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Case: A 32-year-old patient was diagnosed with a vertical patella fracture nonunion after a bone–patellar tendon–bone (BTB) anterior cruciate ligament reconstruction. In addition, a 1 × 2 × 1 cm patellar bone defect was noticed at the graft harvesting site. The patient was treated surgically with open reduction and internal fixation and iliac crest bone autograft which resulted in fracture union. Conclusion: Many intraoperative and postoperative risk factors for iatrogenic patella fracture when harvesting BTB autograft were identified. Surgeons should be aware of technical skills needed to prevent this complication and should treat the fracture appropriately to avoid nonunion and optimize the outcome. [ABSTRACT FROM AUTHOR]

To evaluate the correlation between isometric muscle strength of the hip abductors (HABD) and lateral rotators (HLR) with the range of motion (ROM) of the pelvis/hip in the frontal/transverse planes, respectively, and between the strength of the knee extensors (KExt) with the ROM of the knee in the sagittal plane during seven tasks. Cross-sectional study. Laboratory. Thirty-five women with patellofemoral pain. Maximum isometric muscle strength of the HABD, HLR, and KExt was measured using a manual dynamometer, and pelvis and lower limbs kinematics were evaluated using 3D optical system during gait, ascending and descending stairs, the forward and lateral step down tests, and the propulsion and landing phases of the single leg hop test (SLHT). A weak correlation was found between KExt strength and knee ROM in the sagittal plane (p = 0.05; r = −0.33) during SLHT landing, and a moderate correlation between HABD strength and ROM of pelvic obliquity (p < 0.01; r = 0.50) during ascending stairs. The lower strength of KExt has a weak correlation with higher knee flexion during the landing phase of the SLHT, and the lower strength of HABD has a moderate correlation with lower pelvis ROM in the frontal plane when ascending stairs. • Lower pelvis frontal plane strength and ROM correlated moderately on ascending stairs. • Higher knee flexion has weak correlation with lower knee extensors strength on landing. • Lower limb muscle strength and kinematic have no strong linear association in PFP. [ABSTRACT FROM AUTHOR]

Introduction: Anterior knee pain (AKP) is a very common problem in the community and negatively affects the patient's quality of life. Many pathologies can be the cause of this problem. The principal aim of our study was to evaluate the relationship between the magnetic resonance appearance of the suprapatellar fat pad and AKP. Methods: Knee magnetic resonance imaging of patients with and without AKP was analyzed retrospectively by two independent radiologists in two groups. The morphological structure of the anterior suprapatellar fat pad and other pathologies that may cause AKP in the knee joint were evaluated. Statistical relationships of the findings were investigated. Results: Of the 395 patients who participated in the study, 195 (49.4%) were females and 200 (50.6%) were males. The median age of the patients was 43 (18-90) years. There was no significant difference in mean age between individuals with and without AKP (p=0.376). A significant difference was found between patients with and without AKP in terms of posterior contour bowing of the anterior suprapatellar fat pad, edema, and diameter increase in the fat pad, patellar tendinopathy, quadriceps tendinopathy, and medial patellar retinaculum damage (p<0.001, p<0.001, p<0.001, p=0.015, p=0.002, and p=0.032, respectively). Discussion and Conclusion: Anterior suprapatellar fat pad syndrome is one of the pathologies involved in the etiology of AKP. The close relationship between the posterior contour bowing of the anterior suprapatellar fat pad we defined and AKP should be considered in radiological reporting. [ABSTRACT FROM AUTHOR]

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Objectives: To (1) compare physical activity variability between individuals with patellofemoral pain (PFP) and pain-free individuals and (2) evaluate the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts., Design: Cross-sectional case-control study., Setting: University research laboratory., Participants: Individuals with PFP (N=34) and pain-free individuals (N=34) aged 18 to 40 years., Interventions: Not applicable., Main Outcome Measures: We assessed physical activity (daily steps and moderate-to-vigorous physical activity [MVPA]) over a period of 14 consecutive days using a triaxial accelerometer. Variability (coefficient of variation) for daily steps and MVPA was calculated, where higher coefficient of variation values indicate greater physical activity variability. We evaluated pain severity (numeric pain rating scale), symptom duration (months), disability (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral subscale), and pain catastrophizing (Pain Catastrophizing Scale). Independent t tests or Mann-Whitney U tests evaluated group differences in physical activity variability. Spearman ρ correlation coefficients were calculated to determine the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts. Correlation coefficients were interpreted as weak (<0.40), moderate (0.40-0.70), and strong (>0.70)., Results: Age, height, and mass did not differ between individuals with PFP and pain-free individuals (P>.05). Individuals with PFP displayed greater variability in daily steps (P<.001) and MVPA (P=.001) compared to pain-free individuals. In individuals with PFP, greater variability in daily steps was moderately related to higher pain severity (ρ=0.41, P=.016), while greater variability in MVPA was weakly related to higher pain severity (ρ=0.36, P=.037)., Conclusions: Individuals with PFP demonstrated greater variability in physical activity compared to pain-free individuals, which positively related to more severe pain. Future PFP research should explore the underlying factors contributing to increased physical activity variability and their potential implications for pain management., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to: (i) understand how women perceived their recently developed patellofemoral pain (PFP) regarding its cause, prognosis, and willingness to seek treatment; (ii) investigate self-reported function, knee-related quality of life (QoL), fear of movement, and physical activity level at the onset of PFP., Design: Mixed-methods longitudinal study., Setting: University., Participants: Sixty-eight pain-free women were followed up over one year., Main Outcome Measures: Those who developed PFP were interviewed within one month of the development of symptoms. Self-reported function, kinesiophobia, knee-related QoL, and physical activity were obtained at baseline and follow-up assessments., Results: Twenty-one women developed PFP. Most participants reported believing the increase in physical activity and/or sitting time was associated with the onset of PFP. Many reported believing symptoms would improve over time without any treatment. Only a small number of participants intended to seek care. Quantitatively, decreases in self-reported function and QoL, as well as increases in the physical activity level were observed after PFP development., Conclusion: Although decreases in self-reported function and QoL were observed, women reported believing their PFP is self-limiting and do not need treatment. Strategies to accurately disseminate knowledge about PFP are needed to help stimulating early care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: The appropriateness or necessity of patellar resurfacing in total knee arthroplasty (TKA) is not clearly established. The objective of the present study was to compare the clinical and functional results of patients with bilateral involvement, operated on in one knee by TKA with patellar resurfacing and in the other knee by TKA without resurfacing. The hypothesis was that there was no difference in results between the two sides., Method: This was a retrospective cohort of patients operated on by TKA without patellar resurfacing in a second osteoarthritic knee after contralateral TKA with patellar resurfacing. Twenty consecutive patients who underwent second primary TKA constituted their own control group (40 knees). Iwano scores were comparable. Mean age was 75.9±6.2years. Mean time between the two procedures was 20.6±11.9months., Results: There were no differences in SF-36, KOOS or Lille patellofemoral scores between the right and left knees. Sixty-five percent of patients were unable to differentiate the performance of their knees in activities of daily living., Conclusion: The present study did not differentiate results according to patellar resurfacing, showing the limitations of resurfacing for early functional gain after primary TKA. Resurfacing might thus not be essential, even if it was performed in replacement of the first knee., Level of Evidence: IV; retrospective cohort study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Medial unicompartmental knee arthroplasty (UKA) has increased in popularity for the ​treatment of end-stage anteromedial osteoarthritis in part secondary to its quicker recovery, improved function, and decreased risk of medical complications over total knee arthroplasty (TKA). However, despite the success of medial UKA, dilemma still exists over certain patient characteristics as to suitability for undergoing the procedure. In addition to patient age, body mass index (BMI), and the presence, or lack thereof, of an anterior cruciate ligament (ACL), one of the most contentious issues surrounding suitability for medial UKA is the preoperative status of the patellofemoral joint (PFJ). This review aims to look at the historical factors leading to the current dilemma as well as recent evidence surrounding anterior knee pain and preoperative PFJ arthritis on the survivability and outcomes of medial UKA. This article will also evaluate other PFJ factors possibly affecting the outcome of medial UKA such as lateral patellar subluxation and lateral facet grooving, future perspectives that may influence the utilization of medial UKA such as cementless implants, and the choice of mobile versus fixed bearing articulations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Adolph Lombardi, Jr., MD reports a relationship with Zimmer Biomet that includes: consulting or advisory. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Total Joint Orthopedics that includes: consulting or advisory. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Firstkind that includes: funding grants. Adolph Lombardi, Jr., MD reports a relationship with Parvizi Surgical Innovations Research Institute that includes: equity or stocks and funding grants. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Recovery Rx that includes: funding grants. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with SPR Therapeutics Inc that includes: funding grants. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Prescribe Fit that includes: equity or stocks and funding grants. Adolph Lombardi, Jr., MD reports a relationship with Smith and Nephew Inc that includes: funding grants. Adolph Lombardi, Jr., MD reports a relationship with SI-BONE Inc that includes: funding grants. Adolph Lombardi, Jr., MD reports a relationship with JIS Ventures that includes: equity or stocks. Adolph Lombardi, Jr., MD reports a relationship with Joint Development Corporation that includes: equity or stocks. Adolph Lombardi, Jr., MD reports a relationship with Operation Walk USA that includes: board membership. Adolph Lombardi, Jr., MD reports a relationship with Central Ohio Orthopaedic Management Company that includes: board membership. Adolph Lombardi, Jr. MD reports a relationship with Current Concepts in Joint Replacement that includes: board membership. Keith Berend, MD reports a relationship with Medacta USA INC that includes: speaking and lecture fees. Keith Berend, MD reports a relationship with Smith and Nephew Inc that includes: funding grants and speaking and lecture fees. Keith Berend, MD (JIS Research Institute) reports a relationship with Zimmer Biomet that includes: funding grants. Keith Berend (JIS Research Institute) reports a relationship with Total Joint Orthopedics that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Firstkind that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Parvizi Surgical Innovations Research Institute that includes: equity or stocks and funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Recovery Rx that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Prescribe Fit that includes: equity or stocks and funding grants. Keith Berend, MD reports a relationship with SPR Therapeutics that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with SI-BONE Inc that includes: funding grants. Keith Berend, MD reports a relationship with JIS Ventures that includes: equity or stocks. Keith Berend, MD reports a relationship with Joint Development Corporation that includes: equity or stocks. Adolph Lombardi, Jr., MD has patent with royalties paid to Zimmer Biomet. Adolph Lombardi, Jr., MD has patent with royalties paid to Innomed. Publications Editorial Boards (Adolph Lombardi, Jr., MD): Journal of Arthroplasty; Journal of Bone and Joint Surgery; Clinical Orthopaedics and Related Research; Journal of the American Academy of Orthopaedic Surgeons; Journal of Orthopaedics and Traumatology; Surgical Technology International; The Knee; The Bone & Joint Journal Publications Editorial Boards (Keith Berend, MD): Journal of Arthroplasty; Reconstructive Review. Todd Bertrand, MD, MBA; Patricia Melvin, MD, MBS have no known competing financial interests or personal relationships to declare that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Dysfunction in efferent pathways after knee pathology is tied to long-term impairments in quadriceps and hamstrings muscle performance, daily function, and health-related quality of life. Understanding the underlying etiology is crucial for effective treatment and prevention of poor outcomes, such as post-traumatic osteoarthritis or joint replacement., Objectives: To synthesize recent evidence of efferent pathway dysfunction (i.e., motor cortex, motor units) among individuals with knee pathology., Design: Commentary., Method: We summarize the current literature investigating the motor cortex, corticospinal tract, and motoneuron pool in individuals with three common knee pathologies: anterior cruciate ligament (ACL) injury, anterior knee pain (AKP), and knee osteoarthritis (OA). To offer a complete perspective, we draw from studies applying a range of neuroimaging and neurophysiologic techniques., Results: Adaptations within the motor cortices, corticospinal tract, and motoneuron pool are present in those with knee pathology and underline impairments in quadriceps and hamstrings muscle function. Each pathology has evidence of altered motor system excitability and reduced volitional muscle activation and force-generating capacity, but few impairments were common across ACL injury, AKP, and OA studies. These findings underscore the central role of the motor cortex and motor unit behavior in the long-term outcomes of individuals with knee pathology., Conclusions: Adaptations in the efferent pathways underlie persistent muscle dysfunction across three common knee pathologies. This review provides an overview of these changes and summarizes key findings from neurophysiology and neuroimaging studies, offering direction for future research and clinical application in the rehabilitation of joint injuries., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Orthopaedic surgeons hold differing opinions on replacing the patella during total knee arthroplasty (TKA) for knee osteoarthritis, sparking a continued discussion on the optimal approach. Patellar resurfacing (PR) replaces the patella's surface with a prosthetic component, aiming to enhance joint function and reduce anterior knee pain. However, it has potential complications such as avascular necrosis, fractures, and patellar clunk syndrome. This analysis evaluates the effectiveness of TKA with and without PR, highlighting the variations in outcomes between the two methods. Findings suggest that resurfacing is associated with improved clinical outcomes, activity level, patient satisfaction, and pain relief. Nevertheless, the decision should be individualized based on patient preferences and circumstances. Additional long-term randomised controlled trials incorporating outcome measures specific to patellar function are required to better understand the effects of PR versus non-resurfacing in TKA., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Upadhyay et al.)

Context: Patellofemoral pain (PFP) has poor long-term recovery outcomes. Central sensitization describes central nervous system changes altering pain modulation, which can complicate recovery (poorer prognosis, worse function). Signs of central sensitization include amplified pain facilitation, pain hypersensitivity, and impaired pain inhibition, which can be measured with temporal summation of pain (TSP), pressure pain thresholds (PPTs) and conditioned pain modulation (CPM), respectively. Sex differences exist for these test responses, but female-only PFP investigations of sensitization are uncommon. Understanding pain modulation in females with PFP could improve treatment protocols., Objective: To determine whether females with PFP exhibit signs of central sensitization (greater TSP, lower PPTs, reduced CPM) compared to pain-free females., Design: Cross-sectional Setting: Laboratory Patients or Other Participants: Thirty-three females [(20 PFP, 13 pain-free); Age: PFP 29.2 ± 7 years, pain-free 28 ± 7 years; Height: PFP 166.7 ± 5.9cm, pain-free 166 ± 9.5cm, Mass: PFP 66.7 ± 9.6kg, pain-free 69.3 ± 7.5kg)., Main Outcome Measures: TSP was assessed with ten punctate stimuli applied to the knee and calculated by the difference in pain intensity between beginning and end responses. PPTs were tested at four sites [3 for local hypersensitivity (knee), 1 for widespread hypersensitivity (hand)]. CPM was conducted by comparing PPTs during two conditions (baseline, ice immersion). CPM response was defined as the percent difference between conditions. Between-group differences in TSP response were analyzed with a Welch's test. Separate Welch's tests analyzed group comparisons of PPTs and CPM responses at four sites., Results: Females with PFP exhibited greater TSP response (P=0.019) and lower CPM response at patella center (P=0.010) and hand sites (P=0.007) than pain-free females. PPT group differences were not observed at any site (P>0.0125)., Conclusions: Females with PFP modulate pain differently than pain-free females. Clinicians should recognize signs of central sensitization and their potential impact on treatment options.

Background: International rates of patellar resurfacing in primary total knee arthroplasty (TKA) are highly variable. This study sought to determine how trends in patellar resurfacing rates have changed between 2004 and 2022. In addition, we investigated how modern rates of revision have varied between resurfaced and unresurfaced patellae in primary TKA among national joint registries., Methods: Data between 2004 and 2022 was obtained either from the publicly available joint registry annual reports, a literature review, or via direct correspondence with registry personnel in Sweden, New Zealand, Australia, the United States, Norway, the United Kingdom, the Netherlands, Switzerland, Canada, and India. Only English language national joint registries or data via direct correspondence with registry administrators were utilized. Additionally, the 10-year cumulative risk of revision TKA with and without patellar resurfacing was pulled from those registries that had this data available., Results: There were persistent differences in the rates of patellar resurfacing among countries. Australia documented a 40% increase in patellar resurfacing rates, while other countries demonstrated modest or little change in resurfacing rates. This may indicate that surgeons are making the decision to resurface based on national TKA revision rates. The average rates of patellar resurfacing in primary TKA ranged from 4% in Sweden to 94% in the United States. Canada, the United States, Australia, and Switzerland documented a lower risk of revision when the patella was resurfaced, while Sweden, conversely, showed a higher risk of revision with resurfacing., Conclusions: Rates of patellar resurfacing in primary TKA were highly variable among countries, as were rates of change over time. It appears that the optimal patellar resurfacing strategy may depend mostly on unique patient factors and surgeon expertise. Future studies should attempt to elucidate the individual patient characteristics that contribute to increased risks of revision or anterior knee pain to determine who will most benefit from patellar resurfacing in primary TKA., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Thigh muscles imbalance leads to the increase of lower extremity injury in long-distance running. This study aimed to compare isokinetic parameter of bilateral strength imbalance in long distance runners with and without history of anterior knee pain. Forty-eight long distance runners; 26 males and 22 females were divided into two groups 1) with history of anterior knee pain and 2) no history of anterior knee pain. Knee flexors and extensors were assessed by Biodex isokinetic dynamometer at 3 angular velocities. The results showed that the quadriceps peak torque had significant differences at 60 o s -1 and 120 o s -1 between groups, p=0.007 and 0.038 respectively. The quadriceps total work at the speed of 120 o s -1 and 180 o s -1 demonstrated significant difference between two groups, p

Abstract BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

Background: The anterior tibial translation (ATT) in case of Anterior Cruciate Ligament (ACL) tear can lead to dynamic alterations of the extensor apparatus biomechanics. The aim of this study is to evaluate the dynamic effect of isolated ACL deficiency on patellar height. The hypothesis is that the ATT of ACL-insufficient knees dynamically reduces patellar height. Methods: Skeletally mature patients who underwent ACL reconstruction using hamstring graft between January and December 2018 were included in this study. The Posterior Tibial Slope (PTS), Caton–Deschamps (CDI), modified Insall–Salvati (MISI), and Blackburne–Peel (BPI) indices were calculated in standard lateral and TELOS X-rays. The mean of the measurements calculated between two observers was used to compare these parameters. Results: 95 patients (M: 57; F: 38; 95 knees) were included in the study with a mean age of 31.8 years (16–56 years old). Significant patellar height reduction (CDI: 0.11 [− 0.32; 0.31]; MISI: 0.09 [− 0.66; 0.30]) was reported in TELOS compared with standard lateral knee radiography (p < 0.001). 20.0% of the study knees reported an abnormal CDI and 84.2% (16/19 knees) of them reduced this index to within normal limits in TELOS. 20.0% of the knees with mild patella alta reduced CDI in TELOS but always remained above 1.2. Conclusions: The abnormal ATT in case of ACL-deficient knees results in a lowering effect of the patella in TELOS X-rays. In patients with ACL tear and anterior pain the reconstructive ligament surgery should be performed to avoid also chronic anterior knee pain. Level of evidence: Basic Science Study (Case Series). Clinical relevance: The decrease in patellar height in stress-X-rays compared with standard lateral knee radiography in ACL deficient knees, should be considered as a possible contributing cause of anterior pain in these patients. [ABSTRACT FROM AUTHOR]

Anterior knee pain (AKP) is one of the most common conditions to bring active young patients to a sports injury clinic. It is a heterogeneous condition related to multiple causative factors. Compared to the general population, there appears to be a higher risk of development of patellofemoral osteoarthritis in patients with AKP. AKP can be detrimental to the patient's quality of life and, in the larger context, significantly burdens the economy with high healthcare costs. This study aims to present a comprehensive evaluation of AKP to improve clinical daily practice. The causes of AKP can be traced not only to structures within and around the knee, but also to factors outside the knee, such as limb malalignment, weakness of specific hip muscle groups, and core and ligamentous laxity. Hence, AKP warrants a pointed evaluation of history and thorough clinical examination, complemented with relevant radiological investigations to identify its origin in the knee and its cause. Conservative management of the condition achieves good results in a majority of patients with AKP. Surgical management becomes necessary only when it is deemed to provide benefit—when the patient has well-characterized structural abnormalities of the knee or limb that correlate with the AKP clinically or in situations where the patient does not obtain significant or sustained relief from symptoms. AKP has a multifactorial etiology. The treatment strategy must be individualized to the patient based on the patient profile and specific cause identified. Hence, treatment of AKP warrants a pointed evaluation of history and thorough clinical examination complemented with relevant radiological investigations to identify the condition's origin and its cause. A holistic approach focused on the patient as a whole will ensure a good clinical outcome, as much as a focus on the joint as the therapeutic target. [ABSTRACT FROM AUTHOR]

Objectives: To investigate relationships between load tolerance of single leg isometric knee extension and athlete reported knee pain location and severity during the single leg decline squat.Design: Cross-sectional study.Methods: 175 college basketball athletes (99 women, 76 men) in Alberta, Canada participated at the start of the 2018-19 season. Knee pain location (dichotomized into focal/diffuse pain), and severity (numerical rating scale 0-10) were collected during the single leg decline squat. Athletes completed a standardized single leg isometric knee extension to determine load tolerance (defined by pain or reduced form). A quantile regression model was used to examine the association between load tolerance and pain location adjusting for sex, years played, body mass index and team.Results: Athletes with diffuse pain had a significantly lower median load tolerance (-0.89 kg) than athletes without pain (95% confidence interval [-1.49, -0.29]; p = 0.003). Athletes with focal pain tolerated similar median loads (-0.42 kg) to those without pain (95% confidence interval [-1.17, 0.33]; p = 0.26). Higher knee pain severity was associated with a non-linear but consistent reduction in load tolerance (p < 0.001).Conclusions: Athlete-reported knee pain location during the single leg decline squat influenced load tolerance to isometric knee extension. Athletes with focal pain tolerated similar isometric loads to their pain free teammates. Clinicians should consider load selection of isometric knee extension for athletes with diffuse pain given their lower load tolerance. Future research should consider reporting pain location in addition to pain severity to differentiate clinical presentations and response to exercise. [ABSTRACT FROM AUTHOR]

Introduction: Although better surgical exposure is encountered with the excision of infrapatellar pad of fat (IPPF) during total knee replacement (TKR), some studies showed an increase in anterior knee pain and other specific complications associated with such a step. The purpose of this study was to add in literature a new comparison between IPPF excision and preservation during TKR, focusing on the anterior knee pain, functional range, oxford knee score and patellar height through a randomized clinical trial Methods: This prospective randomized study was conducted from 2016 to 2019 on 90 patients with knee osteoarthritis treated with elective primary TKA by same surgeons at one hospital with the same implant design with a mean follow up of 18 month. Patients were randomized into two groups: one group including patients with IPPF complete excision and the other group include patients with IPPF preservation. No patella resurfacing was done. Pre and postoperative anterior knee pain was recorded and compared using VAS score in addition to Oxford knee score. Results: At 6 months follow-up, 10 knees and 14 knees (27%) had anterior aching discomfort with a mean postoperative extension were -5.3 and -5.2 in IPPF preservation and excision group patients, respectively. There was no statistically significant differences between both groups regarding anterior knee pain, range of motion, oxford knee score or patellar height measurement through the follow up period. No patellar complications were recorded in all cases. Conclusion: Although Infrapatellar fat pad excision in TKA resulted in a minor increase in number of patients with postoperative anterior knee pain, it was of no statistically significant difference. Hence, whenever a better surgical exposure is needed, IPPF excision should be considered. Additional large scale randomized studies should be added to the calling literature for more result validation and guidelines formulation. [ABSTRACT FROM AUTHOR]

Chronic forms of anterior knee issues are an increasingly more common condition from the clinical standpoint, mostly within active individuals. Incidence and risk factors have not been clearly defined of yet, though, patellar chondromalacia is one of the most likely causes. In our study, we aimed to investigate the possible relationship between patellar chondromalacia and meniscopathy in young and active patients without tibiofemoral joint arthrosis and patellar instability. Patients between the ages of 18-39, complaining of anterior knee discomfort and who had undertaken MRI between April 1 and May 31, 2021 at Malatya Training Research Hospital, Radiology Department were screened. Conditions such as significant patellar tilt/shift/translation, alta/baja and trochlear dysplasia were studied and measurements taken according to the methods specified in the literature. In this respect, patients outside of normal limits, those with osteochondoral lesions in the tibiofemoral joint or patients admitted after acute trauma were disqualified from the study. 337 receipients of MRIs of the knee, with chondromalacia and/or meniscopathy were reviewed. The average or mean age of the group was calculated as 28.66 ± 6.40, with 52.2% (n=176) between the ages of 18-29, and 61.1% (n=206) were women. Chondromalacia was present in 40.7% (n=137), lateral meniscal degeneration in 58.5% (n=197), medial meniscus degeneration in 82.8% (n=279), a lateral meniscus tear in 4.2% (n=14), a medial meniscal tear in 12.5% (n=42). In this study, no difference was found in terms of the coexistence and/or frequency of medial or lateral meniscopathy and patellar chondromalacia. [ABSTRACT FROM AUTHOR]

Objective: To present a clinical case exploring the occurrence and management of a tear to the infrapatellar fat pad IFP of a high school football player. Background: Acute tears to the IFP are rare. Typically, the (IFP) becomes impinged (i.e., Hoffa's disease) through a fall, direct knee trauma, or surgical complications, and require conservative treatment. Treatment: A 15-year-old high school football player reported to the athletic training clinic complaining of right knee discomfort and the inability to fully flex the knee. The patient stated that during a field goal attempt he missed the ball and hyperextended his right knee. Hoffa's disease and impingement of the IFP have been well documented, but these injuries have a different mechanism of injury. Uniqueness: More common injuries to the IFP occur because of microtraumas (i.e., Hoffa's disease or direct trauma to the knee (i.e., IFP impingement) in older populations. For this patient, the mechanism of injury was non-contact with minimal swelling, and no visual deformity or dislocation were present to suggest an injury. Additionally, the patient was able to complete functional movements with complaining only of "weird tightness" in the knee during extension. Conclusion: Due to the similarity of multiple knee pathologies, unknown mechanisms of injury need to be considered when evaluating the knee structure. Further examination is needed to determine demographic data and the probability of non-contact injury to the IFP, especially in pediatric patients. [ABSTRACT FROM AUTHOR]

Patellofemoral pain (PFP) is a common overuse condition seen in high-volume runners, such as military recruits. Exercise is commonly prescribed, with benefit, for the rehabilitation of individuals with PFP. However, a substantial number of individuals with the condition do not achieve an optimal outcome, suggesting the condition can be difficult and complex. Given the challenging nature of the condition, and the risk of developing PFP in high-volume runners, it seems logical to investigate options for injury prevention. Eccentric exercise has been useful in the prevention of some pathologies so its utility in preventing PFP should be explored. Current evidence regarding prevention programs for PFP are limited. Preventative exercise programs for PFP have not been well described or reported, and questions remain regarding their effectiveness. Based on available evidence or lack thereof, and known physiological and clinical effects of eccentric exercise, suggestions for integration of eccentric exercise into PFP prevention programs are offered. Eccentric exercise may be useful for PFP prevention from a theoretical framework however additional longitudinal cohort studies would be useful in determining its utility.

Knee osteoarthritis (OA) is a degenerative condition that can develop in people who have quadriceps muscle weakness. Knee OA is more likely to develop in people who have weak quadriceps muscles, which extend the knee. Dysfunction of articularis genu muscle (AGM) is thought to be a cause of anterior knee pain in patients having OA of the knee joint. Herein, we report a case of anterior knee pain caused due to the dysfunction of AGM in a 41-year male who was initially treated with physical therapy, and it failed to ease the patient's problems completely. Intramuscular electrical stimulation (IMES) along with mirror therapy relieved his symptoms with no recurrence till 2 months of follow-up. IMES of the AGM combined with mirror therapy can be a viable therapeutic option for muscle reeducation and anterior knee pain.

Background/Objective: Hip- and knee-muscle-strengthening programs are effective in improving short-term patient-reported and disease-oriented outcomes in individuals with patellofemoral pain (PFP), but few to no data exist on moderate- to longterm postrehabilitative outcomes. The first purpose of the study was to assess differences in pain, function, strength, and core endurance in individuals with PFP before, after, and 6 mo after successful hip- or knee-muscle-strengthening rehabilitation. The second purpose was to prospectively follow these subjects for PFP recurrence at 6, 12, and 24 mo postrehabilitation. Methods: For 24 mo postrehabilitation, 157 physically active subjects with PFP who reported treatment success were followed. At 6 mo postrehabilitation, pain, function, hip and knee strength, and core endurance were measured. At 6, 12, 18, and 24 mo, PFP recurrence was measured via electronic surveys. Results: Sixty-eight subjects (43%) returned to the laboratory at 6 mo. Regardless of rehabilitation program, subjects experienced significant improvements in pain and function, strength, and core endurance pre- to postrehabilitation and maintained improvements in pain and function 6 mo postrehabilitation (Visual Analog Scale/Pain--pre 5.12 ± 1.33, post 1.28 ± 1.14, 6 mo 1.68 ± 2.16 cm, P < .05; Anterior Knee Pain Scale/ Function--pre 76.38 ± 8.42, post 92.77 ± 7.36, 6 mo 90.27 ± 9.46 points, P < .05). Over the 24 mo postrehabilitation, 5.10% of subjects who responded to the surveys reported PFP recurrence. Conclusions: The findings support implementing a hip- or knee-muscle-strengthening program for the treatment of PFP. Both programs improve pain, function, strength, and core endurance in the short term with moderate- and long-term benefits of improved pain and function and low PFP recurrence. [ABSTRACT FROM AUTHOR]

Background: MRI is a good diagnostic tool in identifying cartilage and soft tissue lesions as well as detecting underlying predisposing anatomical factors of patellar instability, it has a high specification for detecting the grades and the types of some of these diseases or factors that may predispose to them such as trochlear dysplasia and patella alta. Aim of the Work: The aim of this study was to evaluate the role of MRI in diagnosis of Patellofemoralpain syndrome which is the most common cause of anterior knee pain. Patients and Methods: This prospective study was done on patients referred from the orthopedic clinic to the department of radiodiagnosis, MRI unit at Ain Shams University hospitals. Thirty patients were included (18 females and 12 males) and their age ranged from 20 to 64 years. Conclusion: This study shows that MRI is useful in detecting various predisposing anatomical factors of patellofemoral instability and associated lesions of knee joint thereby enabling orthopedic surgeons to treat joint pathology as well as correct underlying anatomical abnormality. [ABSTRACT FROM AUTHOR]

Introduction: Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the remaining planes and adjacent joints are still to be defined. It was, therefore, the aim of this study to determine the influence of a distal femoral rotation osteotomy on the coronal limb alignment and on the ischiofemoral space of the hip joint. Materials and methods: Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar rotational osteotomies of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip–knee–ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), and the ischiofemoral space were measured. Comparison between means was performed using the Wilcoxon–Mann–Whitney test. Results: Twenty-seven patients underwent isolated supracondylar external rotation osteotomy to reduce the overall antetorsion of the femur. The osteotomy resulted in a 2.4° ± 1.4° mean increase in HKA and 2.4 mm ± 1.7 mm increase in the ischiofemoral space (p < 0.001). Conclusion: Supracondylar external rotation osteotomy of the femur leads to valgisation of the coronal limb alignment and increases the ischiofemoral space. This is resultant to the reorientation of the femoral antecurvature and the femoral neck. When planning a rotational osteotomy of the lower limb, this should be appreciated and may also aid in the decision regarding osteotomy site. [ABSTRACT FROM AUTHOR]

Anterior knee pain is a common problem after primary total knee arthroplasty (TKA). The aim of this study was to find parameters in patellar positioning which influence the clinical and functional outcome after TKA. Included were 59 patients who underwent TKA, of which three patients were treated bilaterally (n = 62 included knees). In a periodical follow-up of up to 5 years, each patient had to answer three questionnaires (HSS, WOMAC, SF-36) and underwent three radiographies of the knee (including merchant view) and a clinical examination, including Range Of Motion (ROM). All radiographs were evaluated by a single observer blinded to clinical data, who collected multiple parameters of sagittal and axial patellar alignment including newly developed methods for measuring patellar shift and tilt. Depending on the measurement results, three groups were built for each parameter and the influence on the outcome was determined. A lateral patellar tilt of more than 4° resulted in lower scores for both the HSS and WOMAC. The rarely investigated patellar facet angle showed a significantly inferior clinical and functional outcome in late follow-up of >24 months if lower than 142°, possibly due to progressive osteosclerotic changes of the patella caused by increased contact stress with corresponding patellar morphology. No significant difference was found for all other parameters. The newly developed method for measuring patellar shift has proven to be a valuable and easy instrument in the postoperative setting. [ABSTRACT FROM AUTHOR]

To compare beliefs of physical therapists (PTs) who read the clinical practice guideline (CPG) for the management of individuals with patellofemoral pain (PFP) to those who have not read the CPG. Cross-sectional study. Online survey. 494 currently licensed/registered PTs or physiotherapists. Respondents answered Likert-based or open-ended questions regarding the diagnosis, prognosis, risk factors, and management of individuals with PFP, as well as confidence for managing individuals with PFP, especially the ability to identify beneficial and non-beneficial interventions. We dichotomized responses into participants who read (READERS) and did not read (NonREADERS) the CPG. Most respondents held inaccurate beliefs about risk factors and prognosis; however, READERS' beliefs better aligned with the CPG than NonREADERS (P < 0.01). Most respondents correctly agreed that hip and knee exercise was the recommended treatment strategy; yet NonREADERS believed in implementing unsupported passive treatments (P < 0.01). READERS reported greater confidence in managing individuals with PFP, delivering evidence-based interventions, identifying less beneficial treatments, and locating evidence-based resources than NonREADERS (P < 0.01). While READERS and NonREADERS held accurate beliefs for exercise-based treatment for PFP, greater knowledge translation is needed to counter inaccurate beliefs regarding risk factors, prognostic factors, and passive treatments. • READERS′ beliefs more likely to be consistent with the clinical practice guideline. • Incorrect beliefs persist for risk factors and prognosis for patellofemoral pain. • Clinicians correctly identified exercise therapy as important for management. • NonREADERS were more likely to believe that passive adjuncts are helpful. • Additional educational platforms may increase clinician knowledge on best practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patellofemoral pain syndrome is a common disease in the field of sports injuries. Research in and outside China is increasing year by year, but there is no visual analysis for patellofemoral pain syndrome. OBJECTIVE: To objectively analyze the literature research on patellofemoral pain syndrome in and outside China in the past 13 years, to summarize the recent research directions in this field and to sort out the knowledge structure in and outside China. METHODS: Relevant articles on patellofemoral pain syndrome were collected from Web of Science and CNKI. Citespace software was used for visual analysis to show the research hotspots and development trends of this field. RESULTS AND CONCLUSION: (1) A total of 1 679 articles were finally included in the Web of Science database. The authors with the most articles are De Oliveira Silva D from La Trobe University in Melbourne, Australia and Crossley KM from the University of Melbourne, Australia. Hot keywords are hip, biomechanics, prevention (prognosis), prevalence disease rate, consensus statement, gender differences, electromyographic activity, risk factor, and osteoarthritis. (2) A total of 214 articles were included and analyzed in the CNKI database. The author with the most articles is Miao Ping from the Rehabilitation Department of the Second Affiliated Hospital of Guangzhou Medical University. Hot keywords are arthroscopy, biomechanics, strength training, lateral femoral muscle, surface electromyography, patellofemoral arthritis, and joint replacement. (3) International research hotspots show the biomechanical characteristics of increased knee external rotation, increased hip adduction, and decreased hip internal rotation during patient exercise. Strengthening the hip abductors and external rotators can effectively improve the pain and function of patients. At present, the most appropriate method to treat the disease in the world is a customized multi-modal intervention program, including strengthening of the gluteal muscles and quadriceps, emphasizing education and activity adjustment. (4) The results of major Chinese studies in this field confirm that the use of arthroscopic surgery can improve the pain of patients with patellofemoral pain syndrome, and patellofemoral joint replacement has a certain effect on early severe patellofemoral arthritis in such patients. Rehabilitation training methods are mainly based on hip joint strength training, supplemented by core muscles, lower limb eccentric strength and neuromuscular control training. Compared with foreign countries, the unique research hotspots in China are acupuncture and Chinese medicine. [ABSTRACT FROM AUTHOR]

Background: A convincing association between the foot and ankle alignment (FAA) and patellofemoral pain syndrome (PFPS) remains debatable in the literature. Therefore, all studies investigating the role of FAA in patients with PFPS were systematically reviewed. Methods: A systematic literature search was performed on the databases PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were all studies investigating static and/or dynamic FAA factors and PFPS. Studies with less than 20 patients or with patellofemoral osteoarthritis were excluded. The quality assessment was based on Cochrane study criteria, and the maximum score was set at eight. Results: Of 2246 articles, only 13 case-control studies were eligible. Considering static FAA factors, two studies found an association with rearfoot eversion and one with rearfoot inversion. While examining dynamic FAA characteristics, one study found an association with rearfoot eversion range of motion and three with gait kinematics. No further associations were reported. The quality assessment mean score was 5.5 (SD = 0.97) corresponding to moderate quality. Conclusions: In contrast to our expectations, a limited number of studies were founded supporting an association between FAA and PFPS. At present, the quality of the literature is still poor and conflicting, thus the need for further studies to determine any association between FAA and PFPS. [ABSTRACT FROM AUTHOR]

Background: Some patients with developmental dysplasia of the hip (DDH) complained of anterior knee pain (AKP) before and after Bernese periacetabular osteotomy (PAO) surgery. The purpose of this study was to (1) identify the characteristics of patellofemoral joint (PFJ) deformities in patients with DDH and (2) to determine the effects of PAO on the PFJ.Methods: Seventy patients (86 hips) were included in the DDH group. Thirty-three patients (33 knees) without AKP and hip pain were included in the control group. All patients underwent simultaneous CT scans of the hip and knee joints before PAO and after hardware removal surgery. The distance from the anterior inferior iliac spine to the ilioischial line (DAI), was measured in DDH patients. Imaging parameters of knees, including the sulcus angle (SA), femoral trochlear depth (FTD), patellar width (PW), tibial tuberosity-trochlear groove (TT-TG), patellar tilt angle (PTA) and lateral shift of the patella (LSP) were measured in patients in both the DDH and control group. TT-TG, PTA, and LSP of DDH patients were measured before PAO and after hardware removal. The DAI, PTA, LSP and TT-TG of all DDH patients before and after Bernese PAO were compared using paired t-tests. The FTD, PW, and SA of the DDH patients and the control group were analyzed using independent t-tests. PTA, TT-TG, and LSP between the control group and preoperative DDH patients, between the control group and post PAO patients were compared using independent t-tests.Results: The DAI changed from 4.04 ± 0.61 mm before PAO surgery to 5.44 ± 0.63 mm after PAO surgery. The SA of the DDH group (140.69 ± 11.30 degree) was greater than that of the control group (130.82 ± 6.43 degree). The FTD and the PW of the DDH group (5.45 ± 1.59 mm, 4.16 ± 0.36 mm) were smaller than that of the control group (7.39 ± 1.20 mm, 4.24 ± 0.38 mm). The changes in LSP, PTA, and TT-TG before and after surgery were not statistically significant. Both before and after PAO, there was no statistically significant difference in the parameters of LSP, PTA, and TT-TG compared with the control group.Conclusion: The knee joints of DDH patients presented a certain degree of femur trochlear groove dysplasia and patellofemoral instability. PAO surgery did not change PFJ stability, although the origination point of the rectus femoris muscle moved laterally during PAO surgery. [ABSTRACT FROM AUTHOR]

Patellofemoral pain (PFP) is a frequent knee condition. The aim of this study was to investigate strength, flexibility and postural control in people with and without PFP. Fifty-five participants between 14 and 54 years of age (PFP = 18, control group = 37) were included. Strength and flexibility for all trunk, hip, knee and ankle muscle groups were measured along with postural control outcomes. Analyses were conducted based on the "affected" and "non-affected" leg within-group and between-groups. Between-groups analysis demonstrated a statistically lower strength of trunk muscles (range: 35.8–29.3%, p < 0.001), knee extensors (20.8%, p = 0.005) and knee flexors (17.4%, p = 0.020) in PFP participants. Within-group analysis proved an 8.7% (p = 0.018) greater hip internal rotation strength and ankle extension flexibility (p = 0.032) of the "affected side" in PFP participants. This was, to our knowledge, the first study to investigate the strength of all trunk muscle groups. The results indicate that participants with PFP exhibit impaired strength of trunk muscle groups, along with knee muscle deficits, which may present a rehabilitation target. Clinicians should consider implementing trunk strengthening exercises into PFP programs along with knee-targeting exercise programs. [ABSTRACT FROM AUTHOR]

Purpose: Despite numerous well-conducted studies and meta-analyses, the management of the patella during total knee arthroplasty (TKA) remains controversial. The aim of our study was to compare the clinical and radiological outcomes between patients with and without patellar resurfacing and to determine the influence of resurfacing on patellar tracking with a "patella-friendly" prosthesis. Methods: A single-centered prospective randomized controlled study was performed between April 2017 and November 2018. Two hundred and forty-five consecutive patients (250 knees) scheduled for TKA were randomized for patellar resurfacing or patella non-resurfacing. All patients received the same total knee prosthesis and were evaluated clinically and radiologically, including the International Knee Society Score (KSS knee and function), Forgotten Joint Score (FJS), anterior knee pain (AKP), pain when climbing stairs, patellar tilt, and patellar translation. Results: Two hundred and twenty-nine knees were available for clinical evaluation and 221 knees for radiographic analysis. The revision rate for patellofemoral cause was 3.1% (7 cases) with no difference between the groups (p = 0.217). There was no difference in survival rate between patellar resurfacing (88.3%) and non-resurfacing (85.3%) after 24 months (p = 0.599). There were no differences in KSS functional component (p = 0.599), KSS knee component (p = 0.396), FJS (p = 0.798), and AKP (p = 0.688) at a mean follow-up of 18 months. There was twice as much stair pain for the non-resurfacing group (17.1% versus 8.5%) (p = 0.043). There was patellar tilt in 43% of resurfaced knees (n = 50/116) versus 29% in non-resurfaced knees (n = 30/105) (p = 0.025); however, there was more patellar translation in the non-resurfaced group (21.0% versus 7.8%) (p < 0.001). There were no specific complications attributed to the patellar resurfacing procedure. There were four secondary patellar resurfacing procedures (3.6%) in the non-resurfaced group after a mean of 10 ± 7 months (1–17) postoperatively. Conclusion: There is no superiority of patellar resurfacing or non-resurfacing in terms of clinical or radiological outcomes at mid-term. Secondary patellar resurfacing is rare. There is not enough evidence to recommend systematic patellar resurfacing with a "patella-friendly" prosthesis. Level of evidence: 1. [ABSTRACT FROM AUTHOR]

To identify if any differences exist in IFM size and quality in single leg weight bearing position between healthy and PFP participants based on foot posture. Cross-sectional, matched case-comparison study University Laboratory Setting 35 PFP (age:20.46 ± 3.79yrs, mass:73.28 ± 26.58 kg, height:170.80 ± 11.91 cm) and 35 healthy (age:20.40 ± 3.16yrs, mass:64.76 ± 11.52 kg, height:169.55 ± 9.10 cm) participants After measuring Foot Posture Index (FPI), ultrasound images (USI) of Abductor Hallucis (AH), Flexor Digitorum Brevis (FDB) and Quadratus Plantae (QP) were taken in a single limb weight bearing position. Cross-sectional area (CSA) and echogenicity were measured on the USI. FPI was not different between groups (PFP:2.34 ± 3.76, Healthy:2.34 ± 3.10, 9 pronated and 26 non-pronated in both groups). AH CSA was smaller in PFP than healthy group (PFP:0.030 ± 0.01 cm (Smith et al., 2018)/kg, Healthy:0.042 ± 0.01 cm (Smith et al., 2018)/kg, P < 0.001) with a large effect (d = −1.20(-1.71, −0.69). There were no other significant group main effects or group-by-FP interactions in AH/FDB/QP CSA or echogenicity. AH CSA was smaller in PFP than healthy controls, but no difference in CSA or echogenicity of FDB/QP exist, as well as no difference in foot posture between groups. While single limb weight bearing, the PFP group presented with a smaller IFM which provides eccentric control of medial longitudinal arch, which may have implications up the chain during weight bearing functional tasks. • Individuals with PFP have a smaller cross-sectional area of the AH than health. • There are no differences in muscle quality of IFM between PFP and healthy controls. • No differences in cross-sectional area of FDB, QP was found between PFP and healthy. [ABSTRACT FROM AUTHOR]

Background Forward and side lunge exercises strengthen hip and thigh musculature, enhance patellofemoral joint stability, and are commonly used during patellofemoral rehabilitation and training for sport. Hypothesis/Purpose The purpose was to quantify, via calculated estimates, patellofemoral force and stress between two lunge type variations (forward lunge versus side lunge) and between two step height variations (ground level versus 10 cm platform). The hypotheses were that patellofemoral force and stress would be greater at all knee angles performing the bodyweight side lunge compared to the bodyweight forward lunge, and greater when performing the forward and side lunge at ground level compared to up a 10cm platform. Study Design Controlled laboratory biomechanics repeated measures, counterbalanced design. Methods Sixteen participants performed a forward and side lunge at ground level and up a 10cm platform. Electromyographic, ground reaction force, and kinematic variables were collected and input into a biomechanical optimization model, and patellofemoral joint force and stress were calculated as a function of knee angle during the lunge descent and ascent and assessed with a repeated measures 2-way ANOVA (p<0.05). Results At 10° (p=0.003) knee angle (0° = full knee extension) during lunge descent and 10° and 30° (p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in forward lunge than side lunge. At 40°(p=0.005), 50°(p=0.002), 60°(p<0.001), 70°(p=0.006), 80°(p=0.005), 90°(p=0.002), and 100°(p<0.001) knee angles during lunge descent and 50°(p=0.002), 60°(p<0.001), 70°(p<0.001), 80°(p<0.001), and 90°(p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in side lunge than forward lunge. At 60°(p=0.009) knee angle during lunge descent and 40°(p=0.008), 50°(p=0.009), and 60°(p=0.007) knee angles during lunge ascent patellofemoral joint force and stress were greater lunging at ground level than up a 10cm platform. Conclusions Patellofemoral joint loading changed according to lunge type, step height, and knee angle. Patellofemoral compressive force and stress were greater while lunging at ground level compared to lunging up to a 10 cm platform between 40° - 60° knee angles, and greater while performing the side lunge compared to the forward lunge between 40° -100° knee angles. [ABSTRACT FROM AUTHOR]

Objective The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta‐analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing. Methods A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non‐PD group. Subgroup analyses were carried out according to the follow‐up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time. Results Ten RCTs were included in this meta‐analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, −0.37; 95% CI, −0.69 to −0.05; P = 0.02) in the PD group when compared to the non‐PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3‐ and 12‐month follow‐up but not after 12‐month follow‐up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found. Conclusion PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12‐month follow‐up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing.

Individuals with patellofemoral pain (PFP) experience discomfort during various functional activities. Long-term pain is a common consequence of PFP, yet little is known about daily pain variability. Our study consisted of 25 individuals with PFP who completed the Anterior Knee Pain Scale (AKPS) and recorded their daily pain over 10 days. Pain was evaluated using 2 measures of intensity (baseline pain, 10-day average pain) and 2 measures of variability (mean square of successive differences, probability of acute change). Associations between AKPS and the 4 pain measures were calculated with Pearson correlations. We calculated a linear regression to examine the amount of variance in the AKPS explained by the 4 pain measures. Greater mean square of successive differences values were moderately associated with lesser AKPS scores (r = −0.648, P <.001). Mean square of successive differences and 10-day averaged pain were the strongest predictors of AKPS (R2 = 0.565, P <.001). Pain variability provided a unique perspective on the pain experience and predicted patient-oriented function in individuals with PFP. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Glaviano, NR and Saliba, S. Differences in gluteal and quadriceps muscle activation during weight-bearing exercises between female subjects with and without patellofemoral pain. J Strength Cond Res 36(1): 55–62, 2022—Therapeutic exercises targeting gluteal and quadriceps muscles have been previously investigated; however, these studies have only been conducted on healthy individuals. Female subjects with patellofemoral pain (PFP) present with weakness in their gluteal and quadriceps muscles and commonly perform exercises that target these muscles. Therefore, the purpose of this study was to compare lower extremity muscle activity during 5 weight-bearing exercises between female subjects with and without PFP. Twenty female subjects with PFP and 20 healthy female subjects completed 5 weight-bearing tasks: a single-leg squat (SLS), lateral step-down, step-up task, step-down task, and lunge. Surface electromyography of the gluteus medius (GMed), gluteus maximus (GMax), vastus lateralis (VL), and vastus medialis oblique (VMO) were collected. Electromyography activity were normalized to maximal voluntary isometric contractions to represent each gluteal and quadriceps muscle as a percentage. Female subjects with PFP completed a SLS and step-up tasks with less GMed and GMax activity (p < 0.05) compared with those without PFP. Female subjects with PFP also had greater VMO activity (p < 0.05) during the step-up, step down, and lunge and VL activity (p < 0.05) during the step-up and SLS compared with healthy female subjects. Practitioners should be aware that there are differences in gluteal and quadriceps muscle activation between female subjects with and without PFP while performing weight-bearing exercises. These findings should influence both the selection of specific exercises and exercise progression when developing a treatment program that has the intended focus to address gluteal or quadriceps strength deficits in female subjects with PFP. [ABSTRACT FROM AUTHOR]

Patellofemoral pain (PFP) is prevalent and challenging to manage. Most patients with PFP are unsatisfied with their knee function at 6 months after treatment and report ongoing pain up to 16 years after diagnosis. The confidence and knowledge of athletic trainers (ATs) in providing evidence-based care to people with PFP is unknown. To investigate the confidence and knowledge of ATs in the diagnosis, risk factors, prognosis, and treatment with current evidence for PFP. Cross-sectional study. Online survey. A random sample of 3000 ATs were invited to participate; 261 completed the survey (10% participation rate, 88% completion rate). We surveyed AT demographics, confidence in PFP management, and knowledge related to diagnosis, risk factors, prognosis, and treatment. The confidence and knowledge of ATs in managing PFP was assessed. Their beliefs about evidence were compared with the available evidence (ie, consensus statements, position statements, systematic reviews). Of the ATs surveyed, 91% were confident that their management of PFP aligned with the current evidence, but only 59% were confident in identifying risk factors for PFP development. In addition, 91% to 92% of ATs agreed that quadriceps and hip muscle weakness were risk factors for PFP, which aligns with the current evidence for the former but not the latter. Moreover, 93% to 97% of ATs' responses related to therapeutic exercise aligned with current evidence. However, 35% to 48% supported the use of passive treatments, such as electrophysical agents and ultrasound, which did not align with the current evidence. Most ATs were aware of supporting evidence for therapeutic exercise in PFP management and were confident providing it, creating a strong foundation for evidence-based care. However, varying levels of awareness of the evidence related to risk factors and passive treatments for PFP highlight the need for professional development initiatives to better align ATs' knowledge with the current evidence. [ABSTRACT FROM AUTHOR]

To test 1) if the 45-second Anterior Knee Pain Provocation Test (AKPP-test) could differentiate between adolescents with patellofemoral pain (PFP) and pain-free controls and; 2) whether improvements in the AKPP-test over 12 weeks were associated with improvements in self-reported knee function and pain. Prospective cohort. 151 with PFP and 50 pain-free controls (age 10–14 years). The AKPP-test was performed at baseline, 4- and 12-week follow-up. Pain and function were collected using Knee Injury and Osteoarthritis Outcome Score (KOOS). At baseline, the AKPP-test provoked pain to a median of 5 points (IQR: 3–7) on the 0–10 Numeric Pain Rating Scale in adolescents with PFP, compared to 0 (IQR 0-0) in controls. Higher pain during the AKPP-test was associated with worse KOOS-Sport/Rec (r = −0.33, P < 0.001), worse KOOS-Pain (r = −0.47, P < 0.001), and pain intensity (worst pain last 24 hours) (r = −0.39, P < 0.001) at baseline. Improvements in the AKPP-test over 12 weeks were associated with improvements in KOOS Pain (r = 0.48, P < 0.001) and KOOS Sport/Rec (r = 0.40, P < 0.001). Improvements in the AKPP-test were associated with improvements in self-report knee pain and limitations in sports, suggesting the AKPP-test may be a clinically responsive test of knee pain and sporting function in adolescents with PFP. • We tested a new quick pain provocation test for adolescents with Patellofemoral Pain. • The 45-s Anterior Knee Pain Provocation Test (AKPP-test) was performed at baseline, 4- and 12-week follow-up. • The AKPP-test was moderately associated with self-report pain and sporting function, and responsive to change over 12 weeks. • The test provides a simple and time efficient tool to assess improvements over time in clinical practice. [ABSTRACT FROM AUTHOR]

Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results. [ABSTRACT FROM AUTHOR]

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Purpose: The main purpose of this study was to determine whether there is a correlation between the change of tibial tuberosity-trochlear groove (TT-TG) distance and clinical outcomes after total knee arthroplasty (TKA). Methods: A total of 52 knees undergoing TKA due to primary osteoarthritis were included in this retrospective study. All patients had pre- and postoperative CT scans. TT-TG distance was measured by two independent observers and the following alignment parameters were measured: hip-knee ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA), and posterior condylar angle (PCA). Clinical outcome was assessed using Knee Society Score (KSS) pre- and post-operatively and at a minimum of 12-month follow-up. Evidence of AKP was noted from follow-up reports. Pre- and postoperative scores were compared using a paired Student t-test. Pearson correlations were calculated to assess the influence of TT-TG on clinical outcome and of alignment parameters on the change in TT-TG. TT-TG between patients with and without AKP was compared using unpaired Student's t-test (p < 0.05). Results: Neither the absolute postoperative TT-TG nor the amount of change in TT-TG correlated with the post-operative KSS or the change in KSS. Post-operative TT-TG and change in TT-TG did not differ significantly between patients with and patients without AKP. Only the change in FMA showed a correlation with the change in TT-TG (p = 0.01, r = 0.36). Conclusion: Despite a missing correlation between outcomes and TT-TG distance in this study, excessive TT-TG distance should be avoided. Furthermore, surgeons need to be aware that changes in femoral joint line orientation might affect TT-TG distance. [ABSTRACT FROM AUTHOR]