Vasti Control of Patellofemoral Kinematics in Patients with chronic Patellofemoral pain

Vasti 控制慢性髌股疼痛患者的髌股运动学

• 批准号: 10687739
• 负责人: frances t sheehan
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10687739
• 关键词: 3-Dimensional; Address; Analysis of Variance; Anterior; Bupivacaine; Chronic; Complex; Confounding Factors (Epidemiology); Data; Data Collection; Degenerative polyarthritis; Enrollment; Equilibrium; Event; Exercise; Extensor; Freedom; Goals; Iatrogenesis; Individual; Injections; Isometric Exercise; Joints; Knee; Knee bone; Knee joint; Kolmogorov-Smirnov Test; Lateral; Lead; Leg; Lidocaine; Linear Regressions; Link; Local Anesthetics; Magnetic Resonance Imaging; Measurement; Measures; Medial; Modeling; Motion; Movement; Muscle; Nerve Block; Normalcy; Operative Surgical Procedures; Pain; Patellofemoral Pain Syndrome; Patients; Peripheral Nerves; Phase; Protocols documentation; Recording of previous events; Rotation; Running; Source; Stress; Structure; Techniques; Testing; Translations; Trauma; Visit; Volition; Work; kinematics; knee pain; loss of function; pain reduction; pain relief; quadriceps muscle; skeletal; theories; tool; vastus lateralis; vastus medialis; volunteer

The most widely accepted model addressing the source of PF pain is that a force imbalance in the muscles controlling the knee joint leads to static patellofemoral (PF) malalignment and dynamic PF maltracking. In turn, this malalignment and maltracking leads to elevated joint contact stresses, which ultimately leads to PF pain and potentially OA. This model has been substantiated by a recent study that demonstrated a direct correlation between the degree of pain at the PF joint and patellofemoral kinematics. In addition, studies focused on McConnell taping have consistently shown that by adding a medializing force through taping an immediate reduction in pain can be seen. Yet, the source of the force imbalance around the knee is still open to debate with some postulating the cause to be delayed timing in the vastus medialis oblique (VMO) muscle, imbalance in the passive structures, or a loss of strength in the VMO. Numerous studies refute these claims as well. Therefore, the goal of this current protocol is to determine if a temporary immediate medialization of the quadriceps force can reduce excessive lateral shift and tilt in individuals with PF pain and by doing so provide immediate pain relief. This will be accomplished by using bupivacaine to create a short-term, instantaneous loss of function in the VL muscle in patients with PF pain. Bupivacaine is a local anesthetic which is closely related to lidocaine and commonly used for peripheral nerve blocks. Cine-PC (CPC) MR imaging will be the primary measurement tool to assess the PF kinematics pre- and post-block. This is the only non-invasive technique that can accurately (<0.33mm) measure three-dimensional skeletal and muscular motion simultaneously. The two specific primary hypotheses and the secondary hypothesis to be addressed are: 1) A short-term loss of function in the VL in patients with PF pain will result in a reduction in their PF lateral shift and tilt; 2) A short-term loss of function in the VL in patients with PF pain will result in a reduction of pain; and 3) A short-term loss of function in the VL will result in a no change in the maximum isometric extensor strength of the quadriceps muscles. Ultimately, we hope to establish direct links between medialization of the quadriceps force, normalization of knee kinematics, and a reduction in pain. In order to better understand potential confounding variables, this protocol plans to enroll 10 healthy control subjects prior to evaluating individuals with PF pain. To date, five asymptomatic volunteers with no prior history of knee pain, trauma, leg surgery, or contraindications to having an MRI have been enrolled. For all subjects, the PF and tibiofemoral (TF) kinematics will be derived from dynamic cine phase contrast velocity data during the first visit. The subject will then be asked to return within a week for the second segment of the study. For the second visit, the subject's isometric strength and level of pain during various activities will be assessed first. Then, the vasti lateralis block will be performed using 1-5 cc of 0.5% solution of bupivacaine. After it has been confirmed that the block is effective, the subject's strength and level of pain will be reassessed. Following this, cine-phase contrast data will be again collected during a flexion-extension exercise in order to quantify the subject patellofemoral kinematics. A repeated measures analysis of variance (ANOVA) will be used to test the null hypothesis that the post- and pre-injection kinematics were no different across the knee angles of extension. A Kolmogorov-Smirnov test for normality will be run. If the data are normally distributed a repeated measures ANOVA will be run using Hotellings T2 test statistic; if not, the non-parametric Friedman's test statistic will be used. Upon rejection of the null hypothesis a post-hoc analysis (Wilcoxon signed rank test) will be completed to determine at which knee angles the null hypothesis could be rejected. Pearsons correlations between the change in kinematics post-injection and the pre-injection kinematics will quantified at these same knee angles. This will followed by a step-wise linear regression. Significance is set at p less than or equal to 0.05. This project remains in the data collection phase.

针对PF疼痛来源的最广泛接受的模型是，控制膝关节的肌肉中的力失平会导致静态patelofemoral（pf）疾病和动态PF Maltracking。反过来，这种失误和误导会导致关节接触应力升高，最终导致PF疼痛并可能导致OA。最近的一项研究证实了该模型，该研究证明了PF关节的疼痛程度与pat股股权运动学之间的直接相关性。此外，关注麦康奈尔录音的研究始终表明，通过添加中介力来通过立即减轻疼痛的减轻。然而，膝盖周围力失衡的根源仍在辩论中，有些假定会延迟延迟时间的肌肉（VMO）肌肉（VMO）肌肉，被动结构失衡或VMO中的力量损失。许多研究也驳斥了这些主张。 因此，目前协议的目的是确定股四头肌的临时立即中介是否可以减少PF疼痛个体中的过度横向转移和倾斜，并通过这样做可以立即缓解疼痛。这将通过使用布比卡因在PF疼痛患者的VL肌肉中创建短期，瞬时的功能丧失来实现。布比卡因是一种局部麻醉剂，与利多卡因密切相关，通常用于周围神经阻滞。 Cine-PC（CPC）MR成像将是评估PF运动学前和块后块的主要测量工具。这是唯一可以准确（<0.33mm）同时测量三维骨骼和肌肉运动的非侵入性技术。两个特定的主要假设和要解决的次要假设是：1）PF疼痛患者VL的短期功能丧失将导致其PF侧向移位和倾斜度减少； 2）PF疼痛患者VL的短期功能丧失将导致疼痛减轻； 3）VL的短期功能丧失将导致股四头肌肌肉的最大等距伸肌强度无变化。最终，我们希望在股四头肌的内侧化，膝盖运动学的正常化和疼痛减轻之间建立直接联系。 为了更好地理解潜在的混杂变量，该协议计划在评估PF疼痛的个体之前招募10名健康控制对象。 迄今为止，五名无症状志愿者没有膝盖疼痛，创伤，腿部手术或进行MRI的禁忌症的史。对于所有受试者，PF和胫骨（TF）运动学将在第一次访问期间源自动态的CINE相比速度数据。然后，将要求受试者在一周内返回研究的第二部分。对于第二次访问，将首先评估受试者在各种活动中的等距强度和疼痛水平。然后，将使用布比卡因的0.5％溶液1-5 cc进行巨大的外侧块。在确认区块有效后，受试者的力量和疼痛程度将得到重新评估。此后，将在屈伸延伸练习期间再次收集Cine相对造影剂，以量化受试者的patelo股运动学。重复的方差分析（ANOVA）将用于测试零假设，即在延伸的膝关节角度上，后注射和注射前运动学没有什么不同。将运行Kolmogorov-Smirnov测试。如果数据正态分布，则使用Hotellings T2测试统计量进行重复测量方差分析；如果没有，将使用非参数Friedman的测试统计量。拒绝零假设后，将完成事后分析（Wilcoxon签名的等级检验），以确定可以拒绝零假设的膝盖角度。注射后运动学变化与注射前运动学之间的梨子相关性将以这些相同的膝盖角度进行量化。随后将进行逐步线性回归。显着性设置为P小于或等于0.05。 该项目仍处于数据收集阶段。