Esfandiarpour Fateme, Lebrun Constance M, Dhillon Sukhvinder, Boulanger Pierre
Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
Musculoskeletal Rehabilitation Research Center, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
J Orthop Res. 2018 Feb 28. doi: 10.1002/jor.23887.
Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in-vivo joint motion. This study compared six degree-of-freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual-orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three-dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior-inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non-weight-bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
对髌股关节疼痛的确切病因的理解一直受到评估体内关节运动方法学挑战的限制。本研究比较了髌股关节疼痛患者和健康个体在动态弓步任务期间的六自由度髌骨运动。对八名患有髌股关节疼痛的女性和十名健康女性的膝关节，先在仰卧位使用CT扫描仪成像，然后在她们进行弓步动作时通过双正交荧光透视仪成像。为了量化髌骨运动，使用Fluomotion配准软件将从CT扫描重建的膝关节骨骼三维模型配准到荧光透视图像上。在膝关节完全伸展时，髌股关节疼痛组的髌骨明显向外侧倾斜（髌股关节疼痛组：11.77°±7.58°，健康组：0.86°±4.90°；p = 0.002）且向上移位（髌股关节疼痛组：17.49±8.44mm，健康组：9.47±6.16mm，p = 0.033），与健康组相比有显著差异。在膝关节屈曲45°、60°和75°时髌骨倾斜以及在膝关节屈曲30°时髌骨上下移位方面，两组之间也存在显著差异（p≤0.031）。在非负重膝关节伸展位，髌股关节疼痛组的髌骨明显向外侧倾斜（7.44°±6.53°），与健康组（0.71°±4.99°）相比有显著差异。这些发现表明被动和主动髌骨稳定器作为髌骨排列不齐/轨迹不良潜在致病因素的关键作用。未来的研究应在同一样本中研究髌骨运动学与关节形态、肌肉活动和肌腱功能之间的关联，以全面了解髌股关节疼痛的病因。©2018骨科研究协会。由Wiley Periodicals, Inc.出版。《矫形外科研究杂志》
