Stephen Joanna, Ephgrave Caroline, Ball Simon, Church Sam
Fortius Clinic London, United Kingdom of Great Britain and Northern Ireland; Mechanical Engineering, Imperial College London, United Kingdom of Great Britain and Northern Ireland; Physiotherapist London, United Kingdom of Great Britain and Northern Ireland.
Physiotherapist London, United Kingdom of Great Britain and Northern Ireland.
Knee. 2020 Mar;27(2):280-286. doi: 10.1016/j.knee.2019.12.006. Epub 2020 Jan 31.
Patellofemoral pain is a prevalent and significant clinical problem that is often reported to persist even following evidence based intervention. It is clear therefore that there is much about this complex patient group that is not presently fully understood. This is particularly concerning given the reported links between patellofemoral pain in adolescence and the subsequent development of osteoarthritis and anxiety.
Clinical assessment has historically focussed on biomechanical factors such as altered lower limb kinematics, muscle weakness and late muscle 'onset or activation' during activity. However when examined it is clear that study findings from patellofemoral populations are often inconsistent. Reasons for this are discussed and specifically the limitations around current 'gold standard' measurement methods, such as motion capture are outlined. A biomechanical approach is applied to demonstrate the importance of ensuring optimal patient alignment during rehabilitation, where optimal is defined as ensuring the most energy efficient muscle or muscles are used by the patient to perform a movement. This in turn ensures that the direction, magnitude and location of load applied to the skeleton during activity is optimal and therefore less likely to lead to injury.
The role of alignment in patellofemoral pain and the importance of correcting this during rehabilitation is discussed, and examples provided. Validated, reliable, and reproducible methods of measuring skeletal geometry, muscle geometry, muscle force and direction, and kinematics of activity must be developed as a priority in order for us to further our understanding and improve outcomes in this complex clinical population.
髌股疼痛是一个普遍且严重的临床问题，即使经过循证干预，仍常被报告持续存在。因此，很明显，对于这个复杂的患者群体，目前仍有许多方面尚未完全理解。鉴于青少年髌股疼痛与随后的骨关节炎和焦虑症之间的报道联系，这尤其令人担忧。
历史上，临床评估主要集中在生物力学因素上，如下肢运动学改变、肌肉无力以及活动期间肌肉“起始或激活”延迟。然而，经检查发现，髌股人群的研究结果往往不一致。本文讨论了其原因，并特别概述了当前“金标准”测量方法（如动作捕捉）的局限性。应用生物力学方法来证明在康复过程中确保患者最佳对线的重要性，其中最佳对线定义为确保患者使用最节能的一块或多块肌肉来完成动作。这反过来又确保了活动期间施加于骨骼的负荷方向、大小和位置是最佳的，因此导致受伤的可能性较小。
讨论了对线在髌股疼痛中的作用以及在康复过程中纠正对线的重要性，并提供了示例。必须优先开发经过验证、可靠且可重复的测量骨骼几何形状、肌肉几何形状、肌肉力量和方向以及活动运动学的方法，以便我们进一步了解并改善这个复杂临床群体的治疗效果。
