Beit Ner Eran, Rabau Oded, Essa Ahmad, Vinograd Ofir, Asaaf Roy, Gilat Ron, Anekstein Yoram
Department of Orthopaedics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sports Health. 2024 Dec 18:19417381241300159. doi: 10.1177/19417381241300159.
The contribution of vastus medialis oblique muscle (VMO) weakness or dysfunction to patellofemoral pain syndrome is well recognized, yet its role in lateral patellar instability and recurrent patellar dislocations remains unclear. This study investigates the association between VMO characteristics and patellar instability.
Altered VMO structure, characterized by differences in muscle elevation and cross-sectional area (CSA), is associated with patellar instability.
A case-control study.
Level 3.
The study included 204 participants, matched on a 1:1 ratio by age and sex, from a local hospital registry from 2005 to 2020. VMO measurements were taken via magnetic resonance imaging, and included muscle elevation, CSA, fiber angulation, and CSA-to-thigh circumference ratio. Univariate analysis, and multivariable regression model with adjustment for potential confounders were constructed. In addition, a secondary analysis was performed to evaluate the variations in VMO characteristics and mass across primary and recurrent patellar instability groups.
Patients with patellar instability demonstrated significant differences in VMO characteristics compared with controls, including increased muscle elevation (13 mm vs 5.9 mm; < 0.01), increased muscle fiber angulation (42.5° vs 35.3°; < 0.01), reduced CSA (716 mm vs 902 mm; < 0.01), and a lower CSA-to-thigh circumference ratio (0.05 vs 0.07; < 0.01). These findings remained significant in the multivariable adjusted model. Moreover, the secondary analysis revealed that both primary and recurrent instability patients had similar VMO characteristics alterations compared with controls, with slightly more pronounced reductions in VMO CSA in those sustaining recurrent instability episodes.
This study confirms a statistically significant association between altered VMO characteristics and patellar instability, emphasizing the importance of considering VMO characteristics in the evaluation and management of patients with patellar instability.
股内侧斜肌（VMO）无力或功能障碍对髌股疼痛综合征的影响已得到充分认识，但其在髌骨外侧不稳定和复发性髌骨脱位中的作用仍不明确。本研究调查了VMO特征与髌骨不稳定之间的关联。
以肌肉高度和横截面积（CSA）差异为特征的VMO结构改变与髌骨不稳定有关。
病例对照研究。
3级。
该研究纳入了204名参与者，这些参与者来自2005年至2020年当地医院登记处，按年龄和性别1:1匹配。通过磁共振成像测量VMO，包括肌肉高度、CSA、纤维角度和CSA与大腿周长之比。构建了单变量分析以及对潜在混杂因素进行调整的多变量回归模型。此外，进行了二次分析以评估初次和复发性髌骨不稳定组中VMO特征和质量的变化。
与对照组相比，髌骨不稳定患者的VMO特征存在显著差异，包括肌肉高度增加（13毫米对5.9毫米；<0.01）、肌肉纤维角度增加（42.5°对35.3°；<0.01）、CSA降低（716平方毫米对902平方毫米；<0.01）以及CSA与大腿周长之比降低（0.05对0.07；<0.01）。这些发现在多变量调整模型中仍然显著。此外，二次分析显示，与对照组相比，初次和复发性不稳定患者的VMO特征改变相似，在经历复发性不稳定发作的患者中VMO CSA的降低略为明显。
本研究证实了VMO特征改变与髌骨不稳定之间存在统计学上的显著关联，强调了在评估和管理髌骨不稳定患者时考虑VMO特征的重要性。
