0000000000148158
AUTHOR
Vicente Sanchis-alfonso
Biological Causes of Anterior Knee Pain
We review the pathophysiology of anterior knee pain in the young patient. Emphasis is placed on newer findings. We have developed what we call the “Neural Model” as an explanation for the genesis of anterior knee pain. We have demonstrated a neuroanatomical basis for PFPS in the young patient and the clinical observation that the lateral retinaculum may have a key role in the origin of this pain. According to our studies we hypothesize that periodic short episodes of ischemia in the lateral retinaculum could be implicated in the pathogenesis of anterior knee pain, at least in a subgroup of anterior knee pain patients, by triggering neural proliferation of nociceptive axons (substance P posi…
Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients
AKP patients express chronic pain but also disability. However, the correlation between pain and disability is not complete and linear. Some patients with a lot of pain show mild disability while others with much less pain also show great disability. The disability is profoundly influenced by other emotional and cognitive factors that are associated with the perception of pain. Therefore, the clinical efforts do not have to be focused only on treating the pain as a feeling but on identifying and modifying these factors.
Pathogenesis of Anterior Knee Pain in the Active Young: Is There a Relation Between the Presence of Patellofemoral Malalignment and Pain?
This chapter is not intended to advocate for a particular surgical technique, but it does provide insight into improving our understanding of the pathophysiology of anterior knee pain syndrome. Our objectives were: to identify a relationship, or lack of one, between the presence of PFM and the presence of anterior knee pain; to analyze the long-term response of VMO muscle fibers to increased resting length; and to determine the incidence of patellofemoral osteoarthritis after IPR surgery. Our findings indicate (1) that not all PFM knees show symptoms; that is, PFM is not a sufficient condition for the onset of symptoms, at least in postoperative patients; (2) that the advancement of VMO has…
Kinetic Analysis: A Sensitive Outcome Objective Measurement Method in Evaluating Lateral Patellar Instability
There are many diagnostic clinical tests (e.g., apprehension patellar test or the moving patellar apprehension test), outcome measures (general health and knee scales [IKDC form, Kujala scale, Fulkerson scale, Lysholm knee scoring scale, Tegner activity level scale, short form-36]), and instrumented measurements of patellar mobility (static stability), to assess lateral patellar instability.7,10,15,16 However, according to Smith and colleagues,15 the sensitivity/specificity – reliability/validity of such tests and outcome tools remain unclear for this patient population. These authors conclude that further work is needed to assess the appropriateness of these tests and outcomes.15Moreover, …
Kinetic and Kinematic Analysis of Iatrogenic Medial Patellar Instability: Clinical Relevance
We speculate that chronic recurrent soft tissue fatigue or overload due to patellofemoral imbalance could cause anterior knee pain. However, many chondropathies can be asymptomatic due to the biomechanic defence strategies used by the patients. Moreover, we emphasize the importance of the passive restraining structures in patellar stability, in contrast to the role of muscle function advocated by some authors. This could explain why an exercise rehabilitation program could be unsuccessful in improving patellar instability, as it occurred in our cases. Finally, these cases highlight the need for surgeons to be more judicious in their surgical selection for patellofemoral instability and serv…
Relationship between the practice of physical activity and quality of movement in adolescents: a screening tool using self-organizing maps.
The aim of this study was to determine whether the most physically active adolescents have better lower limb control.31 high school students (12 males and 19 females) participated in this study. The Anterior Knee Pain Scale was used to find any cases of knee pain. Only subjects with high scores were selected, to exclude those with knee pain or lower limb injuries. Single Leg Squat and Tuck Jump Assessment were used to evaluate movements with two cameras in a two-dimensional assessment. The IPAQ Questionnaire was used to score the physical activity and to classify it into MET total, MET moderate activity, MET vigorous activity and MET walking. These scores were related to knee angle at landi…
The Patellofemoral Arthroplasty: The Great Solution, the Great Problem
Unfortunately, many orthopedic surgeons believe that the definite solution for eliminating anterior knee pain in a young patient with multiple operations is the patellofemoral prosthesis (“The Great Solution”). But, they fail to ask themselves the most important question; what is causing the pain? When a patellofemoral prosthesis is implanted in these young patients without finding out the cause of the pain, a more serious problem could be created with a worse solution (“The Great Problem”). The cases we present spotlight this abuse.
Medial Patellar Instability: A Little Known Cause of Anterior Knee Pain
Anterior knee pain (AKP) is one of the most common patient complaints heard by orthopedic surgeons. A wide variety of causes of AKP have been ascribed to it. Medial patellar instability (MPI) is an objective condition with its own personality provoking incapacitating AKP that should be included in the differential diagnosis of AKP patients, above all in disabling AKP patients after realignment surgery. However, this condition can be difficult to diagnose because it is not well described in the medical literature. Its clinical repercussion was identified at the end of the 1980s. We can now state that it is an objective cause of AKP and that it is more frequent than we had thought, although i…
Biomechanical Bases for Anterior Knee Pain and Patellar Instability
The anterior knee pain syndrome and functional patellar instability in the active young person is one of the most complex knee disorders, with a multiple factor and highly variable pathogenesis, with intermingling mechanical and neurological factors. Probably the neural factor is the cause of the well established symptoms in patients with certain mechanical anomalies and a knee overuse.
Graft Healing in ACL Reconstruction: Can We Enhance It in Clinical Practice?
The ACL-Deficient Knee: A Problem Solving Approach, focuses on problem analysis and problem solving, as well as analyzing the possibility of prevention. In each chapter, the biomechanics, anatomy, etc. that are relevant to the topic are reviewed. There are chapters where highly specialized surgical techniques are presented (v. gr. double bundle reconstruction or meniscal transplant), as well as developing areas such as ACL tears in children, where we are finding a growing number of injuries due to the increase of sports at early ages Surgical reconstruction of the anterior cruciate ligament (ACL) using tendon grafts is the current standard to treat the functionally ACL-deficient knee. The s…
Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain
Purpose. The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain. Methods. A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting. Pain was measured with the visual analogue scale and disability with the Lysholm scale. The psychological variables, such as anxiety, depression, pain coping strategies, catastrophizing and fear to movement beliefs, were studied by using self-administered questionnaires. Results. Among the pain coping strategies, only the catastrophizing subscale showed a significant red…
Healing of the patellar tendon donor defect created after central-third patellar tendon autograft harvest
Patellar tendon donor defect (PTDD) healing after patellar tendon autograft (PTA), was evaluated in 12 lambs (24 knees), by means of conventional histology, immunohistochemistry and image analysis. The results of this study indicate that the PTDD is replaced by a tissue that does not assume the histological characteristics of a normal patellar tendon. Both the Hoffa fat pad (HFP) and the paratenon play an important role in the healing process, although qualitative and quantitative chronological differences were found, which supports the concept of a “two-time process”. The HFP initiates the repair process, and is the main active proliferative tissue compartment during the first week. Once t…