Adolescents and adults with patellofemoral pain exhibit distinct patellar maltracking patterns.

Autor: Shen A; Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA., Boden BP; The Orthopaedic Center, Rockville, MD, USA. Electronic address: bboden@starpower.net., Grant C; Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA. Electronic address: camila.grant@nih.gov., Carlson VR; Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA., Alter KE; Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA. Electronic address: kalter@nih.gov., Sheehan FT; Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA. Electronic address: gavellif@cc.nih.gov.
Jazyk: angličtina
Zdroj: Clinical biomechanics (Bristol, Avon) [Clin Biomech (Bristol, Avon)] 2021 Dec; Vol. 90, pp. 105481. Date of Electronic Publication: 2021 Sep 10.
DOI: 10.1016/j.clinbiomech.2021.105481
Abstrakt: Background: Chronic idiopathic patellofemoral pain is associated with patellar maltracking in both adolescents and adults. To accurately target the underlying, patient-specific etiology, it is crucial we understand if age-of-pain-onset influences maltracking.
Methods: Twenty adolescents (13.9 ± 1.4 years) and 20 adults (28.1 ± 4.9 years) female patients with idiopathic patellofemoral pain (age-of-pain-onset: < 14 and > 18 years of age, respectively) formed the patient cohort. Twenty adolescents and 20 adults (matched for gender, age, and body mass index) formed the control cohort. We captured three-dimensional patellofemoral kinematics during knee flexion-extension using dynamic MRI. Patellar maltracking (deviation in patient-specific patellofemoral kinematics, relative to their respective age-controlled mean values) was the primary outcome measure, which was compared between individuals with adolescent-onset and adult-onset patellofemoral pain using ANOVA and discriminant analysis.
Findings: The female adolescent-onset patellofemoral pain cohort demonstrated increased lateral (P = 0.032), superior (P = 0.007), and posterior (P < 0.001) maltracking, with increased patellar flexion (P < 0.001) and medial spin (P = 0.002), relative to the adult-onset patellofemoral pain cohort. Post-hoc analyses revealed increased lateral shift [mean difference ± 95% confidence interval = -2.9 ± 2.1 mm at 10° knee angle], posterior shift [-2.8 ± 2.1 mm, -3.3 ± 2.3 mm & -3.1 ± 2.4 mm at 10°, 20°& 30°], with greater patellar flexion [3.8 ± 2.6 mm & 5.0 ± 2.8 mm, at 20°& 30°] and medial spin [-2.2 ± 1.7 mm & -3.4 ± 2.3 mm at 20°& 30°]. Axial-plane maltracking accurately differentiated the patient age-of-pain-onset (60-75%, P < 0.001).
Interpretation: Age-of-pain-onset influences the maltracking patterns seen in patients with patellofemoral pain; with all, but 1, degree of freedom being unique in the adolescent-onset-patellofemoral pain cohort. Clinical awareness of this distinction is crucial for correctly diagnosing a patient's pain etiology and optimizing interventional strategies.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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