/or surgery can be expected.
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PMID:Anterior knee pain in the military population. 914 May 80

Anterior knee pain is a frequent musculoskeletal complaint affecting adolescent population with incidence of 36% in 14 years old schoolchildren. Until late sixties anterior knee pain used to be associated with chondromalacia. This review discusses etiology and treatment of anterior knee pain. Various etiologic theories exist ranging from trauma and patellar maltracking to retinacular nerves injury. None of these theories has been generally accepted and etiology of patellofemoral pain remains unclear.
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PMID:[Anterior knee pain syndrome: a historical review]. 985 57

The aim of the study was to assess knee function after arthroscopic anterior cruciate ligament reconstruction and to analyse complications impeding rehabilitation, additional surgery until the final follow-up, as well as residual patellofemoral pain and donor-site problems. Between 1991 and 1994, 635 patients were operated on using patellar tendon autografts and interference screw fixation. Of these, 604 (95.1%) patients (403 male and 201 female) were re-examined by independent observers at the final follow-up 38 (range 21-68) months post-operatively. The Lysholm score was 85 (range 14-100) points and the Tegner activity level was 6 (range 1-10). Using the IKDC score, 206 patients (34.1%) were classified as normal, 244 (40.4%) as nearly normal, 122 (20.2%) as abnormal and 32 (5.3%) as severely abnormal. In patients with an uninjured contralateral knee (n = 527), the KT-1000 revealed a total side-to-side difference of 1.5 (range -7-11) mm, and 384/527 (72.9%) had a side-to-side difference of < or = 3 mm. The one-leg-hop test was 95% (range 0%-167%). One or more complications impeding rehabilitation were recorded in 184/604 patients (30.5%). The most common was an extension deficit (> 5 degrees), in 81 patients (13.4%). During the period until the final follow-up, 196 re-operations were performed in 161/604 (26.7%) patients. More than one re-operation was required in 27 patients. Shaving and anterior scar resection due to extension deficit were the most common procedures performed (on 65 occasions). Moderate to severe subjective anterior knee pain related to activity, walking up and down stairs, and sitting with the knee flexed was found in 203/604 patients (33.6%). The median loss of anterior knee sensitivity was 16 (range 0-288) cm2. Patients with a full range of motion had less anterior knee pain than patients with isolated flexion or extension deficits, or combined flexion and extension deficits (P < 0.05, P = 0.08 and P < 0.001, respectively). Patients with a full range of motion had less anterior knee pain than patients with extension deficits (with and without flexion deficits) (P < 0.001). Patients with a full range of motion and a minimal loss (< or = 4 cm2) of anterior knee sensitivity had significantly (P < 0.01) less subjective anterior knee pain than patients who did not fulfil these criteria. A considerable number of complications hindering the rehabilitation and conditions requiring additional surgery until the final follow-up were recorded. Anterior knee pain and problems with knee-walking were correlated with the loss of range of motion and anterior knee sensitivity.
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PMID:Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. 1002 55

Anterior knee pain (AKP) is a common pathological condition, particularly among young people and athletes, associated to an abnormal motion of the patella during the bending of the knee and possibly dependent on a muscular or structural imbalance. A lack of synergy in the quadriceps muscles results in a dynamic misalignment of the patella, which in turn produces pain. AKP rehabilitative therapy consists of conservative treatment whose main objective is to strengthen the Vastus Medialis. The aim of this article is to study the quadriceps muscle control strategy in AKP patients during an isokinetic exercise. Analysis of the muscle activation strategy is important for an objective measurement of the knee functionality in that it helps to diagnose and monitor the rehabilitative treatment. Surface electromyography (EMG) from the three superficial muscles of the femoral quadriceps during a concentric isokinetic exercise has been analyzed along with the signals of knee joint position and torque. A group of 12 AKP patients has been compared with a group of 30 normal subjects. Analysis of the grand ensemble average of the EMG linear envelopes in AKP patients reveals significant modifications in Vastus Medialis activity compared to the other quadriceps muscles. In order to study the synergy of the muscles, temporal identifiers have been associated to the EMG linear envelopes. To this end, EMG linear envelope decomposition in Gaussian pulses turned out to be effective and the results highlight an appreciable delay in the activation of the Vastus Medialis in AKP patients. This muscular unbalance can explain the abnormal motion of the patella.
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PMID:Study of the control strategy of the quadriceps muscles in anterior knee pain. 1100 13

Since the introduction of the Total Condylar Prosthesis (TCP) in 1974, concomitant improvements in surgical technique and prosthetic design have occurred. The individual effects of each of these variables have not been investigated, however. This study evaluates 2 different knee designs using the same operative technique by a single surgeon. All primary total knee arthroplasties performed between 1986 and 1989 were entered into a database of 2 cohorts, TCP and Press Fit Condylar (PFC) knees, matched for age, gender, body weight, and diagnosis. Follow-up data within 12 months of each other were used, evaluating patients clinically and using a self-administered questionnaire. In each cohort, 74 knees were matched by these criteria. Follow-up time was 4.04 and 4.45 years for the TCP and PFC cohorts. Range of motion averaged 107 degrees and 112 degrees for the TCP and PFC cohorts. This difference was statistically significant. Total knee score and functional score improved significantly. Anterior knee pain was present in 9 TCP and 3 PFC knees. Lateral release was performed in 30 TCP and 18 PFC knees. The PFC showed an advantage in ROM, stair function, anterior knee pain, and use of lateral release. Both designs showed comparable pain relief and walking ability.
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PMID:Posterior cruciate-sacrificing versus posterior cruciate-substituting total knee arthroplasty: a study of clinical and functional outcomes in matched patients. 1140 1

This study compared the efficacy of two approaches to treating therapy-resistant patellofemoral pain syndrome. In a prospective randomized study 20 patients were treated for 8 weeks with 16 physiotherapeutic exercises on a neurophysiological basis (proprioceptive neuromuscular facilitation) while another 20 patients underwent a special training program using a special resistance-controlled knee splint for 15 min three times daily. We measured muscle activity on a Cybex 6000 and performed surface electromyography of the vastus medialis and vastus lateralis muscles. Anterior knee pain was assessed by the Bessette and Hunter score and a visual analogue scale. An increase in electromyographic activity in the vastus medialis muscle and significant improvement in individual comfort were observed only in those treated by knee splint. The knee splint thus proved more effective than proprioceptive neuromuscular facilitation for treating cases of patellofemoral pain syndrome resistant to conservative therapy.
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PMID:Chronic patellofemoral pain syndrome: alternatives for cases of therapy resistance. 1168 60

Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with four-strand gracilis and semitendinosus tendon (N = 37) or with patellar tendon-bone (N = 35) from the ipsilateral side. The groups were similar in terms of age, sex, level of activity, degree of laxity, meniscal lesions found surgically, and rehabilitation program. The follow-up was performed at another hospital by independent observers after 6, 12, and 24 months. Sixty-one patients (32 with hamstring tendon grafts and 29 with patellar tendon grafts) complied with the follow-up routine for the full 24 months. No differences were found between the groups with respect to Cincinnati functional score, KT-1000 arthrometer measurements, or stairs hopple test results. The subjective result and the single-legged hop test result were better for the hamstring tendon group after 6 and 12 months, but no differences were found after 24 months. The hamstring tendon group showed better isokinetic knee extension strength than did the patellar tendon group after 6 months, but not after 12 and 24 months. There was a significant weakness in isokinetic knee flexion strength among the hamstring tendon group. Anterior knee pain was not significantly different between the groups, but kneeling pain was significantly less common in the hamstring tendon group after 24 months.
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PMID:Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. 1173 84


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