Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome
Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome
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DOI：
10.2106/jbjs.e.00674
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发表时间：
2006-12-01
影响因子：
5.3
通讯作者：
Wilson, D. R.
中科院分区：
文献类型：
--
作者：
MacIntyre, N. J.;Hill, N. A.;Wilson, D. R.
背景：髌股关节疼痛综合征是年轻人的一种常见疾病。虽然人们普遍认为髌骨轨迹异常在髌股关节疼痛综合征的发生中起作用，但这种联系尚未建立。本横断面病例对照研究的目的是检验以下假设：髌骨旋转、倾斜和侧向平移的模式可以区分患有髌股关节疼痛综合征和髌骨对线不良临床证据的个体与患有髌股关节疼痛综合征和没有对线不良临床证据的个体以及没有膝关节问题的个体。方法：使用一种新的、经验证的基于磁共振成像的方法评估了60名志愿者（上述每组20名）各一个膝关节的三维髌股关节运动学。在5个不同的膝关节屈曲角度（范围在-4度和600度之间）下采集负载膝关节的静态低分辨率扫描。将髌骨、股骨和胫骨的高分辨率几何模型以及相关坐标轴与低分辨率扫描上的骨骼位置配准，以确定髌骨运动作为膝关节屈曲角度的函数。分层模型用于确定髌骨旋转、倾斜和侧向translation.Results模式的组间差异：髌骨运动的总体模式在组间无差异（所有全局最大似然比检验p > 0.08）。髌骨旋转和倾斜模式的特征在所有三组受试者之间差异很大，未检测到显著的组间差异。在膝关节屈曲190 °时，髌股疼痛和临床证据显示的对线不良组的髌骨比对照组的髌骨平均外侧多定位2.25 mm，该差异具有轻微显著性（p = 0.049）。其他功能的模式的横向平移没有不同，并在所有groups.Conclusions观察值的大重叠：它不能确定从我们的横断面研究是否更外侧的髌骨位置在组中的临床证据排列不良之前或之后的症状发作。从数据中可以清楚地看出，即使观察到机械异常的临床证据，也不能通过检查髌骨的旋转、倾斜或侧向平移的模式来区分髌股疼痛综合征患者和对照组。临床相关性：由于大多数髌股关节疼痛综合征患者在膝关节屈曲时髌骨轨迹没有异常，必须探索其他致病机制，以便为这种常见的肌肉骨骼疾病制定有效的诊断和治疗策略。
Background: Patellofemoral pain syndrome is a prevalent condition in young people. While it is widely believed that abnormal patellar tracking plays a role in the development of patellofemoral pain syndrome, this link has not been established. The purpose of this cross-sectional case-control study was to test the hypothesis that patterns of patellar spin, tilt, and lateral translation make it possible to distinguish individuals with patellofemoral pain syndrome and clinical evidence of patellar malalignment from those with patellofemoral pain syndrome and no clinical evidence of malalignment and from individuals with no knee problems.Methods: Three-dimensional patellofemoral joint kinematics in one knee of each of sixty volunteers (twenty in each group described above) were assessed with use of a new, validated magnetic resonance imaging-based method. Static low-resolution scans of the loaded knee were acquired at five different angles of knee flexion (ranging between -4 degrees and 600). High-resolution geometric models of the patella, femur, and tibia and associated coordinate axes were registered to the bone positions on the low-resolution scans to determine the patellar motion as a function of knee flexion angle. Hierarchical modeling was used to identify group differences in patterns of patellar spin, tilt, and lateral translation.Results: No differences in the overall pattern of patellar motion were observed among groups (p > 0.08 for all global maximum likelihood ratio tests). Features of patellar spin and tilt patterns varied greatly between subjects across all three groups, and no significant group differences were detected. At 190 of knee flexion, the patellae in the group with patellofemoral pain and clinical evidence of malalignment were positioned an average of 2.25 mm more laterally than the patellae in the control group, and this difference was marginally significant (p = 0.049). Other features of the pattern of lateral translation did not differ, and large overlaps in values were observed across all groups.Conclusions: It cannot be determined from our cross-sectional study whether the more lateral position of the patella in the group with clinical evidence of malalignment preceded or followed the onset of symptoms. It is clear from the data that an individual with patellofemoral pain syndrome cannot be distinguished from a control subject by examining patterns of spin, tilt, or lateral translation of the patella, even when clinical evidence of mechanical abnormality was observed.Clinical Relevance: Since most patients with patellofemoral pain syndrome did not demonstrate abnormalities in patellar tracking during loaded knee flexion, other causative mechanisms must be explored to develop effective diagnostic and treatment strategies for this common musculoskeletal condition.