PATELLOFEMORAL AĞRI SENDROMU

Abstract

Patellofemoral ağrı sendromu (PFAS) ön diz ağrısının genellikle genç bayanları etkileyen sık bir nedenidir. Patellofemoral ağrı, tüm kas-iskelet sistemi yakınmalarının yaklaşık %9-10’unu, tüm diz problemlerinin ise %20-40’ını oluşturan en yaygın kas-iskelet tanılarından biridir. Geçmişte sadece patellofemoral dizilim bozukluğu kaynaklı olduğuna inanılan patellofemoral ağrı günümüzde kompleks ve multifaktöriyel bir problem olarak ele alınmaktadır. Patellofemoral eklem ağrısı olan hastaların değerlendirilmesinde anamnez, klinik ve radyolojik bulgular bir arada değerlendirilmelidir. PFAS tanısında halen bir netlik olmamakla beraber, dokulara direnç göstereceği yükün üzerinde yüklenmelerin doku homeostazını bozması ve bunun sonucunda da ağrının oluşumunu öne süren doku homeostazisi teorisi popülerlik kazanmaktadır. Bu direncin miktarı ise kişinin özelliklerine göre (obezite, cinsiyet, spor, genetik vb) değişebilir.

Keywords

• Patellofemoral ağrı sendromu,diz önü ağrısı,Q açısı

PATELLOFEMORAL PAIN SYNDROME

Abstract

Patellofemoral pain syndrome (PFPS) is a common cause of anterior knee pain, usually affecting young women. Patellofemoral pain is one of the most common musculoskeletal diagnoses, corresponding to approximately %9-10 of all of the musculoskeletal complaints, and 20 to 40% of all knee problems. Patellofemoral pain, which was in the past believed to be originating only from patellofemoral malalignment, is nowadays considered as a complex and multifactorial problem. In the assessment of patients with patellofemoral joint pain patient history, clinical and radiological findings should be evaluated together. Although there is still not a clear evidence on diagnosis of PFP; the tissue homeostasis theory, suggesting that excessive loads on tissues over their resistance results in pain, is gaining popularity. The amount of this resistance can vary according to the patient's properties like obesity, gender, sports, genetics.

Keywords

• Patellofemoral pain syndrome,anterior knee pain,Q angle

References

1. 1. Netter’s Orthopaedics MD Consult Netter Clinical Science Series Walter B. Greene Saunders Elsevier, 2006
2. 2. Patellofemoral eklem anatomisi Tülin Şen, Ali Fırat Esmer, İbrahim Tekdemir TOTBİD Dergisi 2012;11(4):265-268
3. 3. Standring S. Gray’s anatomy. 40th ed. Philadelphia: Elsevier Churchill Livingstone; 2008.
4. 4. O’Brien M. Clinical anatomy of the patellofemoral joint. Int Sport Med J 2001;2:1-8.
5. 5. Şendur ÖF, Turan Y. Ön diz ağrıları. Türk Fiz Tıp Rehab Derg 2007; 53(supl 2):47-51
6. 6. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A(2010) Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports20(5):725–730
7. 7. Robinson RL, Nee RJ (2007) Analysis of hip strength in femalesseeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther 37:232–238
8. 8. Fulkerson JP, Arendt EA (2000) Anterior knee pain in females. Clin Orthop Relat Res 431:69–73

9. 9. Sanchis-Alfonso V. Pathophysiology of anterior knee pain.In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral pain, instability, and arthritis. Berlin Heidelberg: Springer; 2010. p. 1-16.
10. 10. Hughston JC. Subluxation of the patella. J Bone Joint Surg[Am] 1968;50:1003-26.
11. 11. Insall J. “Chondromalacia patellae”: patellar malalignment syndrome. Orthop Clin North [Am] 1979;10:117-27.
12. 12. Merchant AC, Mercer RL. Lateral release of the patella. A preliminary report. Clin Orthop Relat Res 1974;103:40-5.
13. 13. Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain. A prospective randomized study. Am J Sports Med 2004; 32: 1122-1130.
14. 14. Yılmaz B, Alaca R, Göktepe S, Möhür H, Kalyon TA. Patellofemoral ağrı sendromunda izokinetik egzersiz programının fonksiyonel kapasite ve ağrı üzerindeki etkisi. Türk Fiz Tıp Rehab Derg 2001; 47: 5-11.
15. 15. Heintjes E, Berger MY, Bierma-Zeinstra SMA, et al. Exercise therapy for patellofemoral pain syndrome. Cochrane Database of Systematic Reviews 2003; 4. CD003472.
16. 16. Dye SF, Stäubli HU, Biedert RM, Vaupel GL. The mosaic of pathophysiology causing patellofemoral pain: Therapeutic implications. Operative Techniques in Sports Medicine 1999;7:46–54
17. 17. Fulkerson JP. The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop Relat Res 1983;179:129-33.
18. 18. Fulkerson JP, Tennant R, Jaivin JS, Grunnet M. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment. Clin Orthop Relat Res 1985;197:196-205
19. 19. Mori Y, Fujimoto A, Okumo H,Kuroki Y. Lateral retinaculum release in adolescent patellofemoral disorders: its relationship to peripheral nerve injury in the lateral retinaculum. Bull Hosp Jt Dis Orthop Inst 1991;51:218-29.
20. 20. Insall J. “Chondromalacia patellae”: patellar malalignment syndrome. Orthop Clin North Am 1979;10:117-27.
21. 21. Semih Aydoğdu. “Patellofemoral eklem hastalıklarının sınıflandırmasıTOTBİD Dergisi“ 2012;11(4):284-289
22. 22. Merchant AC. Classification of patellofemoral disorders.Arthroscopy 1988;4:235-40.
23. 23. Crossley K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain. Am J Sports Med 2002; 30: 857-865
24. 24. Sanchis-Alfonso V, editor. Anterior Knee Pain and Patellar İnstability.Singapore, KYO: Springer; 2006
25. 25. Draper CE, Besier TF, Santos JM, Jennings F, Fredericson M,Gold GE, Beaupre GS, Delp SL (2009) Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res 27(5):571–577
26. 26. Wilson NA, Press JM, Koh JL, Hendrix RW, Zhang LQ (2009) In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 91(3):558–566).
27. 27. Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study.Am J Sports Med 28:480–489
28. 28. Pal S, Draper CE, Fredericson M, Gold GE, Delp SL, Beaupre GS, Besier TF (2011) Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients. Am J Sports Med 39(3):590–598
29. 29. Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J (2001) Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil 82(2):183–189
30. 30. Pattyn E, Verdonk P, Steyaert A, Vanden Bossche L, Van denBroecke W, Thijs Y, Witvrouw E (2011) Vastus medialis obliquus atrophy: does it exist in patellofemoral pain syndrome? Am J Sports Med 39(7):1450–1456
31. 31. Sebik A. Patellofemoral eklemin anatomisi ve biyomekanik özellikleri. Acta Orthop Traumatol Turc 1995;29:351-6.
32. 32. Cox JS. An evaluation of the Elmslie-Trillat procedure formanagement of patellar dislocations and subluxations: a preliminary report. Am J Sports Med 1976;4:72-77.
33. 33. Rauh MJ, Koepsell TD, Rivara FP, Rice SG, Margherita AJ (2007) Quadriceps angle and risk of injury among high school cross-country runners. J Orthop Sports Phys Ther 37:725–733
34. 34. Park SK, Stefanyshyn DJ (2011) Greater Q angle may not be a risk factor of patellofemoral pain syndrome. Clin Biomech (Bristol, Avon) 26(4):392–396
35. 35. Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, Rauh MJ, Divine JG, Hewett TE (2010) The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon) 25(7):700–707
36. 36. Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM(2011) Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med 39:866–873
37. 37. MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR (2006) Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am 88(12):2596–2605
38. 38. Baldon R, Nakagawa TH, Muniz TB, Amorim CF, Maciel CD, Serra˜o FV(2009) Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train 44(5):490–496
39. 39. Bolgla LA, Malone TR, Umberger BR, Uhl TL (2008) Hip strength and hip and knee kinematics during stair descent infemales with and without patellofemoral pain syndrome. J OrthopSports Phys Ther 38(1):12–16
40. 40. Padua DA, Marshall SW, Beutler AI, Demaio M, Boden BP, Yu B, Garrett WE (2005) Predictors of knee valgus angle during a jump-landing task. Med Sci Sports Exerc 37:398–404
41. 41. Barton CJ, Levinger P, Crossley KM, Webster KE, Menz HB(2012) The relationship between rearfoot, tibial and hip kinematicsin individuals with patellofemoral pain syndrome. ClinBiomech (Bristol, Avon) 27(7):702–705
42. 42. Barton CJ, Levinger P, Menz HB, Webster KE (2009) Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture 30(4):405–416
43. 43. Levinger P, Gilleard W (2007) Tibia and rearfoot motion andground reaction forces in subjects with patellofemoral pain syndrome during walking. Gait Posture 25(1):2–8.
44. 44. Wu CC, Shih CH (2004) The influence of iliotibial tract on patellar tracking. Orthopedics 27(2):199–203
45. 45. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clinical Journal Of Sports Medicine 2006; 16:261-268
46. 46. White LC, Dolphin P, Dixon J (2009) Hamstring length in patellofemoral pain syndrome. Physiotherapy 95(1):24–28
47. 47. Patil S, White L, Jones A, Hui AC (2010) Idiopathic anterior knee pain in the young. A prospective controlled trial. Acta OrthopBelg 76(3):356–359 .
48. 48. Tsuji T, Matsuyama Y, Goto M, Yimin Y, Sato K, Hasegawa Y, Ishiguro N (2002) Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain. J Orthop Sci 7(5):519–523