The SP-ET Index is a New Index for Assessing The Vertical Position of Patella

Background. There were some parameters in previous studies did not better reflect the vertical position of the patella relative to the femoral trochlear. The purposes of this study were to assess the value of the most superior point of patella - entrance of femoral trochlea distance ratio (SP-ET index) as a newer index in defining the vertical position of patella relative to the trochlea, correlate it with the Insall-Salvati ratio, and investigate the effect of the new index on chondromalacia patella. Methods. A total of 99 knees of 77 patients with chondromalacia patella were retrospectively analyzed using magnetic resonance imaging (MRI) data from our database. The Insall–Salvati ratio and SP-ET index were measured on MR images. There were 99 knees just with meniscus rupture were enrolled as the control group. The two parameters of the chondromalacia patella were compared with those of the control group. Results. The Insall–Salvati ratio and SP-ET index in the chondromalacia patella group were significantly higher than those in the control group (p < 0.001). The SP-ET index showed a moderate positive correlation with the Insall–Salvati ratio (r=0.307, p<0.001). Receiver operating characteristic (ROC) analysis showed the diagnostic efficiency of the SP-ET index was better than that of the Insall–Salvati ratio in patients with chondromalacia patella. Conclusion. The SP-ET index may be a useful complement parameter to define the vertical position of the patella relative to the femoral trochlear. Increased of the SP-ET index may be an important risk factor for chondromalacia patella.

PROLOTHERAPY COMBINED WITH PHYSICAL THERAPY IN A RECREATIONALLY ACTIVE MIDDLE-AGED MAN WITH CHONDROMALACIA PATELLA

The purpose of this case report is to describe the use of physical therapy combined with prolotherapy in a recreationally active, middle-aged man with knee pain and chondromalacia patella. The patient was a 50 year-old male triathlete presenting with a chief complaint of persistent left knee stiffness and anterolateral knee pain. The patient’s symptoms began insidiously 9 months prior after an increase in his triathlon training activities. His knee pain progressed to the point that he could not perform any weight bearing exercise without significant discomfort. Previous treatments included management by a physical therapist, as well as corticosteroid and hyaluronic acid injections. Although these previous treatments provided minimal benefit, the patient sought further management by another physical therapist. Magnetic resonance imaging findings revealed moderate to severe chondromalacia at the lateral patellar facet. In addition to management by a physical therapist, the patient received a series of three prolotherapy injections to the knee. Physical therapy management consisted of manual therapy for the lower quarter, targeted therapeutic exercise to address strength deficits of the quadriceps and hamstring muscles, and a gradual return to weight bearing exercise and functional activity. At 4 months following the physical therapy and prolotherapy injections, the patient reported no pain during daily activities. Additionally, he had returned to swimming, cycling, unlimited walking and hiking on various surfaces, and agility drills. In patients with knee pain and chondromalacia patella, especially those who have not responded to prior interventions, physical therapy combined with prolotherapy may serve as a treatment option. <p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0887/a.php" alt="Hit counter" /></p>

Correlation between Chondromalacia Patella and Patellofemoral Factors in Middle-Age Population: A Clinical, Functional, and Radiological Analysis

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.

Changes In Gait Biomechanics As Functional Symptom Of Chondromalacia Patella

The goal of this research was to investigate functional and biomechanical symptoms in patients with chondromalacia patella. Material and Methods — Gait biomechanics was assessed in 35 patients with diagnosed unilateral chondromalacia patella and in 20 healthy adult controls. We recorded hip and knee movements, impact loads and temporal characteristics of the gait cycle (GC) during self-paced walking. Results — The temporal characteristics of gait and the impact loads remained normal in the patient population. Hip flexion amplitude decreased both on the affected (p=0.002) vs. unaffected (p=0.016) sides, compared to healthy control, whereas the amplitude phase increased on the affected (p=0.012) vs. unaffected (p=0.001) sides, versus healthy control. Hip extension and adduction-abduction amplitudes did not change significantly. Stance-phase and swing-phase knee flexion amplitudes did not change significantly. Knee extension amplitude on the affected limb increased (p=0.015), and knee rotation on the unaffected limb decreased versus control (p=0.016). The so-called stairstep symptom defined in the study was found in 83% of patients: in 23 patients bilaterally and in 6 patients unilaterally. Conclusion — Chondromalacia patella affected the gait biomechanics on both sides. The changes in the kinematic patterns during the flat-surface walking were not substantial. The only pathognomonic functional symptom of the condition was the stairstep symptom.