Experimental and Computational Analysis of Patellofemoral Rehabilitation

描述（由申请人提供）：髌股疼痛患者的物理治疗方案通常强调训练股内侧斜肌（VMO），试图改善已注意到的患者的VMO力量缺陷和VMO激活延迟。训练VMO的目的是减少髌股关节外侧超载软骨区域的压力，尽管缺乏显示改善VMO功能的生物力学数据。本研究提出的假设是，改善VMO功能可以减少施加在髌股关节外侧软骨上的压缩力，降低髌股关节压力，但由于解剖因素或软骨退化，这些变化可能很小。计划进行一项体外实验研究，以确定提高VMO强度和时间如何改变压力分布。在弱VMO、VMO激活延迟和VMO施加的典型力的模拟膝关节功能中，压力传感器将测量8个膝关节的髌骨股压力分布。将创建计算模型来代表实验测试的膝盖，并将计算和实验数据进行比较，以验证计算建模技术。还将创建计算模型来代表10例髌骨股痛患者的症状性膝关节。该模型将用于计算研究VMO强度和时间对髌股压力分布的影响。该模型将允许更真实地表示体内四头肌负荷，并表征解剖因素和软骨病变如何影响与VMO训练相关的生物力学变化。本研究将提供数据，用于评估专注于VMO训练的物理治疗方案的疗效，并确定最不可能从VMO训练中获益的患者。相关性：大约三分之一的患者，物理治疗不能减轻膝盖骨周围的疼痛。虽然通常采用以训练内股四头肌为重点的物理治疗方案，但这种方法的益处尚未得到证实。拟议的研究将利用尸体膝盖的测试和膝关节疼痛患者的计算分析来确定训练内股四头肌是否有效地缓解膝关节软骨的压力。

DESCRIPTION (provided by applicant): Physical therapy regimens prescribed for patients with patellofemoral pain commonly emphasize training the vastus medialis obliquus (VMO) in an attempt to improve deficits in VMO strength and delays in VMO activation that have been noted for patients. The goal of training the VMO is to decrease the pressure applied to areas of overloaded cartilage in the lateral half of the patellofemoral joint, although biomechanical data showing the benefit of improving VMO function is lacking. The proposed study is based on the hypothesis that improving VMO function reduces the compressive force applied to the lateral cartilage of the patellofemoral joint and reduces patellofemoral pressures, but that these changes can be small due to anatomical factors or cartilage degradation. An in vitro experimental study is planned to determine how improving VMO strength and timing alters the pressure distribution. During simulated knee function with a weak VMO, a delay in VMO activation and a typical force applied by the VMO, pressure sensors will measure the patellofemoral pressure distribution for eight knees. Computational models will be created to represent the knees tested experimentally, and the computational and experimental data will be compared to validate the computational modeling technique. Computational models will also be created to represent the symptomatic knees of 10 patients with patellofemoral pain. The models will be used to computationally investigate the influence of VMO strength and timing on the patellofemoral pressure distribution. The models will allow for a more realistic representation of in vivo quadriceps loading and characterization of how anatomical factors and cartilage lesions influence the biomechanical changes associated with VMO training. This study will provide data that can be used to assess the efficacy of physical therapy regimens that focus on training the VMO and identify patients that are least likely to benefit from VMO training. Relevance: Physical therapy fails to reduce pain felt around the knee cap in approximately one third of patients. Although physical therapy regimens focused on training the inner quadriceps muscle are commonly employed, the benefit of this approach has yet to be established. The proposed study will utilize testing of cadaver knees and computational analysis of patients with knee pain to determine if training the inner quadriceps muscle effectively relieves pressure applied to cartilage within the knee.