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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anterior knee pain or patellofemoral pain syndrome is commonly encountered by clinicians, but the pathogenesis of this condition is not well understood. While much research has centred around the relationship between vastus medialis and anterior knee pain, little is known about the most lateral of the quadriceps muscle group, vastus lateralis (VL). Knowledge of the anatomical organization of VL is not only necessary to understand its precise function, but to also assist in the development of clinical and biomechanical models of knee dysfunction. The purpose of this study was to investigate the detailed morphology of VL, specifically to provide data relating to architecture, attachment sites, innervation, and the presence of anatomical partitioning within the muscle. The VL muscle was examined in 10 cadaveric lower limbs using macrodissection techniques. On the basis of architecture and innervation, this muscle comprised four partitions with each receiving its own unique nerve branch. The mean fascicular length of VL was 7 cm and the mean fascicular and muscle physiological cross-sectional areas were 1.2 cm(2) and 21.6 cm(2), respectively. In addition to inserting proximally at the base of the greater trochanter and distally into the superolateral border and base of the patella, three additional attachment sites were identified: the lateral intermuscular septum, iliotibial band, and the rectus tendon. The results of this study suggest that the gross morphology of VL is more complex than previously described, and the information provided regarding architecture will contribute to knowledge regarding the function of VL as well as its role in knee joint dysfunction.
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PMID:The vastus lateralis muscle: an anatomical investigation. 2030 54

Although it has been shown that the risk of anterior knee pain is greater in patients with nonresurfaced patellae, it is not exactly clear whether the pain would resolve with secondary resurfacing of the patella. Thirty-nine patients (41 knees) underwent secondary patellar resurfacing between January 2001 and January 2007. The mean age was 66 years. The mean body mass index was 29.2 kg/m(2). The average time from primary total knee arthroplasty to resurfacing procedure was 29 months. The mean follow-up was 54 months. Anterior knee pain was the indication for secondary resurfacing in all patients. Although the clinical and functional knee scores improved significantly for whole cohort, 8 patients (8 knees) were dissatisfied with the outcome of surgery. This study highlights that secondary resurfacing is not an always rewarding procedure and patients need to be consulted appropriately with regard to the outcome.
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PMID:Secondary resurfacing of the patella after primary total knee arthroplasty does the anterior knee pain resolve? 2721 2

Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0.21; 8-12 weeks: SMD -0.22, 95% CI -0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required.
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PMID:Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials. 2214 96

Anterior knee pain is a common presenting complaint, and in many cases no identifiable cause can be found. In these circumstances it is commonly known as anterior knee pain syndrome or patellofemoral pain syndrome. The management for this condition is most commonly non-operative. Treatment strategies include physiotherapy, pharmacotherapy, orthoses and combinations of the above. There are many described methods in the literature with a wide spectrum of outcomes, which in itself is testimony to the lack of any generally accepted gold standard of care for these patients. It is thus unclear to the health care professional treating these patients which is the best treatment to offer. In this review we aim to summarise historical and most up to date literature on the subject and in so doing allow the health care professional pick whichever treatment strategy they feel most beneficial and also provide a guide for appropriate patient education.
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PMID:The non-operative treatment of anterior knee pain. 2289 79

Cycling-related injuries account for 20% of all injuries occurring during triathlons. Traumatic injuries caused by falls or accidents are thankfully rare but can be highly variable and very serious in nature. The best approach to these injuries is prevention. The majority of complaints arising from cycling are due to overuse or poor technique. The knee joint, lower back, neck, and Achilles tendon are the most frequently affected anatomic sites. Anterior knee pain, lower back and neck myofascial pain, iliotibial band friction syndrome, and Achilles tendonitis are the most common diagnoses. Initial treatment should always use rest, ice, compression, and elevation. Muscle strengthening and stretching as well as other physical modalities are helpful in the subacute setting. The need for surgery is rare. Improper bike fit contributes to the causation of a significant number of these conditions. Bike geometry may also be altered to alleviate symptoms.
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PMID:Chronic musculoskeletal conditions associated with the cycling segment of the triathlon; prevention and treatment with an emphasis on proper bicycle fitting. 2314 89

Anterior knee pain is a very common condition, particularly amongst young people. Those patients who have demonstrable pathological or biomechanical abnormalities can often be helped surgically. However, there are many others who have severe patellar pain despite normal, or near normal, clinical and arthroscopic examination. There have been a plethora of conservative treatments the mainstays of which are rest and exercise. However, the rationale behind these conservative methods has been largely empirical, and progress subjective. Treatment may be more effectively applied if further evidence is established about the relationship between the foot and ankle biomechanics and the patellofemoral joint. Kinematic and kinetic gait analyses have recently been reported as being of major importance in the objective measurement of lower limb function and its effects on the patellofemoral joint.
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PMID:Anterior knee pain: the need for objective measurement. 2391 81

Anterior knee pain (or patellofemoral pain) continues to be a source of frustration and confusion among clinicians. There is wide variation in symptom history, physical exam findings, imaging, and treatment that often confounds the use of any straightforward algorithm or decision tree. This review aims to provide an approach that partners the adolescent athlete with clinician and an experienced physiotherapist. This team approach uses available evidence to develop a treatment program that is specific to the adolescent's symptoms, body movement patterns, and activity demands.
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PMID:Anterior knee pain in the active and athletic adolescent. 2422 26

Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.
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PMID:MRI of anterior knee pain. 2447 94

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free.
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PMID:Anterior knee pain associated with an anterior superior patellar bony spur: a case report. 2457 90

[Purpose] The aim of this study was to examine the incidence and patterns of referred pain in patients with hip disease, as well as the nerve distribution in the hip and knee joints of 2 cadavers. [Subjects and Methods] A total of 113 patients with hip joint disease were included in the investigation. The incidence of regional pain and referred pain patterns were evaluated before and after arthroplasty. Two cadavers were macroscopically observed to verify the nerve innervation of the hip and knee joints. [Results] Anterior knee pain was observed preoperatively in 13.3% (in resting) and 33.6% (in motion) of the patients, which was comparable with the incidence of greater trochanter pain. In addition, the preoperative incidence rates of knee pain in resting and motion markedly decreased postoperatively. Of note is the remarkable incidence of pain radiating to the ventral lower limb. An anteromedial innervation was determined in the cadavers by the articular branches of the obturator and femoral nerve, which supply small branches to the knee joints. [Conclusion] Our results suggest that the distribution of the incidence of pain among the patients with hip disease is diverse owing to the sensory distribution of the femoral and obturator nerves.
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PMID:Investigation and macroscopic anatomical study of referred pain in patients with hip disease. 2464 32


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