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Background: Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. Methods: Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created. Results: Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = –0.76, 95% confidence interval (95%CI) : –1.32 to –0.21) and concentric contractions (SMD = –0.97, 95%CI : –1.49 to –0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = –0.48, 95%CI : –0.82 to –0.14), concentric (SMD = –1.07, 95%CI : –2.08 to –0.06), and eccentric contractions (SMD = –0.59, 95%CI : –0.97 to –0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = –0.76, 95%CI : –1.15 to –0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders. Conclusion: Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.

Introduction: Anterior knee pain commonly affects young women resulting in the declination of the quality of life. One of the possible pathologies causing this symptom is chondromalacia patellae (CMP). Although CMP is used to describe the softening of patellar articular cartilage, it remains a general descriptive term as it cannot be associated with a specific pathophysiologic mechanism. The objective of this study is to investigate the effect of injectable PRP on patients with anterior knee pain in absence of altered patellofemoral joint anatomy. Methods: For this purpose, 43 patients of the affected population were recruited to participate in this non-randomized controlled trial, 28 patients in the injection group and 15 in the only-physiotherapy group. While patients in the experimental group received three PRP injections and one injection of hyaluronic acid (HA), comparators received the standard physical therapy regimen. The treatment choice was based on patients own decree. Patients between the ages of 18 to 50 years with anterior knee pain and positive Clarke´s sign were eligible for inclusion. Patients with evident anatomical abnormalities, chronic conditions affecting the knee and severe symptoms such as blocking, were excluded from the study. Patient related measures (PROMS) in the form of the VAS and the Kujala scores were the main outcome of interest. All outcomes were measured at baseline, and after 3 and 6 months after the treatment. Results: Although an improvement was seen in both groups, a statistically significant difference favoring the injection of PRP over the physiotherapy-only group was observed (p < 0.001). The superiority of the therapeutic modality under investigation was observed at 3 and 6 months after the initial diagnosis was made. Furthermore, the results of this study revealed a significant improvement at 3 and 6 months when compared to baseline measures. The analysis of the patients age showed a negative correlation when baseline values were compared to measures at 3 and 6 months, meaning younger patients had more benefit from the treatment. Discussion: The main results of this study affirm the positive effects of PRP and HA for the treatment of anterior knee pain described by previous research and the subsequent improvement of the quality of life. Relatively little information was found in the literature search regarding the therapeutic effects of PRP on anterior knee pain and chondropathies. While a previous radiologic study found no evidence regarding the effect of PRP, this study found a benefit when comparing PROMs between patient groups. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of myofascial trigger point manual massage combined with isokinetic strength training in the treatment of chondromalacia patellae. Methods Sixty patients with chondromalacia patellae who were treated at the outpatient department of Guangxi Orthopedic and Traumatology Hospital from April 2019 to April 2021 were randomly divided into two groups, each with 30 cases. The control group received oral non steroidal anti inflammatory drugs combined with static squat training, while the treatment group received myofascial trigger point manual massage combined with isokinetic strength training. Visual Analogue Scale (VAS) scores, Lysholm scores, and Hospital for Special Surgery (HSS) scores were observed before treatment, one week after treatment, and six months after treatment. The cure rate and efficacy rate were evaluated one week after treatment. Results One week and six months after treatment, the treatment group showed better VAS scores, Lysholm scores, HSS scores, and cure rates compared to the control group (P<0.05), but no significant difference was observed in the efficacy rate (P>0.05). One week and six months after treatment, the treatment group showed significant improvements in VAS scores, Lysholm scores, and HSS scores compared to before treatment (P<0.05). Conclusion Myofascial trigger point manual massage combined with isokinetic strength training can effectively relieve knee joint pain and improve knee joint function. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the effectiveness of electroacupuncture in treating chondromalacia patella (CMP) in soldiers. Topics explored include a comparison between electroacupuncture and physical therapy in terms of treatment efficacy and complications, the management of clinical symptoms of CMP particularly anterior knee pain, and the pain and disability Visual Analog Scale (VAS) scores recorded following treatment.

• Gradual-onset knee disorders are associated with reduced hamstring strength. • Individuals with patellofemoral pain present with reduced hamstring flexibility. • The unaffected limb may not be a valid reference of normative value. • Studies are lacking on hamstring morphology in gradual-onset knee disorders. • The lack of investigations in chondromalacia patellae precludes any conclusion. Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders. Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created. Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = –0.76, 95% confidence interval (95%CI) : –1.32 to –0.21) and concentric contractions (SMD = –0.97, 95%CI : –1.49 to –0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = –0.48, 95%CI : –0.82 to –0.14), concentric (SMD = –1.07, 95%CI : –2.08 to –0.06), and eccentric contractions (SMD = –0.59, 95%CI : –0.97 to –0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = –0.76, 95%CI : –1.15 to –0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders. Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: To evaluate magnetic resonance image (MRI) findings in children and adolescents suffering from knee pain without traumatic or physical overload history and to identify potential anatomic risk factors. Material and Methods: A total of 507 MRIs of 6- to 20-year-old patients (251 males; 256 females) were evaluated with regard to detectable pathologies of the knee. The results were compared to a control group without pain (n = 73; 34 males; 39 females). A binary logistic regression model and t-tests for paired and unpaired samples were used to identify possible risk factors and significant anatomic differences of the study population. Results: In 348 patients (68.6%), at least one pathology was detected. The most commonly detected finding was chondromalacia of the patellofemoral (PF) joint (n = 205; 40.4%). Chondral lesions of the PF joint occurred significantly more often in knee pain patients than in the control group (40% vs. 11.0%; p = 0.001), especially in cases of a patella tilt angle > 5° (p ≤ 0.001), a bony sulcus angle > 150° (p = 0.002), a cartilaginous sulcus angle > 150° (p = 0.012), a lateral trochlear inclination < 11° (p ≤ 0.001), a lateralised patella (p = 0.023) and a Wiberg type II or III patella shape (p = 0.019). Moreover, a larger patella tilt angle (p = 0.021), a greater bony sulcus angle (p = 0.042), a larger cartilaginous sulcus angle (p = 0.038) and a lower value of the lateral trochlear inclination (p = 0.014) were detected in knee pain patients compared to the reference group. Conclusion: Chondromalacia of the PF joint is frequently observed in children and adolescents suffering from non-overload atraumatic knee pain, whereby a patella tilt angle > 5°, a bony sulcus angle > 150°, a cartilaginous sulcus angle > 150°, a lateral trochlear inclination < 11°, a lateralised patella and a Wiberg type II or III patella shape seem to represent anatomic risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Chondromalacia patellae (CP) is common among patients with anterior knee pain (AKP), characterized by softening and deterioration of the patellar cartilage. Although the exact etiology is unknown, risk factors include lower extremity muscle weakness, obesity, and female sex. Further, patellar maltracking may play a role in developing CP. Treatment algorithms for CP remain vague and inconsistent as the significance of the diagnosis remains in question. Initial treatment is typically nonoperative with various adjunct modalities. However, surgery may have a role for recalcitrant cases. Objectives: Although CP is a common diagnosis, there is still much to be learned about the significance of this diagnosis and subsequent treatment strategies. Knowledge of this will help to guide providers moving forward. Methods: The authors completed a thorough literature search of available published work through December 31, 2021, discussing CP and its relationship with AKP, and distilled this information into current concepts regarding history, diagnosis, treatment, and future directions. Results: Although much is still unknown about the significance and best treatment strategy for patients with AKP pain and CP, it is likely that in many cases chondromalacia is a finding in the presence of AKP, rather than the cause of the AKP. Conclusions: More work must be done to fully elucidate the underlying causes of CP. However, some of these cases are likely related to subtle maltracking and perhaps can be surgically corrected. In most cases, extensive nonoperative measures and searching for other causes of AKP is most prudent.

Background: Meniscal root repair can improve patient outcomes significantly; however, several contraindications exist, including arthritic change to the medial or lateral tibiofemoral compartments. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes of meniscal root repair in patients with advanced patellofemoral chondromalacia (PFC). It was hypothesized that the presence of advanced PFC would not significantly affect the postoperative outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted of patients who underwent meniscal root repair with at least 2 years of follow-up data. Patients with chondromalacia as determined by arthroscopic visualization (defined as Outerbridge grade 3 or 4) were placed in the PFC group; patients with Outerbridge grade 0 to 2 chondromalacia were placed in the non-PFC group. Outcomes were measured by the Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form. Clinical outcomes including complications were also recorded. Quantitative data between the groups were analyzed using the 2-tailed independent-samples t test. Results: Overall, this study included 81 patients (35 in the PFC group, 46 in the non-PFC group). The mean follow-up times were 25.1 months in the PFC group and 24.8 months in the non-PFC group. In both groups, Lysholm and IKDC scores improved significantly with 24-month Lysholm scores averaging 85.86 in the PFC group and 86.61 in the non-PFC group (P =.62) and 24-month IKDC scores averaging 77.66 for the PFC group and 79.59 for the non-PFC group (P =.45). The cohorts demonstrated similar rates of retear, arthrofibrosis, infection, and progression to total knee arthroplasty. Conclusion: The presence of advanced PFC was not associated with inferior outcomes in patients who underwent posterior meniscal root repair, and rates of recurrent tears, postoperative infection, arthrofibrosis, and conversion to total knee arthroplasty were similar between the study groups. These findings suggest that PFC may not significantly alter the results of meniscal root repair and should not be considered an absolute contraindication for this procedure. [ABSTRACT FROM AUTHOR]

Objective:Purpose of the study is to analyze the association between trochlear dysplasia and chondromalacia patellae.Method:Knee magnetic resonance imaging of 191 patients (103 female and 88 male, mean age: 33±3.1, range: 18-49) with trochlear dysplasia were involved in the retrospective study. Patients without trochlear dysplasia (100 female and 91 male, mean age: 31±4.2 years, range: 18-49) were considered as the controls. Trochlear dysplasia was classified (type A, type B, type C, type D). Tibial tuberosity-trochlear groove distance was detected. Chondromalacia patellae was examined separately at the medial and lateral facet.Results:The distribution of trochlear dysplasia was as follows; type A (50.2%), Type B (30.3%), type C (13.6%), type D (5.9%). Chondromalacia patellae was detected in 81 (42.4%) of patients with trochlear dysplasia and in 39 (20.4%) of the controls (p

Background: Meniscal ramp lesions are associated with anterior cruciate ligament (ACL) injuries and may affect knee stability when left untreated. The diagnostic accuracy of magnetic resonance imaging (MRI) to identify this meniscocapsular injury of the posterior horn of the medial meniscus remains poor, and the arthroscopic findings require vigilance. Purpose: To determine the concordance of arthroscopic and MRI findings to better identify the presence of a ramp lesion in children and adolescent patients undergoing primary ACL reconstruction. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients aged <19 years who underwent primary ACL reconstruction at a single institution between 2020 and 2021 were included. Two cohorts were developed by the presence of a ramp lesion arthroscopically. Basic patient descriptive data, preoperative imaging (radiologist assessment and independent reviewer assessment), and concomitant arthroscopic findings at the time of ACL reconstruction were recorded. Results: An overall 201 adolescents met criteria with a mean age of 15.7 years (range, 6.9-18.2) at the time of injury. A ramp lesion was identified in 14% of patients (28 children). No differences were detected between cohorts with regard to age, sex, body mass index, weeks from injury to MRI, or weeks from injury to surgery (P >.15). The primary predictor of an intraoperative ramp lesion was the presence of medial femoral condylar striations, with an adjusted odds ratio of 722.2 (95% CI, 59.5-8768.2; P <.001); the presence of a ramp lesion on MRI had an adjusted odds ratio of 11.1 (95% CI, 2.2-54.8; P =.003). Patients with neither a ramp lesion on MRI nor medial femoral condylar striations had a 2% rate (2/131) of ramp lesion; those with either of the significant risk factors had a 24% rate (14/54). All patients with both risk factors (100%; n = 12) had a ramp lesion noted on intraoperative examination. Conclusion: The concordance of medial femoral condylar chondromalacia, particularly striations, noted during arthroscopy and posteromedial tibial marrow edema on MRI with or without direct evidence of posterior meniscocapsular pathology should increase suspicion for the presence of a ramp lesion in adolescents undergoing ACL reconstruction. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Anterior cruciate ligament (ACL) repair had previously been considered the standard of care for a ruptured ACL; however, ACL reconstruction has became the standard of care because of poor midterm outcomes after ACL repair. Recently, studies have suggested that the treatment paradigm should shift back to ACL repair. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes of ACL repair augmented with suture tape in a high-demand military population. We hypothesized that for proximal ACL avulsions, ACL repair with suture tape augmentation would lead to acceptable failure rates, satisfactory knee stability, excellent functional outcomes, and high rates of return to preinjury activity levels. Study Design: Case series; Level of evidence, 2. Methods: Patients who were treated with ACL repair by a single surgeon between March 2017 and June 2019 and who had a minimum of 2 years of follow-up were included. Intraoperatively, all patients first underwent an arthroscopic examination. If an ACL avulsion of the proximal insertion with adequate remaining tissue was visualized, then ACL repair was performed. The primary outcome assessed was ACL repair failure, defined as reruptures or clinical instability requiring revision to ACL reconstruction. Analysis of the risk factors for ACL repair failure was conducted, with age at surgery, sex, body mass index, level of competition, and tobacco use evaluated. Results: Included were 46 patients (32 male and 14 female; mean age, 28.3 ± 8.4 years) who underwent ACL repair with suture tape augmentation. There were 12 cases of failure (26.1%; 8 male and 4 female). The mean time from injury to surgery in the failure group was 164.1 ± 59.4 days compared to 107.3 ± 98.0 days in the nonfailure group (P =.02). According to multivariate regression analysis, patients aged ≤17 and ≥35 years, elite/competitive/operational patients, and current smokers had a higher chance of ACL repair failure. The mean time to pass a military physical fitness test was 5.0 months. There were no complications other than ACL repair failure. Conclusion: Primary arthroscopic ACL repair with suture tape augmentation resulted in unacceptably high failure rates at a minimum of 2 years of follow-up in a highly active military population. Age ≤17 and ≥35 years, elite level of competition, time from injury to surgery, and active tobacco use were independent risk factors for ACL repair failure. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP). Material and Methods: This study was designed as a prospective study in 30 patients (15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20-50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients. Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p<0,05). There were no significant differences in thigh circumference and other parameters of certain SF-36 quality of life components (p>0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p>0,05). Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment. [ABSTRACT FROM AUTHOR]

Background: Cartilage mapping using Magnetic Resonance Imaging T2 is a functional non-invasive scanning procedure delivering cartography of the cartilage T2 relaxation time without using any contrast. It is tissue anisotropy sensitive, and compositional data on the collagen network of cartilage, content of water and concentration of proteoglycans are provided by it. Aim of the Work: there is limited studies for evaluation the T2 mapping role in detection of chondromalacia and osteoarthritis in knee pain patients, therefore the aim of this work is to evaluate the additional value of T2 mapping overusing a baseline standard knee MRI to detect patellofemoral cartilage lesions including chondromalacia patella and knee osteoarthritis in patients presented with anterior knee pain. Patients and Methods: This Cross-Sectional Study was conducted at Ain Shams University Hospital, Radio diagnosis department on 35 patients with anterior knee pain for at least 6 months. Results: Among the study population 27 (77.1 %) of patients were diagnosed with OA by conventional MRI & T2 mapping with accuracy 85.7%, while only 13 (37.1%) of patients were diagnosed with chondromalacia by MRI & T2 mapping with accuracy 74.3%. In the comparison between conventional MRI & MRI T2 mapping to detect OA & chondromalacia lesions the sensitivity and specificity for OA 84.4% & 100%, while it was 59.1% & 100% for chondromalacia respectively. Conclusion: T2 mapping may offer added value in the assessment of knee joint conditions such as OA and chondromalacia, with higher sensitivity and accuracy rates compared to conventional MRI. T2 mapping may be particularly useful in detecting early degenerative changes in the knee joint, which may allow for earlier intervention and management of these conditions. [ABSTRACT FROM AUTHOR]

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Abstract Chondromalacia patellae (CMP), also known as runner’s knee, typically occurs in young patients, which is characterized by anterior knee pain (AKP) that is associated with visible changes in patellar cartilage. The initial pathological changes include cartilage softening, swelling, and edema. CMP is caused by several factors, including trauma, increased cartilage vulnerability, patellofemoral instability, bony anatomic variations, abnormal patellar kinematics, and occupation hazards. CMP may be reversible or may progress to develop patellofemoral osteoarthritis. Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications. Additionally, radiological examinations are also necessary for diagnosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic method, which holds a promise in having the unique ability to potentially identify cartilage lesions. Modalities are conventionally proposed to treat cartilage lesions in the PF joint, but none have emerged as a gold standard, neither to alleviated symptoms and function nor to prevent OA degeneration. Recently, researchers have been focused on cartilage-targeted therapy. Various efforts including cell therapy and tissue emerge for cartilage regeneration exhibit as the promising regime, especially in the application of mesenchymal stem cells (MSCs). Intra-articular injections of variously sourced MSC are found safe and beneficial for treating CMP with improved clinical parameters, less invasiveness, symptomatic relief, and reduced inflammation. The mechanism of MSC injection remains further clinical investigation and is tremendously promising for CMP treatment. In this short review, etiology, MRI diagnosis, and treatment in CMP, especially the treatment of the cell-based therapies, are reviewed.

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.

Objective: Chondromalacia patella, one of the most common musculoskeletal problems encountered in clinical practice. The isometric test using the isokinetic dynamometer can be used for a valid assessment and follow-up of knee strength during the rehabilitation of chondromalacia patella. Our study investigates the effectiveness of the isokinetic dynamometer as a monitoring tool for individuals with chondromalacia patella. Methods: Twenty-eight patients with chondromalacia patella (mean age 39±10.84 years, mean symptom duration 11.75±7.38 months) were included in the study. All patients had physical therapy and rehabilitation program that was applied for 15 sessions, 5 days a week during 3 weeks. Knee flexion and extension strengths were measured at 60°/second and 180°/second (5 sets) angular velocity with an isokinetic dynamometer system before and after physical therapy and rehabilitation program. Visual analog scale (VAS)-pain value was used for clinical assessment. Modifies magnetic resonance imaging (MRI) staging system was used in the staging of chondromalacia patella. The relationship between VAS pain value and isokinetic dynamometer parameters was analyzed, as well as correlation in radiological MRI staging, treatment effectiveness, symptom duration. A value of p<0.05 was considered significant. Results: Statistically significant improvement was observed in the knee flexion and extension muscle strengths at 60°/second and the 180°/the second angular velocity (PTE_60, PTF_60, PTE_180, PTF_180) after the physical therapy and rehabilitation program in affected knees (p=0.0001 for all). Analysis of correlation and interaction of chondromalacia patella MR stages, VAS pain value, body mass index, duration of symptoms, and treatment efficacy was also statistically significant (p<0.05). Conclusion: Our study results suggest that physical therapy and rehabilitation program improves the strength of both knee extensors and flexors, and isokinetic parameters have a significant effect on the treatment effectiveness. The isokinetic dynamometer may provide a precise monitoring to assess treatment efficacy of patients with chondromalacia patella. More studies are needed for further scientific evidence. [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]

BACKGROUND: There is a high incidence of patellofemoral cartilage injury in clinical practice. However, the current research on its etiology is insufficient. Hyperactivity is one of the pathological mechanisms widely recognized in clinic, and understanding the occurrence and development of patellofemoral injury is of great significance. OBJECTIVE: To study the effect of uniaxial fatigue exercise on the patellofemoral articular cartilage, and to explore patellofemoral cartilage injuries caused by fatigue in rabbits, so as to provide an experimental basis for understanding the effect of hyperactivity on patellofemoral cartilage lesions. METHODS: Eight New Zealand white rabbits were adaptively fed for 1 week. The right knee of each rabbit was selected as the experimental side and the left knee as the control side. The right knee was fixed on a modeling machine for uniaxial fatigue exercise, and the activity angle was set to be 0°-95° and the activity frequency was set at 60 beats per minute, 90 minutes a day, for 2 weeks. The left knee of each rabbit was untreated. After modeling, MRI images of the rabbit knee joints were collected. The animals were then sacrificed and sampled, and the cartilage tissue sections of the patellofemoral joint were observed and assessed by the Mankin score. RESULTS AND CONCLUSION: The patellar cartilage of the experimental side was significantly damaged. After 2 weeks of uniaxial fatigue exercise, the patellar cartilage of the experimental side had dull color, visible fissures, rough surface, and hyperplasia at the edge of the patellofemoral interface, while no obvious cartilage degeneration was observed on the control side. The results of knee MRI showed that the signal intensity of the patellar cartilage on the experimental side was heterogeneous. Hematoxylin-eosin staining results revealed that the cartilage surface of the experimental side was not smooth, and chondrocyte proliferation, disarrangement, and multiple tidal lines were observed under a light microscope. The Mankin score of the experimental side was significantly higher than that of the control side (P < 0.05). These findings indicate that 2-week uniaxial fatigue exercise can cause mild damage to the cartilage of the patellofemoral joint in rabbits, accompanied by pathological changes such as cartilage swelling and fissures. [ABSTRACT FROM AUTHOR]

The evolution of the rehabilitation treatment to patients with patellar chondromalacia, is one of the polemical topics among the specialists of physical medicine and rehabilitation. This paper aims to elaborate an alternative of rehabilitative treatment for patients with patellar chondromalacia. Different methods and technics were used which allowed us the development of the whole investigative process. The elaboration of the scientific results is corroborated beginning from the diagnosis, where the necessity of an alternative treatment is revealed, because in the consulted literature it becomes evident the presence of lacks of the practical order which justify the present investigation. The results were compared applying the treatment to two groups of patients randomnly selected, one group received the traditional treatment and the other one received the alternative treatment. Some statistical tests were applied like t Student test. The achieved results reveal their validity in practice since the quasi-experiment and it was demonstrated that the relevant clinical effect is high. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Brasileira de Prescrição e Fisiologia do Exercício is the property of Instituto Brasileiro de Pesquisa e Ensino em Fisiologia do Exercicio and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Magnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae.

Chondromalacia patellae (CMP), also known as runner's knee, typically occurs in young patients, which is characterized by anterior knee pain (AKP) that is associated with visible changes in patellar cartilage. The initial pathological changes include cartilage softening, swelling, and edema. CMP is caused by several factors, including trauma, increased cartilage vulnerability, patellofemoral instability, bony anatomic variations, abnormal patellar kinematics, and occupation hazards. CMP may be reversible or may progress to develop patellofemoral osteoarthritis. Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications. Additionally, radiological examinations are also necessary for diagnosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic method, which holds a promise in having the unique ability to potentially identify cartilage lesions. Modalities are conventionally proposed to treat cartilage lesions in the PF joint, but none have emerged as a gold standard, neither to alleviated symptoms and function nor to prevent OA degeneration. Recently, researchers have been focused on cartilage-targeted therapy. Various efforts including cell therapy and tissue emerge for cartilage regeneration exhibit as the promising regime, especially in the application of mesenchymal stem cells (MSCs). Intra-articular injections of variously sourced MSC are found safe and beneficial for treating CMP with improved clinical parameters, less invasiveness, symptomatic relief, and reduced inflammation. The mechanism of MSC injection remains further clinical investigation and is tremendously promising for CMP treatment. In this short review, etiology, MRI diagnosis, and treatment in CMP, especially the treatment of the cell-based therapies, are reviewed. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effects of tibial rotation on in situ strain in the peripatellar retinaculum and patellofemoral contact pressures and areas. Patellofemoral joint biomechanics demonstrate a strong correlation with the etiology of patellofemoral disorders, such as chondromalacia, and are significantly influenced by tibial rotation. Six human cadaveric knees were used along with a patellofemoral joint testing jig that permits physiological loading of the knee extensor muscles. Patellofemoral contact pressures and areas were measured with a Fuji pressure-sensitive film, and the changes in in situ strain in the peripatellar retinaculum were measured with four differential variable reluctance transducers. Tibial rotation had a significant effect on patellofemoral joint biomechanics. The data showed an inverse relationship between increasing knee flexion angles and the change in patellofemoral contact pressures and in situ strain with tibial rotation. At higher knee flexion angles, the patella is well-seated in the trochlear groove and the function of the peripatellar retinaculum is minimized and less affected by tibial rotations.

Selective strengthening of the vastus medialis (VM) muscle is a conservative treatment used to address some patellofemoral joint (PFJ) problems. The objective of this study was to examine the effects of varying VM strength on PFJ kinematics and contact pressures and areas. We tested five fresh-frozen cadaveric knees using a custom knee jig, which permits the simulation of physiologic quadriceps loading while also allowing the VM force to be varied. PFJ kinematics were measured with a magnetic tracking device. PFJ contact pressures and areas were measured with Fuji pressure-sensitive film. For PFJ kinematics, the change in the medial-lateral and superior-inferior translation was significant at 0% of VM strength and 150% of VM strength with respect to the 100% of VM strength condition (p < 0.05). Extreme changes in the VM force had a statistically significant effect on patellofemoral contact pressures (0% of VM strength (19 +/- 10%) and 150% of VM strength (17 +/- 3%) with respect to 100% of VM strength condition (p < 0.05)). No statistically significant differences were shown in the patellofemoral contact areas (p > 0.05). The functional range of VM strength is between 75% and 125% of total VM strength. The PFJ kinematics and contact pressures were not significantly influenced by VM strength except at extreme conditions (0% of VM strength or 150% of VM strength) in human cadaveric knees.

Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients.

* OBJECTIVES: To identify the most common type and timing of interventions used to initially manage patellofemoral pain (PFP), and whether exercise therapy as an initial treatment was associated with a decreased likelihood of recurrence of PFR. *DESIGN: Retrospective cohort. *METHODS: Active-duty military service members (n = 74408) aged 18 to 50 years and diagnosed with PFP between 2010 and 2011 were included. We identified the type and timing of interventions from electronic medical records and insurance payer claims, and studied the influence of early exercise therapy use on injury recurrence rates. * RESULTS: In this cohort of patients with PFR 62.3% (n = 46338) sought no additional care after the initial visit. The most common initial pharmacological interventions were nonsteroidal anti-inflammatory drugs (4.1%), corticosteroid injections (0.4%), and muscle relaxers (0.3%). The most common initial nonpharmacological treatments were exercise therapy (7.6%), passive modalities (eg, hot packs, electrical stimulation, ultrasound; 0.6%), and manual therapy (joint manipulation and mobilization; 0.5%). Common specialty referrals were to physical therapy (3.3%) and orthopaedic providers (0.8%). If patients received at least 6 exercise therapy visits during the initial episode of care, they were less likely to have a recurrence of knee pain (odds ratio = 0.46; 95% confidence interval: 0.42, 0.49). *CONCLUSION: Two in every 3 patients did not seek additional care after PFP diagnosis. For those who sought additional care, exercise therapy was the most common intervention, and higher doses of exercise therapy were associated with a reduced likelihood of having a recurrent episode of knee pain. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Despite higher incidence of patellofemoral pain (PFP) and consequently morbidity, the understanding about PF factors leading to PF arthritis is way lacking. Material and Methods A prospective study of first 80 patients who were diagnosed with chondromalacia patella (CMP) on magnetic resonance imaging (MRI) divided into early and late CMP groups were evaluated clinically, radiologically, and in terms of functional outcome. Results : Quadriceps angle, Clark's test, and Insall–Salvati ratio results were nonsignificant despite greater values were observed in late CMP group, whereas trochlear morphology results (sulcus angle: 153:138 degrees and sulcus depth 3.9:5.4 mm) and clinical scores were significant in late CMP group (Kujala's score: 61:78, whereas PF pain score: 43:25). Type-C patellar morphology was found in greater number in late CMP cohort. Conclusion Trochlear and patellar morphologies along with clinical scores play a key role in understanding of the CMP. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Chondromalacia patella is the degeneration of articular cartilage on the posterior facet of the patella and may indicate the onset of osteoarthritis. Conservative management is the main treatment option, and surgical intervention is considered the last option in a small percentage of patients. Perineural Injection Treatment (PIT) is a recently developed treatment option that is directed adjacent to the peripheral nerves that are the source of pathology causing neurogenic inflammation and pain. Objective: The objective of this study was to evaluate the efficacy of PIT combined with a home physical therapy program in patients with a diagnosis of chondromalacia patella compared with a control group receiving physical therapy only. Methods: Two patient groups were involved in this randomized clinical trial. The first received PIT combined with physical therapy (PIT + PT group) and the second was managed with physical therapy alone (PT group). Both groups were indicated to follow a 6-week home therapy plan afterward. The Western Ontario and McMaster Osteoarthritis Index was used to assess the patients at baseline and 6 months after therapy interventions. Results: Fifty patients (38 women and 12 men, median age 54.7 ± 14.8 years) were included; sex distribution and age did not differ between groups. Both groups had chondromalacia grade II or III, but the degree of gonarthrosis did not differ significantly between groups. The PIT + PT group outperformed PT group for pain (7.3 ± 3.5 vs. 3.2 ± 2.9 points; p < 0.010), stiffness (3 ± 1.69 vs. 1.6 ± 1.5 points; p < 0.010), and functional capacity (23.2 ± 10.7 vs. 11.1 ± 8.9 points; p < 0.010). Conclusions: Compared with physical therapy alone, PIT plus physical therapy reduced pain and stiffness and restored functional capacity. ClinicalTrials.gov Register Number #NCT03515720. [ABSTRACT FROM AUTHOR]

Objective:To observe the clinical effect of extracorporeal shock wave combined with rehabilitation training on patients with chondromalacia patellae (CP).Methods:Sixty patients with CP were treated in Weihaiwei People's Hospital were randomly divided into the control group (n=20), the shock wave group (n=20) and the combined group (n=20). The control group were given routine rehabilitation training, five times a week, continuous treatment for eight weeks. The shock wave group was treated with extracorporeal shock wave therapy. The D20 was probed to pulse the quadriceps femoris, iliotibial band, tibialis anterior muscle, hamstring muscle and triceps muscle of the leg with the frequency of 14 Hz and the intensity of 1.8-2.5 Bar. Each muscle was pulsed 800-1000 times to relax the muscles. According to the frequency of 15 Hz and the intensity of 1.5-2.5 Bar, the D15 was used to move the patella along the edge of the patella or the condyle of the femur. During the pulse, the patella was pushed to the opposite side, so that the shock wave could reach the cartilage surface of the patella as far as possible. The pulse at each point was 300 times, one time a week, continuous treatment for eight weeks. The combined group was given rehabilitation training and divergent extracorporeal shock wave therapy, and the specific treatment method and course of treatment were the same as those in the control group and shock wave group. Visual analogue score (VAS) was used to evaluate the pain improvement, Lysholm scale was used to evaluate knee joint function; Magnetic resonance imaging (MRI) was used to evaluate the staging of patellar osteomalacia according to Recht criteria; The curative effect was evaluated according to the curative effect evaluation standard of chondromalacia patellae.Results:Compared with before treatment, the VAS score decreased significantly and the Lysholm knee joint function score increased significantly in the three groups after treatment for eight weeks, and the difference was statistically significant (PPP

Objective: To establish the prevalence of patellar chondropathy using 3T magnetic resonance imaging (MRI) and to correlate the findings with individual features such as gender, age, and body mass index. Materials and Methods: Data consisted of collecting 3T MRIs of patients' knees obtained between October 2016 and September 2017, comprising a period of 12 months. These MRIs were assessed by an experienced musculoskeletal radiologist who confirmed the presence of patellar chondropathy and, when present, rated the finding into the four grades ascribed by the International Cartilage Repair Society. Results: A total number of 291 patients were assessed during the period with 389 MRI scans. Of those patients, 308 (79.2%) were diagnosed with patellar chondropathy, while 81 (20.8%) were not. Chondropathy was more prevalent in the female gender, in subjects above 40 years of age, and in obese patients. When the results were weighed in International Cartilage Repair Society classification, the milder grades (1 and 2) were seen in younger men (< 30 years of age), while the more severe grades (3 and 4) were mostly present in females, those above 40 years of age, and in obese patients. Conclusion: There was a high prevalence of patellar chondropathy in patients who had undergone high-field knee MRIs (79.2%), being highest in the female gender and in subjects above 40 years of age. The most prevalent group was graded as 4 by the International Cartilage Repair Society classification. [ABSTRACT FROM AUTHOR]

Background/purpose of the study: Aim of the study was to investigate whether ellipsoid sign (ES) in the region corresponding to the cartilaginous facet of the medial femoral condyle (MFC) indicates early cartilage lesion. The finding has not been defined in the literature yet. Methods: The study was performed retrospectively with 50 patients who underwent articular cartilage examination and arthroscopy between 2015 and 2018. Patients were divided into two according to the presence or absence of ES. There were 24 patients in case group (Group A) and 26 patients in controls (Group B). Weight-bearing cartilage areas of MFC in the region where ES was found in both groups were classified according to arthroscopic Outerbridge classification (OC) and compared statistically with each other. Results: There was no significant difference in terms of age, gender and alignment between Group A and Group B (p > 0.05). All OC grades were higher in Group A (p < 0.001). Positive correlation between ES and MFC chondromalacia grade was detected (r: 0.671, t: 6.266, p < 0.05). Conclusion: ES, which refers to the difference in bone density in MFC seen in antero-posterior (AP) X-Ray, is a result of changes in subchondral bone due to chronic cartilage loss. ES detected on AP X-Ray may help in early diagnosis of medial femoral articular cartilage chondromalacia, even at grade 0 or 1. We recommend searching for ES, as the earliest symptom of chondromalacia, which occurs even before MRI lesions. Future studies may reveal additional information about ES. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical effect of low-intensity focused ultrasound (LFU) combined with exercise therapy on chondromalacia patellae. From July to December 2018, 60 outpatients in the Department of Rehabilitation, Third Hospital of Peking University were selected and divided into three groups according to the order of visiting time. Treatment: 1) Conventional group: use the ultrasonic therapy of conventional physical therapy on the affected part, for 4 weeks; 2) Treatment Group: The affected part was treated with low intensity focused ultrasound for 4 weeks; 3) exercise therapy group: use low-intensity focused ultrasound to treat the affected part, and at the same time cooperate with exercise rehabilitation, for 4 weeks. The NRS pain score and Lysholm score were evaluated before treatment, in the middle of treatment, after treatment, 15 days after treatment and 30 days after the treatment. The long-term efficacy was evaluated by the follow-up data of 15 days and 30 days after the treatment. Results: The NRS score and Lysholm score of the three groups on the day after the end of ti'eatment were significantly better than those before treatment, and the differences were statistically significant (P < 0.05); the NRS score and Lysholm score of the treatment group and the combined exercise treatment group at the middle of the course were significantly better than those of the conventional group, and the differences were statistically significant (P< 0.05); the total effective rate of combined exercise therapy group was 90% on the 15th clay and 85% on the 30th day after the end of the course of treatment (P < 0.05). All three treatments were effective at the end of the course, where the total effective rate of low intensity focused ultrasound combined with exercise therapy was improved, and the difference was significant. Conclusion: Low intensity focused ultrasound solves the problems of treatment dose, fitting degree of "treatment head" and treatment depth, so it can achieve treatment effect quickly, and relieve the pain of patients more quickly. Static straight leg lifting exercise, static squatting against the wall, hall clamping training and patellar pushing exercise are consistent with the exercise intensity of patients with chondromalacia patella. Low intensity focused ultrasound combined with exercise therapy can increase the stability of the knee joint, which has a better therapeutic effect than the conventional group and treatment group treated with ultrasound alone. In the clinical treatment of chondromalacia patellae, we should pay attention to the combination of exercise therapy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In this study, we evaluated the relationship between patellar volume and chondromalacia patellae. METHODS: A total of 162 patients who underwent knee magnetic resonance imaging (MR) due to knee pain at our department between January 2017 and May 2017 were included in this study. Of the cases, 111 were chondromalacia patellae, and 51 were healthy individuals. The patella volumes of all cases were analyzed using semi-automated software. Staging in cases with chondromalacia was graded according to the Outerbridge classification (stages 1-4). The relationship between patellar volume, presence of chondromalacia, cartilage thickness, age, and sex was analyzed statistically.RESULTS: Of the 162 cases, 67 (41.4%) were male, and 95 (58.6%) were female. The median age of the cases was 44. Patellar volume was a minimum of 12.24, a maximum of 39.44, and a median 21.4 cm3, and it was higher in cases with chondromalacia (p=0.026). In patients with chondromalacia patellae, the thickness of cartilage in the medial facet was lower. There was a statistically significant weak positive correlation between chondromalacia grade and patellar volume (p=0.031, r=0.204). CONCLUSION: This study showed that chondromalacia patellae, one of the important causes of chronic frontal knee pain, has a statistically significant relationship with patellar volume. The medial facial cartilage of the patella was thinner than in cases with chondromalacia patellae. Although the mean age of the cases with chondromalacia was higher than the cases without chondromalacia, there was no significant difference between male and female individuals. [ABSTRACT FROM AUTHOR]

Copyright of Spor Hekimligi Dergisi/Turkish Journal of Sports Medicine is the property of Turkish Journal of Sports Medicine / Spor Hekimleri Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Clinical & Experimental Medicine is the property of Archives of Clinical & Experimental Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Meniscal root tears have been shown to accelerate cartilage breakdown and increase the risk of total knee arthroplasty (TKA) if left unaddressed. Unfortunately, many patients with meniscal root tears already have associated chondromalacia which can impact surgical outcomes. The presence of advanced chondromalacia in the medial or lateral compartments of the knee is a known contraindication to performing meniscal root repair; however, the effect of advanced patellofemoral chondromalacia on meniscal root outcomes is not known. The purpose of this study was to compare the outcomes of meniscal root repair in patients with and without advanced patellofemoral chondromalacia (PFC). Methods: A retrospective review of prospectively collected data of patients undergoing meniscal root repair by a single surgeon was conducted between January 2016 and December 2019. Patients were included if they had undergone an isolated posterior medial or lateral meniscal root repair. The meniscal root repair was performed using a transtibial suture technique. Patients were placed into one of two groups depending on the amount of patellofemoral chondromalacia present at the time of surgery. Patients with Outerbridge grade 0-2 were placed in the Minimal Patellofemoral Chondromalacia (MPFC) Group. Patients with Outerbridge 3-4 changes found the time of surgery were placed in the Patellofemoral Chondromalacia (PFC) Group. Patients with Outerbridge 3-4 changes found in the medial or lateral compartment were excluded from the study. Lysholm Knee Scoring Scale and the International Knee Documentation (IKDC) Subjective Knee Form were collected preoperatively, 6,12 and 24 months after surgery. Clinical outcomes followed included recurrent meniscal tear, conversion to total knee arthroplasty, knee arthrofibrosis requiring manipulation under anesthesia/lysis of adhesions and infection. PASS and MCID were determined using data on meniscal repairs in other literature. Continuous data was compared using two-tailed student-T test while categorical data was compared utilizing chi-square testing. Results: A total of 27 patients made up the PFC group and 54 in the MPFC group. There was no difference between the groups with regards to age, sex, BMI or laterality of the procedure. The PFC group had 26 medial and 1 lateral meniscal root repairs. The MPFC group had 51 medial and 3 lateral repairs. The average Outerbridge score of the patella for the PFC group was 3.2 compared to 1.8 in the MPFC group (p<.001). The Outerbridge score for the trochlea in each group was 3.4 vs. 1.6 for the PFC and MPFC groups respectively (p<.001). No difference was identified between the Outerbridge score for the medial compartment for the PFC and MPFC groups (1.48 vs 1.46 respectively) or the lateral compartments (0.48 vs. 0.61 respectively). Lysholm and IKDC scores rose significantly over the pre- operative value at all time points in the study for both groups. No difference was seen between the two groups for the Lysholm or IKDC scores at any timepoint during study. PASS rates for IKDC between the two groups were similar with 6,12 and 24-month PASS rates being 66.7%, 87.5% and 81.4% respectively for the PFC group and 62.9%, 77.8% and 85.2% for the MPFC group. There was also no difference between the groups with regards to the percentage of patients reaching MCID for IKDC. The PFC group showed the percentage of patients reaching MCID to be 81.5%, 100% and 92.6% at the 6,12, and 24 month time points respectively while the MPFC group showed the percentage of patients reaching MCID to be 75.9%, 88.9% and 94.4% at the 6,12 and 24 month postoperative time points respectively. There was 1 (3.7%) recurrent tear in the PFC group and 3 (5.6%) in the MPFC group (p=.72). One patient (3.7%) in the PFC and none of the MPFC group were converted to TKA by the 2-year follow up (p=.15). Each group had 1 patient develop arthrofibrosis requiring MUA/LOA. There were no infections in the PFC group and one in the MPFC group which was a superficial wound infection that resolved after a course of oral antibiotics. Conclusions: In our series, the presence of advanced patellofemoral chondromalacia did not lead to inferior short-term outcomes in patients undergoing meniscal root repair compared to patients without patellofemoral chondromalacia. IKDC and Lysholm scores were similar between the PFC and MPFC group at all time points while scores for both groups were significantly higher than preoperative levels at all time points. The ability to reach MCID and PASS for IKDC was not significantly different between the two groups. In addition, there was not a significant difference between the two groups in the number of recurrent tears, conversion to total knee arthroplasty or complications identified. Our results show meniscal root repair can be performed in patients with severe patellofemoral chondromalacia with similar results as patients undergoing root repair without severe patellofemoral chondromalacia. Patellofemoral chondromalacia should not be considered a contraindication to meniscal root repair. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate magnetic resonance image (MRI) findings in children and adolescents suffering from knee pain without traumatic or physical overload history and to identify potential anatomic risk factors., Material and Methods: A total of 507 MRIs of 6- to 20-year-old patients (251 males; 256 females) were evaluated with regard to detectable pathologies of the knee. The results were compared to a control group without pain ( n = 73; 34 males; 39 females). A binary logistic regression model and t-tests for paired and unpaired samples were used to identify possible risk factors and significant anatomic differences of the study population., Results: In 348 patients (68.6%), at least one pathology was detected. The most commonly detected finding was chondromalacia of the patellofemoral (PF) joint (n = 205; 40.4%). Chondral lesions of the PF joint occurred significantly more often in knee pain patients than in the control group (40% vs. 11.0%; p = 0.001), especially in cases of a patella tilt angle > 5° ( p ≤ 0.001), a bony sulcus angle > 150° ( p = 0.002), a cartilaginous sulcus angle > 150° ( p = 0.012), a lateral trochlear inclination < 11° ( p ≤ 0.001), a lateralised patella ( p = 0.023) and a Wiberg type II or III patella shape ( p = 0.019). Moreover, a larger patella tilt angle ( p = 0.021), a greater bony sulcus angle ( p = 0.042), a larger cartilaginous sulcus angle ( p = 0.038) and a lower value of the lateral trochlear inclination ( p = 0.014) were detected in knee pain patients compared to the reference group., Conclusion: Chondromalacia of the PF joint is frequently observed in children and adolescents suffering from non-overload atraumatic knee pain, whereby a patella tilt angle > 5°, a bony sulcus angle > 150°, a cartilaginous sulcus angle > 150°, a lateral trochlear inclination < 11°, a lateralised patella and a Wiberg type II or III patella shape seem to represent anatomic risk factors.

Purpose: In this study, the effect of the most superior point of patella-entrance of femoral trochlea distance ratio (SP-ET index) on chondromalacia patella (CP) was investigated with 2 reviewers., Material and Methods: A total of 348 knees of 308 patients were analysed retrospectively with magnetic resonance imaging (MRI). Patients with or without CP constituted the study and the control groups in this cross-sectional investigation. Two reviewers interpreted the dataset regarding the SP-ET index. This ratio was calculated as the distance between the most superior point of patella and the entrance of femoral trochlea (β) divided by the patellar articular surface length (α). The relationship between the SP-ET index and CP was presented using independent samples T-tests, and the intraclass correlation coefficient (ICC) was calculated to reveal the interobserver differences., Results: There was excellent agreement between the reviewers regarding α, β, and SP-ET values (ICC was 0.971, 0.964, and 0.943, respectively). Higher SP-ET values were obtained for patients with CP, in comparison with patients without any chondral lesion ( p < 0.001). A significant, positive, and moderate level of correlation was revealed between SP-ET measurements and CP grades for the total study population., Conclusions: SP-ET index showed high interobserver agreement and indicated a significant difference between patients with and without CP. Both reviewers' results indicated positive and significant correlation between the measured SP-ET values and different grades of CP for females, males, and the total study population., Competing Interests: The authors report no conflicts of interest., (© Pol J Radiol 2024.)

Background: The aim of this study was to investigate the frequency of chondromalacia patella (CMP) and to evaluate its relation with trochlear morphometric and patellofemoral alignment measurements as well as with edema in superolateral region of Hoffa's fat pad (SHFP) in military recruits with anterior knee pain (AKP). Materials and Methods: Knee magnetic resonance imaging examinations of 288 military recruits with AKP were retrospectively evaluated. Patellar cartilage lesions were graded using modified Noyes system. Quantitative measurements of trochlear morphology (sulcus angle, trochlear sulcus depth, and lateral trochlear inclination [LTI]) and patellofemoral alignment (patellar translation [PT], lateral patellofemoral angle (LPA), Insall-Salvati index, and tibial tuberosity-trochlear groove distance) were made. The SHFP region was assessed for the presence of edema. Mean values of measurements in knees with and without CMP and in knees with early and advanced stage CMP were compared. Results: We found CMP in 169 (58.7%) patients. Patients with CMP demonstrated a significantly greater sulcus angle (P = 0.012), smaller LTI (P = 0.004), greater PT (P = 0.01), smaller LPA (P = 0.036), greater Insall-Salvati ratio (P = 0.034), and higher incidence of SHFP edema (P = 0.001) compared to those without CMP. While none of the measurements were associated with the severity of cartilage damage, the incidence of SHFP edema was significantly correlated with the severity of CMP (P = 0.001). Conclusion: CMP is a common disorder among military recruits with AKP. Patellofemoral malalignment is an important contributory factor in the development of CMP, and the presence of edema in SHFP may be a strong indicator of underlying severe CMP in this population. [ABSTRACT FROM AUTHOR]

Introduction: No previous studies have characterised hip joint disease in diabetic patients undergoing hip arthroscopy. The purpose of our study was to evaluate intra-articular hip pathology and surgical variables in patients with diabetes compared to matched, non-diabetic controls. We hypothesised that diabetic patients would demonstrate a higher prevalence and severity of hip chondral pathology. Methods: We retrospectively reviewed 795 consecutive hip arthroscopies performed by a single surgeon between 2010 and 2015. Patients ⩾18 years of age without a history of diabetes served as controls and were matched based on age, sex, body mass index, duration of symptoms, and operative side. Clinical symptoms, preoperative physical examination, and radiologic and intraoperative findings were assessed. The primary outcomes were the acetabular and femoral head chondromalacia index (CMI), calculated as the product of the Outerbridge chondromalacia grade and surface area (mm2*severity). Results: 15 diabetic patients were matched to 137 non-diabetic controls. Diabetic patients demonstrated a higher prevalence of femoral head chondromalacia compared to controls both on magnetic resonance imaging (45.5% vs. 7.5%, p = 0.002) and during arthroscopy (100% vs. 75.9%, p = 0.042). Femoral head chondromalacia in diabetic patients had higher Outerbridge grade (2.4 vs. 2.0, p = 0.030) but similar CMI (513.0 vs. 416.4, p = 0.298) compared to controls. Discussion: Femoral head chondral pathology was more prevalent and of higher severity grade in diabetic patients. The prevalence, size, and severity of acetabular chondral disease were similar between diabetic and non-diabetic patients. Multivariate analysis demonstrated that diabetic status was independently associated with the presence of femoral head chondromalacia. [ABSTRACT FROM AUTHOR]

Controversy still exists regarding the best clinical assessment test for chondromalacia patellae (CMP). Our study aims to evaluate the specificity and sensitivity of a novel clinical test for CMP, the "Patella Slide Test" (PST) against the findings of magnetic resonance imaging (MRI) and arthroscopy. We included 221 consecutive patients planned for elective knee arthroscopic surgery. An MRI scan of the symptomatic knee was performed prior to surgery. On the day of surgery, each patient was examined using the PST followed by a knee arthroscopy to assess the quality of the chondral surfaces of the patellofemoral joint. The MRI and PST results were compared against the arthroscopic findings that served as the gold standard. The PST (0.89) was statistically more sensitive than MRI (0.67) in diagnosing CMP. The PST (0.89) also had a greater negative predictive value (NPV) than MRI (0.74). However, MRI (0.94) was more specific than the PST (0.85). The differences in accuracy and positive predictive value of the PST versus MRI were not statically significant. In conclusion, the PST shows high sensitivity and has a greater NPV than MRI as a clinical test for diagnosing CMP. [ABSTRACT FROM AUTHOR]

This paper describes the most interesting diseases observed in skeletal samples from two necropolises found in Shirak and Lori provinces during archaeological excavations in the last decades and corresponded to Classical/Late Antiquity period (1st century BC - 3rd century AD). The diseases observed were grouped into the following categories: traumas, infections, nutritional diseases, tumors characteristic for group. A relatively low prevalence of fractures suggests a relatively low level of interpersonal violence in this community. Palaeopathology allowed highlighting the spread of some illnesses, many of which can be related to the life and health conditions of the Armenian population. [ABSTRACT FROM AUTHOR]

The article discusses the Outerbridge's classification system of chondral lesions. It discusses the history with regard to examination of cartilage lesions and the understanding of the etiology of chondromalacia of the patella prior to Outerbridge's scheme. It discusses the etiology of chondromalacia of the patella as the purpose of the Outerbridge system when it was developed in 1961, its description, its reliability and validation, and its apparent limitations.