Experimental and Computational Analysis of Patellofemoral Rehabilitation

描述(由申请人提供)：为髌股疼痛患者开出的物理治疗方案通常强调训练股内侧斜肌(VMO)，以试图改善VMO力量的缺陷和VMO激活的延迟，这已为患者所注意到。训练VMO的目的是减少施加在髌股关节外侧半侧超负荷软骨区域的压力，尽管缺乏生物力学数据显示改善VMO功能的益处。这项研究是基于这样一种假设，即改善VMO功能可以减少施加在髌股关节外侧软骨上的压力，并降低髌股压力，但由于解剖学因素或软骨退化，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强度和时机如何改变压力分布。在模拟膝关节功能时，在VMO较弱、VMO激活延迟和VMO施加典型力的情况下，压力传感器将测量八个膝关节的髌股压力分布。将创建计算模型来表示实验测试的膝盖，并将计算数据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表示10名膝盖骨疼痛患者的有症状的膝盖。这些模型将被用来计算研究VMO强度和时机对髌股压力分布的影响。这些模型将允许更真实地表示活体股四头肌的负荷，并描述解剖因素和软骨损伤如何影响与VMO训练相关的生物力学变化。这项研究将提供数据，可用于评估侧重于培训VMO的物理治疗方案的疗效，并确定最不可能从VMO培训中受益的患者。相关性：在大约三分之一的患者中，物理治疗不能减少膝盖部周围的疼痛。尽管以训练股四头肌为重点的物理治疗方案被普遍采用，但这种方法的益处尚未确定。这项拟议的研究将利用对身体膝盖的测试和对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了施加在膝关节内软骨上的压力。

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.