Pal Saikat, Choi Jang-Hwan, Delp Scott L, Fredericson Michael
Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA.
Division of Mechanical and Biomedical Engineering, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea.
J Orthop Res. 2023 May;41(5):962-972. doi: 10.1002/jor.25435. Epub 2022 Sep 5.
The purpose of this study was to determine the effects of botulinum neurotoxin type A (BoNT-A) on vastus lateralis:vastus medialis (VL:VM) muscle balance, patellar tracking, and pain in patients with chronic patellofemoral (PF) pain. We recruited 13 participants (9 females, 4 males) with recalcitrant PF pain who underwent ultrasound-guided BoNT-A injections into the distal third of the VL muscle, followed by a 6-week home exercise program to strengthen their VM muscle. We imaged the participants in a C-arm computed tomography (CT) scanner before and after the intervention. We calculated VL:VM ratios from CT images from a supine, nonweight-bearing condition. We obtained patellar tilt and bisect offset values from CT images from an upright, weight-bearing condition. We recorded functional pain scores before, immediately after, and 2-4 years after the intervention. We classified the participants into normal tracking and maltracking groups based on their patellar tilt and bisect offset values. BoNT-A with home exercise reduced VL:VM ratio (18%; p < 0.001), patellar tilt (19%; p = 0.020), and bisect offset (5%; p = 0.025). Four participants classified as maltrackers before the intervention transitioned to normal tracking after the intervention. Functional pain scores improved immediately after the intervention (13%, p < 0.001) and remained improved at 2-year follow-up (12%, p = 0.011). Statement of Clinical Significance: This study provides new evidence in support of BoNT-A for treatment of PF pain. Classification of patients under weight-bearing conditions may identify individuals who will most benefit from a BoNT-A treatment.
本研究的目的是确定A型肉毒杆菌神经毒素（BoNT-A）对慢性髌股关节（PF）疼痛患者的股外侧肌与股内侧肌（VL:VM）肌肉平衡、髌骨轨迹及疼痛的影响。我们招募了13名患有顽固性PF疼痛的参与者（9名女性，4名男性），对其股外侧肌远端三分之一处进行超声引导下的BoNT-A注射，随后进行为期6周的家庭锻炼计划以增强其股内侧肌。在干预前后，我们在C型臂计算机断层扫描（CT）扫描仪中对参与者进行成像。我们从仰卧、非负重状态的CT图像中计算VL:VM比值。我们从直立、负重状态的CT图像中获取髌骨倾斜度和二分偏移值。我们记录了干预前、干预后即刻以及干预后2至4年的功能疼痛评分。我们根据参与者的髌骨倾斜度和二分偏移值将其分为正常轨迹组和轨迹不良组。BoNT-A联合家庭锻炼降低了VL:VM比值（18%；p < 0.001）、髌骨倾斜度（19%；p = 0.020）和二分偏移（5%；p = 0.025）。4名在干预前被归类为轨迹不良的参与者在干预后转变为正常轨迹。功能疼痛评分在干预后即刻有所改善（13%，p < 0.001），并在2年随访时仍保持改善（12%，p = 0.011）。临床意义声明：本研究为BoNT-A治疗PF疼痛提供了新的证据。在负重条件下对患者进行分类可能有助于识别最能从BoNT-A治疗中获益的个体。
