ارزیابی راستای کشکک در سندرم درد کشککی- رانی

نوع مقاله: مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد فیزیوتراپی دانشکده علوم توانبخشی دانشگاه علوم پزشکی ایران. تهران. ایران

2 دکترای تخصصی فیزیوتراپی، استاد گروه آموزشی فیزیوتراپی. دانشکده علوم توانبخشی دانشگاه علوم پزشکی ایران. تهران. ایران

3 دکترای تخصصی فیزیوتراپی، استادیار گروه فیزیوتراپی. آموزشی دانشکده علوم توانبخشی دانشگاه علوم پزشکی ایران. تهران. ایران

10.22037/jrm.2015.1100217

چکیده

مقدمه و اهداف
سندرم دردکشککی- رانی یک عارضه رایج عضلانی- اسکلتی است. این سندرم، دارای عوامل مختلفی است. راستای نامناسب کشکک، به عنوان علت درد و اختلال مفصل کشککی- رانی، شناخته شده است. هدف از این مطالعه، مقایسه راستای کشکک بین بیماران مبتلا به سندرم درد کشککی- رانی و افراد سالم بود.
مواد و روش ها
روش نمونه گیری به شیوه غیراحتمالاتی ساده از بیماران مراجعه کننده به کلینیک فیزیوتراپی بود. راستای کشکک بین دو گروه مقایسه شد: بیست و پنج بیمار مبتلا به سندرم درد کشککی رانی با سابقه 15-12 ماه  و 25 فرد سالم همجور با بیماران. زاویه کیو به صورت بالینی با استفاده از گونیومتر و زاویه کانگروئنس، طول کشکک و زاویه تیلت خارجی کشکک با استفاده از تصاویر رادیوگرافی اندازه گیری شد.
 یافته ها
طول کشکک و تیلت خارجی کشکک در گروه بیماران، از نظر آماری بزرگتر از افراد سالم بود. زاویه کیو و زاویه کانگروئنس  بین دو گروه، تفاوت آماری معناداری نداشت.
نتیجه گیری
عدم درمان به موقع و سریع بیماران مبتلا به سندرم درد کشککی- رانی زمینه مساعدی برای تغییر راستای کشکک فراهم می کند. بنابراین برای پیشگیری از تغییرات راستای کشکک در این بیماران مناسب است در طراحی برنامه درمانی به رفع هر چه سریعتر عوامل زمینه ساز و اصلاح راستای کشکک توجه شود.

کلیدواژه‌ها


عنوان مقاله [English]

Evaluation of Patellofemoral alignment in patellofemoral pain syndrome

نویسندگان [English]

  • Zohreh Ebrahimi 1
  • Mohammad Akbari 2
  • Ali Amiri 3
1 MSc in Physiotherapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.
2 Professor of Physiotherapy, Department of Physiotherapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
3 Assistant Professor of Physiotherapy, Department of Physiotherapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
چکیده [English]

Background and Aim: Patellofemoral pain syndrome (PFPS) is one of the most frequentl musculoskeletal disorders. The cause of PFPS has been reported to be multifactorial. Patellar malalignments are accepted as the leading cause of PF pain and PF joint disorders. The purpose of the present study was to compare the patellar alignment between subjects with patellofemorall pain syndrome and healthy subjects.
Materials and Methods: Patellar alignment was compared in two groups.  Twenty five patients with 12-15 months of PFPS and 25 matched healthy subjects were selected to take part in the study. Congruence angle, Patella height, and Lateral patellar tilt angle were measured by radiographic images. Also, quadriceps angle was measured clinically.
Results: The patella alta and lateral patellar tilt angle were significantly greater in patients group compared with those in the healthy group. There was no significant difference in Q angle and Congruence angle between the two groups.
Conclusion: Delays in treatment of patients with patellofemoral pain syndrome provide direction changes of patellar alignment. Therefore, to prevent further changes to the patellar alignment in these patients, early resolving of the possible predisposing factors is essential.

کلیدواژه‌ها [English]

  • patellofemoral pain syndrome
  • Patellar alignment
  • Q angle
  • Congruence angle
  • Patella height
  • Lateral patellar tilt angle
  1. Khayambashi K, Mohammadkhani Z, Ghaznavi K, Lyle MA, Powers CM. The effects of isolated hip abductor and external rotator muscle strengthening on pain, health status, and hip strength in females with patellofemoral pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2012;42(1):22-9.##
  2. Nijs J, Van Geel C, Van der auwera C, Van de Velde B. Diagnostic value of five clinical tests in patellofemoral pain syndrome. Man Ther. 2006;11(1):69-77.##
  3. Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012;42(2):81-94.##
  4. Davis  IS, Power C. Patellofemoral pain syndrome: prox- distal and local factor. Journal Orthop physical therapy. 2010;40(3),40-1.##
  5. Song CY, Lin JJ, Jan MH, Lin YF. The role of patellar alignment and tracking in vivo: the potential mechanism of patellofemoral pain syndrome. Phys Ther Sport. 2011;12(3):140-7.##
  6. Watson CJ, Leddy HM, Dynjan TD, Parham JL. Reliability of the lateral pull test and tilt test to assess patellar alignment in subjects with symptomatic knees: student raters. J Orthop Sports Phys Ther. 2001;31(7):368-74.##
  7. Kannus P, Natri A, Paakkala T, Jarvinen M. An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am.1999;81(3):355-63.##
  8. Collins NJ, Bierma-Zeinstra SM, Crossley KM, van Linschoten RL, Vicenzino B, van Middelkoop M. Prognostic factors for patellofemoral pain: a multicentre observational analysis. Br J Sports Med.2013;47(4):227-33.##
  9. Bizzini.M. Systmatic review of Quality of RCT for patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2003 Jan;33(1):4-20.##
  10. JOSPT perspectives for patients. Anterior knee pain: a holistic approach to treatment. J Orthop Sports Phys Ther. 2012 Jun;42(6):573.##
  11. Wilson.T, Kitsell.F. Is the Q angle an absolute or avariable measure? Phsiotherapy.2002;88(5):296-302.##
  12. Magalhaes E, Fukuda TY, Sacramento SN, Forgas A, Cohen M, Abdalla RJ. A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther.2010;40(10):641-7.##
  13. Wang CJ, Chan YS, Chen HH, Wu ST. Factors affecting the outcome of distal realignment for patellofemoral disorders of the knee. Knee.2005;12(3)195-200.##
  14. Utting MR, Davies G, Newman JH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee.2005;12(5):362-5.##
  15. Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors. Dyn Med.2008;7(9):1476-5918.##
  16. Hunter DJ, Zhang YQ, Niu JB, Felson DT, Kwoh K, Newman A, et al. Patella malalignment, pain and patellofemoral progression: the Health ABC Study. Osteoarthritis Cartilage.2007;15(10):1120-7.##
  17. Blond L, Hansen L. Patellofemoral pain syndrome in athletes: a 5.7-year retrospective follow-up study of 250 athletes. Acta Orthop Belg.1998;64(4):393-400.##
  18. Derasari A, Brindle TJ, Alter KE, Sheehan FT. McConnell taping shifts the patella inferiorly in patients with patellofemoral pain: a dynamic magnetic resonance imaging study. Phys Ther.2010;90(3):411-9.##
  19. Sheehan FT, Derasari A, Fine KM, Brindle TJ, Alter KE. Q-angle and J-sign: indicative of maltracking subgroups in patellofemoral pain. Clin Orthop Relat Res. 2010;468(1):266-75.##
  20. Lathinghouse LH, Trimble MH. Effects of isometric quadriceps activation on the Q-angle in women before and after quadriceps exercise. J Orthop Sports Phys Ther.2000;30(4):211-6.##
  21. Grelsamer RP, Weinstein CH, Gould J, Dubey A. Patellar tilt: the physical examination correlates with MR imaging. Knee.2008;15(1):3-8.##
  22. Watson CJ, Propps M, Galt W, Redding A, Dobbs D. Reliability of McConnell's classification of patellar orientation in symptomatic and asymptomatic subjects. J Orthop Sports Phys Ther.1999;29(7):378-85.##
  23. Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehabil.2006;85(3):234-43.##
  24. Kramer PG. Patella malalignment syndrome: rationale to reduce excessive lateral pressure. J Orthop Sports Phys Ther.1986;8(6):301-9.##
  25. Tomsich DA, Nitz AJ, Threlkeld AJ, Shapiro R. Patellofemoral alignment: reliability. J Orthop Sports Phys Ther.1996;23(3):200-8.##
  26. Schulz.B, Brown.M, Ahmad.CS. Evaluation and imaging of patellofemoral joint disorders. Oper Tech sports Med.2010;18:68-78.##
  27. Alemparte J, Ekdahl M, Burnier L, Hernandez R, Cardemil A, Cielo R, et al. Patellofemoral evaluation with radiographs and computed tomography scans in 60 knees of asymptomatic subjects. Arthroscopy.2007;23(2):170-7.##
  28. Smith TO, Davies L, Donell ST. The reliability and validity of assessing medio-lateral patellar position: a systematic review. Man Ther.2009;14(4):355-62.##
  29. Smith TO, Hunt NJ, Donell ST. The reliability and validity of the Q-angle: a systematic review. Knee Surg Sports Traumatol Arthrosc.2008;16(12):1068-79.##
  30. Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC. Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy.2006;22(6):643-9.##
  31. Emami MJ, Ghahramani MH, Abdinejad F, Namazi H. Q-angle: an invaluable parameter for evaluation of anterior knee pain. Arch Iran Med.2007;10(1):24-6.##
  32. Caylor D, Fites R, Worrell TW. The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther.1993;17(1): 6-11.##
  33. Park SK, Stefanyshyn DJ. Greater Q angle may not be a risk factor of patellofemoral pain syndrome. Clin Biomech.2011;26(4):392-6.##
  34. Laprade J, Culham E. Radiographic measures in subjects who are asymptomatic and subjects with patellofemoral pain syndrome. Clin Orthop Relat Res.2003;414:172-82.##
  35. Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther.2005;35(12):793-801.##
  36. del Mar Carrion Martin M, Santiago FR, Calvo RP, Alvarez LG. Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome. Eur J Radiol.2010;75(1):21.##
  37. Kannus PA. Long patellar tendon: radiographic sign of patellofemoral pain syndrome--a prospective study. Radiology.1992;185(3):859-63.##
  38. Pal S, Besier TF, Beaupre GS, Fredericson M, Delp SL, Gold GE. Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study. J Orthop Res.2012;31(3):448-57.##
  39. Mostafa AA, Griffon DJ, Thomas MW, Constable PD. Proximodistal alignment of the canine patella: radiographic evaluation and association with medial and lateral patellar luxation. Vet Surg.2008; 37(3):201-11.##
  40. Herrington L. Does the change in Q angle magnitude in unilateral stance differ when comparing asymptomatic individuals to those with patellofemoral pain? Phys Ther Sport.2012;14(2):94-7.##
  41. Herrington L, Nester C. Q-angle undervalued? The relationship between Q-angle and medio-lateral position of the patella. Clin Biomech.2004;19(10):1070-3.##
  42. Horton MG, Hall TL. Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther.1989;69(11):897-901.##
  43. . Thomee R, Renstrom P, Karlsson J, Grimby G. Patellofemoral pain syndrome in young women. I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports.1995;5(4):237-44.##
  44. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res.1983 (176):217-24.##
  45. Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM. Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study. Clin Orthop Relat Res.2013;471(8):2641-8.##
  46. . Witonski D, Goraj B. Patellar motion analyzed by kinematic and dynamic axial magnetic resonance imaging in patients with anterior knee pain syndrome. Arch Orthop Trauma Surg.1999;119(1-2):46-9.##
  47. Lin YF, Lin JJ, Cheng CK, Lin DH, Jan MH. Association between sonographic morphology of vastus medialis obliquus and patellar alignment in patients with patellofemoral pain syndrome. J Orthop Sports Phys Ther.2008;38(4):196-202.##