Search Results (31)

Introduction: Patellofemoral osteoarthritis (PFOA) remains a therapeutic challenge with few effective non-surgical options. Objective: The aim of this study was to evaluate the feasibility, safety, and preliminary outcomes of ultrasound (US)-guided tibial endplate aspiration and intra-articular injection of bone marrow concentrate (BMC) in patients with isolated PFOA. Methods: In this retrospective case series, seven consecutive patients with symptomatic PFOA unresponsive to conservative therapy were treated with US-guided tibial endplate aspiration followed by intra-articular BMC injection. Clinical outcomes were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12 months. MRI with T2 mapping was performed to evaluate cartilage structure. BMC composition was analyzed, including colony-forming unit fibroblast (CFU-F) assays. Results: The procedures were feasible in all cases, and no adverse events occurred. WOMAC scores improved significantly from 21.7 ± 17.3 at baseline to 9.0 ± 9.3 at 12 months (p = 0.030). MRI showed a mean relative increase of 25.4% ± 43.5% in healthy cartilage volume, though this was not statistically significant (p = 0.49). Correlation analyses revealed no consistent association between clinical response and cellular composition, including estimated MSC dose. Conclusions: This small retrospective series suggests that US-guided tibial endplate aspiration and intra-articular BMC injection are safe, technically feasible, and may provide clinical benefit in isolated PFOA. Larger controlled studies are needed to confirm these preliminary findings. Full article

Patellofemoral osteoarthritis (OA) and chondromalacia patellae (CMP) are common and disabling conditions that significantly affect physical performance and quality of life. Despite the great deal of scientific research on the subject, there is limited evidence regarding the outcome of nonoperative interventional procedures. Platelet-rich plasma (PRP) has demonstrated positive results for tibiofemoral knee osteoarthritis, but its role in anterior knee pain (AKP) remains unclear. The aim of this study was to review the evidence on the efficacy (clinical and radiological) and safety of PRP in patients suffering from patellofemoral OA, CMP, and AKP. Medline/Pubmed, Web of Science, and Scopus databases were systematically searched up to June 2025 to identify all the available relevant studies. Five studies, including 146 patients, fulfilled the eligibility criteria and were included in the systematic review. Although there was a statistically significant improvement in clinical setting, radiologic evidence of cartilage regeneration was limited and uncertain. Specifically, the pooled analysis revealed an improvement of the Visual Analogue Scale from 6.7 to 2.1 (p < 0.001), the Western Ontario and McMaster Universities Osteoarthritis Index score from 24 to 10.3 (p < 0.001), the Oxford score from 35.1 to 37.4 (p < 0.001), the Kujala score from 71 to 83 (p < 0.001), and the Tegner/Lysholm score from 65.3 to 86.5 (p < 0.001). Well-designed and appropriately powered randomized trials with imaging endpoints are needed to validate the efficacy of PRP administration in PFA, CMP, and AKP and refine patient selection criteria. Full article

Objective: Platelet-rich plasma (PRP) therapy has become a popular treatment for knee osteoarthritis. We aimed to determine the outcomes of knee osteoarthritis patients following PRP therapy using magnetic resonance imaging (MRI) findings and patient-reported outcome measures (PROMs). Design: In this retrospective observational cohort study, we enrolled 161 patients (221 knees) with varus knee osteoarthritis who received multiple PRP injections at our hospital from June 2017 to June 2019. Patients underwent whole-body MRI before and 6 months after treatment. Whole-organ MRI score (WORMS) cartilage integrity and synovial fluid volume were assessed for the medial femorotibial (MFTJ), lateral femorotibial (LFTJ), and patellofemoral joints (PFJ). Pain visual analog scale and Knee Injury and Osteoarthritis Outcome scores were used as PROMs. In addition, a historical control group of 30 patients with medial knee osteoarthritis who did not receive intra-articular injections was evaluated by MRI over the same period for comparison. Results: After 6 months of PRP therapy, the mean WORMS cartilage score of the LFTJ and PFJ and the total WORMS cartilage score for all three joints improved significantly, and synovial fluid volume reduced significantly. Moreover, a reduction in synovial fluid volume correlated with improvements in several KOOS subscales but not with VAS, which may explain the lack of association with responder status. These results suggest that synovial fluid reduction reflects functional improvement but is not a direct surrogate for pain relief. In addition, the change score of WORMS PFJ cartilage correlated positively with clinical outcomes in responders. By contrast, in the control group, no compartment demonstrated improvement in WORMS cartilage scores, and several compartments showed a trend toward deterioration. Conclusions: In this retrospective observational study, PRP therapy was associated with improvements in WORMS cartilage integrity scores and reductions in synovial fluid volume, with partial correlations to patient-reported outcomes. The inclusion of a historical control group strengthens the interpretation of these findings, although definitive conclusions cannot be drawn. Further randomized controlled trials are needed to confirm these preliminary observations. Full article

Background: Physical exercise can improve certain musculoskeletal conditions, but adherence remains low due to intimidating environments, limited government support, and financial constraints faced by many individuals. Home-based exercise is a potential strategy to treat that population. Objective: Discuss the main home-based resistance exercise protocols that have been studied and implemented for six highly prevalent musculoskeletal disorders. Methods: A narrative literature review was conducted, using the PubMed database to search for six highly prevalent musculoskeletal conditions: shoulder impingement syndrome (SIS), nonspecific low back pain (NSLBP), greater trochanteric pain syndrome (GTPS), knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and Achilles tendinopathy (AT). The strategy included the listed pathologies and the keywords “physical exercise” or “physiotherapy”. Clinical trials, reviews, and retrospective studies from the last 30 years published in English, Portuguese, or Spanish were included. Only studies with sufficient details on the training protocols used and outcome measures were included in the analysis. Results: In SIS, exercise protocols have been more effective in the long term than in the short term. In PFPS and GTPS, strengthening the quadriceps and hip muscles helps reduce pain and improve function. For NSLBP, exercises like Pilates and core training demonstrate pain relief. In knee osteoarthritis, physical exercise improves pain, function, and quality of life both immediately and over time. Eccentric training promotes type I collagen formation in the tendons of patients with Achilles tendinopathy. Conclusions: Home-based resistance exercises studied and implemented in this review offer several general health benefits, including pain reduction, improved functionality, increased muscle strength, and enhanced motor control. Full article

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following arthroscopic resection of the infrapatellar fat pad in patients with IFPIS. Materials and Methods: Eighteen patients (10 females, 8 males; median age 22) diagnosed with IFPIS and unresponsive to conservative therapy underwent arthroscopic partial or subtotal resection between 2007 and 2013. Diagnosis was based on physical examination (Hoffa’s test), MRI findings, and response to lidocaine injection. Clinical outcomes (VAS, IKDC-2000, Kujala, Lysholm, Tegner activity scores) and radiologic assessments (ISR, CDI, PFJ osteoarthritis grade) were evaluated preoperatively, at 2 years, and at a final follow-up (mean 148.7 months). Results: All clinical scores significantly improved postoperatively. VAS decreased from 7.25 ± 0.79 to 2.43 ± 1.50 at 2 years, and to 3.66 ± 1.50 at the final follow-up (p < 0.001). Similar long-term improvements were observed in the Kujala, IKDC-2000, Lysholm, and Tegner scores (all p < 0.001). Radiographic parameters including ISR and CDI remained stable, and there was no statistically significant progression in patellofemoral osteoarthritis. However, 5 of 18 patients (27.8%) reported persistent symptoms at long-term follow-up. Conclusions: Arthroscopic resection of the infrapatellar fat pad in patients with IFPIS showed favorable and sustained clinical outcomes over a 10-year follow-up, without significant radiological changes. These results suggest that arthroscopic resection is a viable treatment option when accurate diagnosis is established. Full article

Background/Objectives: Patellofemoral pain (PFP) is considered a risk factor for knee osteoarthritis (OA) onset. The purpose of this study was to compare degenerative biomarkers in females with and without PFP and to determine changes in these levels, along with pain and function, over 6 months. Methods: All subjects received a knee x-ray to ensure that none had degenerative changes. Urine and serum were collected and analyzed for C-telopeptide fragments of type II collagen (CTX-II) and C-propeptide II (CP-II); these were then expressed as a cartilage degradation: cartilage synthesis ratio (CTX-II:CP-II). Subjects with PFP rated pain using a 10 cm visual analog scale, and function using the Knee injury and Osteoarthritis Outcome Scores-Patellofemoral (KOOS-PF) questionnaire. Subjects with PFP were tested at baseline and at 6 months. Results: Females with PFP had higher levels of CTX-II:CP-II than controls (p < 0.001) and these remained elevated at 6 months (p = 0.82). Females with PFP reported similar levels of pain (p = 0.30) but higher function at 6 months (p = 0.002). However, the 9.0-point increase in KOOS-PF values did not exceed the minimum important change. Conclusions: Females with PFP but no evident structural changes had more elevated biomarkers than controls. This finding suggests that this cohort may have excessive cartilage turnover which may contribute to knee OA. Full article

Background/Objectives: Patellofemoral pain (PFP) is believed to be a precursor to knee osteoarthritis (OA). The primary purpose of this study was to compare matrix metalloproteinase-9 (MMP-9) levels in young adult females with and without PFP. The secondary purpose was to determine the associations between MMP-9, patella position, hip and knee kinematics, and pain in females with PFP. Methods: Plasma was analyzed for MMP-9. Patellar position was measured using diagnostic ultrasound as the degree of offset (RAB angle) from the deepest aspect of the femoral trochlear groove to the inferior pole of the patella. A positive RAB angle suggested patella lateralization. Hip and knee kinematics during a single-leg squat were measured using 2-dimensional motion analysis and quantified as the dynamic valgus index (DVI), a combined measure of hip and knee motion. A higher DVI suggests increased valgus loading at the patellofemoral joint. Pain was measured using a 10 cm visual analog scale. Results: Females with PFP had significantly higher levels of MMP-9 than controls (72.7 vs. 58.0 ng/mL, p = 0.03). Females with PFP had a significant positive association between MMP-9 and patella lateralization (r = 0.38, p = 0.04), suggesting that greater patellar lateralization may contribute to increased joint inflammation. A significant inverse association was observed between MMP-9 and the DVI (r = −0.50, p = 0.007), indicating that individuals with higher inflammatory marker levels may adopt movement patterns that reduce valgus loading. Conclusions: The significant association between MMP-9 and patella lateralization suggested a potential link between patella alignment and joint inflammation, which may contribute to early joint degeneration. The inverse association between MMP-9 levels and the DVI suggested that subjects with higher MMP-9 levels adjusted their movement pattern as a compensatory mechanism to reduce knee valgus stress to reduce joint degeneration. Full article

Background/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated by numerous anatomical factors that must be considered. This review aims to consolidate current knowledge presented in the literature on radiological diagnostics for PFI in pediatric populations, with the application of all imaging techniques—including ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and radiography (RTG)—which enable the evaluation of anatomical risk factors critical for the diagnosis, prevention, and treatment of PFI. Methods: A search of the PubMed/MEDLINE database was conducted to identify relevant studies from 1975 to 2024. The search terms were as follows: (patellar or patella) and (instability or displacement or dislocation) and (diagnostic or diagnosis or imaging or radiographic). A total of 2743 articles were retrieved, which were screened to yield 29 studies for further review. These studies were then divided into seven categories regarding the diagnostic methods: risk factors, tibial tubercle trochlear groove (TT-TG)/tibial tubercle posterior cruciate ligament (TT-PCL), MPFL injury and cartilage damage, patella and trochlear dysplasia, torsional abnormalities, coronal plane alignment, and genetics. Results: The methods presented statistically significant differences, with those most commonly used for the diagnosis of patella dislocation being TT-TG index, MPFL rapture, and trochlear dysplasia. Conclusions: In summary, multiple diagnostic tools, including MRI, CT, X-ray, and physical examination, are available for the assessment of PFI, each contributing to treatment decisions. Although MRI remains the primary diagnostic tool, further research is needed to establish more precise diagnostic criteria. Full article

While several studies have reported short-term clinical outcomes after medial patellofemoral ligament (MPFL) repair with suture tape augmentation, there is still a dearth of knowledge regarding midterm clinical outcomes. This study aimed to evaluate the midterm clinical outcomes of MPFL repair with suture tape augmentation in patients with patellar dislocation. We retrospectively reviewed the clinical records of patients who underwent MPFL repair with suture tape augmentation for at least one episode of patellar dislocation between 2015 and 2020. Patient-reported clinical outcomes (PROs) were evaluated via the International Knee Documentation Committee (IKDC) score and the knee injury osteoarthritis outcome score (KOOS). In total, 17 knees (4 males and 13 females) who underwent MPFL repair with suture tape augmentation with a mean follow-up of 54.6 ± 19.5 months were included in this study. PROs significantly improved from preoperatively to the final follow-up (IKDC score: 50.7 ± 26.6 vs. 88.8 ± 13.0, p < 0.001; KOOS: 68.8 ± 23.3 vs. 91.2 ± 8.4, p = 0.011) without reducing the patient’s activity level at the final follow-up (UCLA AS score: 7.9 ± 2.4 at preinjury vs. 7.9 ± 2.2 at the final follow-up, p = 0.655). Subgroup analysis revealed good postoperative outcomes, regardless of the patient’s skeletal maturity or the presence or absence of generalized laxity. In conclusion, MPFL repair with suture tape augmentation is a safe and effective treatment for midterm follow-up. Full article

Background/Objectives: After open-wedge high tibial osteotomy (OWHTO), the patella is displaced distally, causing patellofemoral joint degeneration. The objective of this study was to ascertain whether the combination of OWHTO and lateral retinacular release (LRR) can prevent articular cartilage degeneration of the patellofemoral joint using magnetic resonance imaging T2 mapping. Methods: This study included 37 patients (37 knees) who underwent OWHTO alone (OWHTO group) and 37 patients (37 knees) who underwent OWHTO with LRR (OWHTO + LRR group) with a correction angle of <10° for varus knee osteoarthritis. MRI was performed on all knees prior to and 6 months after surgery to assess the patellar cartilage in sagittal images for T2 mapping. Three regions of interest, (the medial facet, patellar ridge, and lateral facet), were established for the articular cartilage on the patellar side. The T2 values were subsequently quantified. Lower limb alignment, patellar height, patellar tilt angle, and lateral shift ratio were evaluated pre-and post-surgery. Results: Mean T2 values at 6 months post-surgery of the medial facet and patellar ridge of the OWHTO group showed a significant increase after surgery; no significant changes were observed in either region in the OWHTO + LRR group. In both groups, a significant decrease in patellar tilt angle was observed postoperatively; no change was noted in the lateral shift ratio or congruence angle. The change in patellar tilt angle was significantly lower in the OWHTO + LRR group than in the OWHTO group. Conclusions: LRR combined with OWHTO prevented patellofemoral joint cartilage degeneration after surgery in cases of varus knee osteoarthritis. Full article

Background: This observational study investigates the efficacy of combining local muscle vibration (LMV) therapy and kinesiotaping using the McConnell method (KMcCM) in patients with patellofemoral pain syndrome (PFPS). PFPS is a prevalent knee condition characterized by anterior or medial knee pain exacerbated by activities that overload the patellofemoral joint. Objective: The primary aim of this study was to evaluate the effectiveness of LMV combined with KMcCM in reducing pain and improving function in PFPS patients. Methods: A total of 52 participants, aged 25–85, with PFPS were included. Participants underwent LMV and KMcCM treatments three times weekly for three weeks. Pain and function were assessed using the Visual Analog Scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline (T0) and six months post-treatment (T1). Radiological assessments of patellar alignment and biomechanics were also conducted through dynamic MRI. Results: Significant pain reduction and functional improvements were observed across all age groups. Notably, younger participants showed greater improvement compared to older participants. Among women, those in the younger age group experienced more substantial reductions in VAS scores compared to their older counterparts. KOOS scores improved significantly, indicating enhanced knee function overall. A significant decrease in VAS scores from T0 to T1 was observed across all patellar alignment groups, signifying a reduction in pain levels. However, Group 2 (Laxation and Subluxation) experienced the most substantial reduction in VAS scores at T1 compared to the other groups. These results suggest that the combination of LMV and KMcCM may be particularly effective in addressing biomechanical abnormalities associated with patellar maltracking and enhancing VMO muscle contraction, leading to more substantial improvements in these patients. Conclusions: The combination of LMV and KMcCM demonstrates promising efficacy in reducing pain and improving knee function in PFPS patients, with age and gender influencing treatment outcomes. The most significant improvements were observed in younger individuals and those with specific patellar alignment issues, highlighting the potential of this combined approach for the targeted treatment of PFPS. Full article

Objectives: To show the superiority of eccentric versus concentric strengthening in terms of improving quadriceps strength in knee osteoarthritis (OA), a randomized controlled study was conducted to perform 12 sessions of either eccentric or concentric isokinetic muscle strengthening over 6 weeks. Methods: We recruited males and females, aged between 40 and 70 years, with predominantly unilateral femorotibial OA. Exclusion criteria were having a prosthesis, inflammatory arthritis or flare-up of OA, symptomatic patellofemoral OA, cardiovascular or pulmonary disease that could be a contraindication to the study treatment, and any pathology that could cause muscle weakness. The primary endpoint was the between-group difference in change in maximum concentric isokinetic knee extension peak torque (PT) at 60°/s on the OA side at 6 weeks. Secondary endpoints were between-group difference in change in concentric hamstring PT at 60°/s; eccentric quadriceps and hamstring PT at 30°/s; 10 m and 200 m walking speeds; pain and functional status (WOMAC score) at 6 weeks and 6 months. Results: The sample consisted of 11 females and 27 males, with a mean age of 57.7 ± 7.52 years and a body mass index (BMI) of 25.95 ± 3.93 kg/m². Quadriceps strength increased more at 6 weeks in the concentric than the eccentric group with no statistical difference. There was a rate of 25% major adverse events in the eccentric group. Conclusions: Eccentric training resulted in a smaller improvement in quadriceps strength than concentric training and was associated with a high risk of muscle injury, particularly to the hamstring muscles. Full article

(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8–77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria. A total of 284 patients and 230 knees were included. Seventy-five percent of patients were graded to have excellent-good clinical outcomes using the Crosby and Insall Grading System. International Knee Documentation Committee score and Knee injury and Osteoarthritis Outcome Score scores showed 59% and 60% post-operative improvement, respectively; (4) Conclusions: All studies showed improvement in post-operative functional outcomes and report no serious adverse events. The 6 mm, LARS (Orthomedic Ltd., Dollard-des-Ormeaux, QC, Canada) proved to have the most improvement in post-operative outcomes when used as a double bundle graft. Full article

Knee range of motion and patient-reported outcome measures (PROMs) are often used as screening tools to assess the severity of knee osteoarthritis and guide the decision to refer patients to an arthroplasty clinic. However, there is little understanding regarding the correlation between these factors. Thus, the purpose of this study was to determine the correlation between patient-reported clinical function measured with the Oxford Knee Score (OKS), pain assessed using the visual analog scale (VAS), knee range of motion (ROM), and characteristic radiographic features in patients with advanced osteoarthritis of the knee. A prospective analysis of a consecutive series of 138 patients with advanced unilateral osteoarthritis (OA) of the knee was performed. The severity of radiographic OA was classified according to the most commonly used Kellgren and Lawrence classification (K&L). Spearman’s rank correlation analysis and multiple linear regression analysis were performed. The OKS was used as a dependent variable and was adjusted for pain, ROM, and nine standardized radiographic parameters on multiple views of the tibiofemoral and patellofemoral joint. OKS and pain correlated weakly with the K&L grade (r = −0.289; p = 0.001; r = 0.258; p = 0.002). K&L grade and the degree of patellofemoral joint space narrowing were identified as independent factors being associated with a poorer OKS (coefficient −4.528, p = 0.021; coefficient −2.211, p = 0.038). Slightly worse results were identified for OKS and pain in patients with K&L grade 4 osteoarthritis compared to patients with K&L grade 3 osteoarthritis (∆OKS 5.5 points, p < 0.001; ∆VAS 1.7 points, p = 0.003). There was no significant difference for passive range of motion between patients with K&L grade 3 or 4. When counseling patients with advanced knee osteoarthritis who may be eligible for knee arthroplasty, it is essential to give primary consideration to pain levels and self-reported limitations experienced during daily activities. Relying solely on knee ROM and PROMs is not an effective screening method for guiding the decision to refer patients to an arthroplasty clinic. Full article

There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique. Full article