Physical Medicine and Rehabilitation Unit, High Specialty Medical Unit, National Western Medical Center, Mexican Social Security Institute, Guadalajara, México.
Biomedical Research Unit 02, High Specialty Medical Unit, National Western Medical Center, Mexican Social Security Institute, Guadalajara, México.
J Altern Complement Med. 2021 Jan;27(1):38-44. doi: 10.1089/acm.2020.0287. Epub 2020 Nov 20.
Chondromalacia patella is the degeneration of articular cartilage on the posterior facet of the patella and may indicate the onset of osteoarthritis. Conservative management is the main treatment option, and surgical intervention is considered the last option in a small percentage of patients. Perineural Injection Treatment (PIT) is a recently developed treatment option that is directed adjacent to the peripheral nerves that are the source of pathology causing neurogenic inflammation and pain. The objective of this study was to evaluate the efficacy of PIT combined with a home physical therapy program in patients with a diagnosis of chondromalacia patella compared with a control group receiving physical therapy only. Two patient groups were involved in this randomized clinical trial. The first received PIT combined with physical therapy (PIT + PT group) and the second was managed with physical therapy alone (PT group). Both groups were indicated to follow a 6-week home therapy plan afterward. The Western Ontario and McMaster Osteoarthritis Index was used to assess the patients at baseline and 6 months after therapy interventions. Fifty patients (38 women and 12 men, median age 54.7 ± 14.8 years) were included; sex distribution and age did not differ between groups. Both groups had chondromalacia grade II or III, but the degree of gonarthrosis did not differ significantly between groups. The PIT + PT group outperformed PT group for pain (7.3 ± 3.5 vs. 3.2 ± 2.9 points; < 0.010), stiffness (3 ± 1.69 vs. 1.6 ± 1.5 points; < 0.010), and functional capacity (23.2 ± 10.7 vs. 11.1 ± 8.9 points; < 0.010). Compared with physical therapy alone, PIT plus physical therapy reduced pain and stiffness and restored functional capacity. ClinicalTrials.gov Register Number #NCT03515720.
髌骨软化症是髌骨后关节面软骨的退行性变，可能表明骨关节炎的开始。保守治疗是主要的治疗选择，而手术干预被认为是一小部分患者的最后选择。周围神经注射治疗（PIT）是一种最近开发的治疗选择，针对的是引起神经源性炎症和疼痛的病理来源的周围神经。本研究的目的是评估 PIT 联合家庭物理治疗方案在髌骨软化症患者中的疗效，与仅接受物理治疗的对照组进行比较。这项随机临床试验涉及两组患者。第一组接受 PIT 联合物理治疗（PIT+PT 组），第二组仅接受物理治疗（PT 组）。两组患者均被指示在治疗后进行为期 6 周的家庭治疗计划。采用西部安大略省和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Osteoarthritis Index）评估患者在治疗干预前和治疗后 6 个月的情况。共有 50 名患者（38 名女性和 12 名男性，中位年龄 54.7±14.8 岁）入组；两组患者的性别分布和年龄无差异。两组患者均患有 II 级或 III 级髌骨软化症，但组间膝关节骨关节炎的严重程度无显著差异。与单纯物理治疗相比，PIT+PT 组在疼痛（7.3±3.5 分比 3.2±2.9 分； <0.010）、僵硬（3 分比 1.6 分； <0.010）和功能能力（23.2±10.7 分比 11.1±8.9 分； <0.010）方面的表现均优于 PT 组。与单纯物理治疗相比，PIT 联合物理治疗可减轻疼痛和僵硬，恢复功能能力。临床试验注册号：NCT03515720。
