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The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions.

ABSTRACT: Patellofemoral pain (PFP) is commonly caused by abnormal pressure on the knee due to excessive load while standing, squatting, or going up or down stairs. To better understand the pathophysiology of PFP, we conducted a noninvasive patellar tracking study using a C-arm computed tomography (CT) scanner to assess the non-weight-bearing condition at 0° knee flexion (NWB0°) in supine, weight-bearing at 0° (WB0°) when upright, and at 30° (WB30°) in a squat. Three-dimensional (3D) CT images were obtained from patients with PFP (12 women, 6 men; mean age, 31 ± 9 years; mean weight, 68 ± 9 kg) and control subjects (8 women, 10 men; mean age, 39 ± 15 years; mean weight, 71 ± 13 kg). Six 3D-landmarks on the patella and femur were used to establish a joint coordinate system (JCS) and kinematic degrees of freedom (DoF) values on the JCS were obtained: patellar tilt (PT, °), patellar flexion (PF, °), patellar rotation (PR, °), patellar lateral-medial shift (PTx, mm), patellar proximal-distal shift (PTy, mm), and patellar anterior-posterior shift (PTz, mm). Tests for statistical significance (p < 0.05) showed that the PF during WB30°, the PTy during NWB0°, and the PTz during NWB0°, WB0°, and WB30° showed clear differences between the patients with PFP and healthy controls. In particular, the PF during WB30° (17.62°, extension) and the PTz during WB0° (72.5?0 mm, posterior) had the largest rotational and translational differences (JCS ? = patients with PFP-controls), respectively. The JCS coordinates with statistically significant difference can serve as key biomarkers of patellar motion when evaluating a patient suspected of having PFP. The proposed method could reveal diagnostic biomarkers for accurately identifying PFP patients and be an effective addition to clinical diagnosis before surgery and to help plan rehabilitation strategies.

SUBMITTER: Yang JS

PROVIDER: S-EPMC7526904 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions.

Yang Jae-Suk JS Fredericson Michael M Choi Jang-Hwan JH

PloS one 20200930 9

Patellofemoral pain (PFP) is commonly caused by abnormal pressure on the knee due to excessive load while standing, squatting, or going up or down stairs. To better understand the pathophysiology of PFP, we conducted a noninvasive patellar tracking study using a C-arm computed tomography (CT) scanner to assess the non-weight-bearing condition at 0° knee flexion (NWB0°) in supine, weight-bearing at 0° (WB0°) when upright, and at 30° (WB30°) in a squat. Three-dimensional (3D) CT images were obtain ...[more]

PMID: 32997727

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Project description:BackgroundDynamic knee valgus (DKV) is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing. Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment. Using a secondary analysis of exiting data sets, we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain, and the relationship between joint-specific kinematics and pain in these 2 pain populations.MethodsIn the original studies, 3-dimensional hip and knee kinematics during a single leg squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV. Pain intensity during the squat was assessed in both groups. For the secondary analysis, kinematic data were compared between pain groups using their respective control groups as a reference. Within each pain group, correlation coefficients were used to determine the relationship between kinematics and pain during the squat.ResultsHip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain (effect sizes ≥ 0.40). Greater knee external rotation (r=0.47, p=0.04) was correlated with greater knee pain in those with patellofemoral pain, while greater hip adduction (r =0.53, p =0.05) and greater hip internal rotation (r =0.55, p =0.04) were correlated with greater hip pain in those with chronic hip joint pain.ConclusionHip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain. In both groups, greater abnormal movement at the respective joint (e.g. knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group) was associated with greater pain at that joint during a single leg squat.

Project description:ObjectivePatellofemoral kinematics and contact mechanics are important measurements for the assessment of patellofemoral joint (PFJ) problems. Simultaneously measuring PFJ contact pressures and kinematics is a challenging task. The purpose of this study was to simultaneously measure the kinematics and mean/peak contact pressures in the PFJs of cadaveric knees.MethodsThis was a comparative study performed on fresh cadaveric knees. The kinematic data was acquired for nine cadaveric knees using an optical tracking system. Data about the contact pressure and contact area in the PFJ was obtained at knee flexion angles of 0°, 30°, 60°, 90°, and 120° using a pressure sensor. Intraclass correlation coefficients (ICCs) and minimal detectable differences (MDDs) of six degrees of freedom (6 DOF) in the PFJs were calculated. ICCs and the MDDs of contact pressure, peak pressure, and contact area in the PFJs were also analyzed. We also compared the kinematics of the cadaveric knees before and after the insertion of the pressure sensor.ResultsAll ICC values of 6 DOF in the PFJs were found to be greater than or equal to 0.924. Regarding medial-lateral rotation, the patellar showed a simplified movement pattern that demonstrated progressive lateral rotation of 4.8° ± 3.4° at 120° of knee flexion. While for patellar tilting, the patella showed medial tilting that peaked at 7.2 ± 2.5° at 30° of knee flexion. Whereas no significant differences in PFJ kinematics were found between with and without the placement of the pressure sensor at all knee flexions (P > 0.05). Most of the ICC values for contact pressure, peak contact pressure, and contact area ranged from 0.8 to 0.9. The MDDs for rotational displacement were 0.9° and 0.6 mm for translational displacement. No statistical differences in patellar kinematics were found before and after the insertion of the pressure sensor.ConclusionsThe setup in the present study enables researchers to simultaneously and synchronously collect real-time PFJ kinematics and tibiofemoral joint (TFJ) biomechanical kinematic data with high reliability. The low MDDs enabled the researchers to obtain an accurate interpretation of the kinematic and contact mechanics measurement using the experimental setting used in the present study.

Dataset Information

The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions.

Publications

The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions.

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