KONDROMALAZİ PATELLA TANILI OLGULARDA KUADRİSEPS GÜÇLENDİRİCİ İZOMETRİK VE İZOTONİK EGZERSİZLERİN AĞRI, YAŞAM KALİTESİ VE FONKSİYONEL KAPASİTE ÜZERİNE ÜSTÜNLÜKLERİNİN KARŞILAŞTIRILMASI

Abstract

Comparison of the Superiority of Quadriceps Strengthening Isometric and Isotonic Exercises with Respect to Pain, Quality of Life, and Functional Capacity of Patients with Chondromalacia Patellae

Abstract

Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP). Methods: This study was designed as a prospective study in 30 patients(15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20–50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients. Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p<0,05). There were no significant differences in thigh circumference and other parameters of certain SF-36 quality of life components (p>0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p>0,05). Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment.

Keywords

• Cartilage
• Chondromalacia patellae
• Exercise
• Knee
• Patellofemoral pain syndrome

References

1. Özdemir M, Kavak RP. Chondromalacia patella among military recruits with anterior knee pain: Prevalence and association with patellofemoral malalignment. Indian J Orthop 2019;53:682-688
2. Esculier JF, Roy JS, Bouyer LJ. Lower limb control and strength in runners with and without patellofemoral pain syndrome. Gait Posture 2015;41:813-819
3. Aysin, I. K., Askin, A., Mete, B. D., Guvendi, E., Aysin, M., Kocyigit, H. Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment. The Eurasian journal of medicine, 2018:50(1), 28–33.
4. Özgen A, Taşdelen N, Fırat Z. A new MRI grading system for chondromalacia patellae. Acta Radiol. 2017;58(4):456-463.
5. Servodio Iammarrone C, Cadossi M, Sambri A, Grosso E, Corrado B, Servodio Iammarrone F. Is there a role of pulsed electromagnetic fields in management of patellofemoral pain syndrome? Randomized controlled study at one year follow-up. Bioelectromagnetics. 2016;37(2):81-88.
6. Petersen W, Ellermann A, Rembitzki IV, et al. Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial. Arch Orthop Trauma Surg. 2016;136(7):975-982.
7. Dos Santos RL, Souza ML, Dos Santos FA. Neuromuscular electric stimulation in patellofemoral dysfunction: literature review. Acta Ortop Bras. 2013;21(1):52-58.
8. de Vasconcelos GS, Nunes GS, Barton CJ, et al. Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial. Trials. 2021;22(1):777.

9. Basbug P, Kilic RT, Atay AO, Bayrakcı Tunay V. The effects of progressive neuromuscular exercise program and taping on muscle strength and pain in patellofemoral pain. A randomized controlled blind study [published online ahead of print, 2021 Oct 29]. Somatosens Mot Res. 2021;1-7.
10. Greaves H, Comfort P, Liu A, Lee Herrington, Richard Jones. How effective is an evidence-based exercise intervention in individuals with patellofemoral pain?. Phys Ther Sport. 2021;51:92-101
11. Manojlović D, Kozinc Ž, Šarabon N. Trunk, Hip and Knee Exercise Programs for Pain Relief, Functional Performance and Muscle Strength in Patellofemoral Pain: Systematic Review and Meta-Analysis. J Pain Res. 2021;14:1431-1449.
12. Bakhtiary AH. Open versus closed kinetic chain exercises for patellar chondromalacia. Br J Sports Med 2008;42:99-102; discussion 102
13. Kasitinon D, Li WX, Wang EXS, Fredericson M. Physical Examination and Patellofemoral Pain Syndrome: an Updated Review [published online ahead of print, 2021 Oct 29]. Curr Rev Musculoskelet Med. 2021;10.1007/s12178-021-09730-7.
14. Kim S, Park J. Patients with chronic unilateral anterior knee pain experience bilateral deficits in quadriceps function and lower quarter flexibility: a cross-sectional study [published online ahead of print, 2021 Jul 13]. Physiother Theory Pract. 2021;1-13.
15. Reijnders L, van de Groes SA. The quality of life of patients with patellofemoral pain - a systematic review. Acta Orthop Belg. 2020;86(4):678-687.
16. Derya C. Translation and cultural adaptation of the Turkish Lysholm Knee Scale: Ease of use, validity, and reliability. Clin Orthop Relat Res 2013;471
17. Celik D, Argut SK, Türker N, Kilicoglu OI. The effectiveness of superimposed neuromuscular electrical stimulation combined with strengthening exercises on patellofemoral pain: A randomized controlled pilot trial. J Back Musculoskelet Rehabil. 2020;33(4):693-699.
18. Ardic, Fusun. Exercise Prescription. FTR - Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2014;60. 1-8. 10.5152/tftrd.2014.25665.
19. Sak D, Dayı T, Günay E, Öniz A, Moderate intensity aerobic exercise effects on the quality of life and general health turksih Journal of Sports Medicine 2021;56;4;192-197 DOI 10.47447/tjsm.0576
20. Lee J, Lee H, Lee W. Effect of Weight-bearing Therapeutic Exercise on the Q-angle and Muscle Activity Onset Times of Elite Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Phys Ther Sci. 2014;26(7):989-992.
21. van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;1:CD010387.
22. Macmull S, Jaiswal PK, Bentley G, Skinner JA, Carrington RW, Briggs TW. The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae. Int Orthop 2012;36:1371-1377
23. Bączkowicz D. Joint motion quality in chondromalacia progression assessed by vibroacoustic signal analysis. PM R 2016;8:1065-1071
24. Atbaşi Z. The Relationship between chondromalacia patella, Q Angle and patella type in young male adults with anterior knee pain Gülhane Tıp Derg 2013; 55:89-93
25. Saç A, Taşmektepligil MY. Correlation between the Q angle and the isokinetic knee strength and muscle activity. Turk J Phys Med Rehab 2018;64:308-313
26. Khayambashi, Posterolateral hip muscle strengthening versus quadriceps strengthening for patellofemoral pain: a comparative control trial, Archives of physical medicine and rehabilitation 2014;95:900-907
27. Eapen C Effect of eccentric isotonic quadriceps muscle exercises on patellofemoral pain syndrome: an exploratory pilot study. Asian J Sports Med 2011;2:227-234
28. Dolak KL, Silkman C, McKeon JM, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2011;41:560-570
29. Garcia FR. Effects of electrical stimulation of vastus medialis obliquus muscle in patients with patellofemoral pain syndrome: an electromyographic analysis. Rev Bras Fisioter 2010;14:477-482
30. Alaca R. Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome. Am J Phys Med Rehabil 2002;81:807-813
31. Song C-Y, Lin Y-F, Wei T-C, Lin D-H, Yen T-Y, Jan M-H. Surplus value of hip adduction in leg-press exercise in patients with patellofemoral pain syndrome: A Randomized Controlled Trial. Phys Ther 2009;89:409-418
32. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High intensity preoperative training improves physical and functional recovery in the early post operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017;25:2864-2872
33. Burich R, Teljigović S, Boyle E, Sjøgaard G. Aerobic training alone or combined with strength training affects fitness in elderly: Randomized trial. Eur J Sport Sci 2015;15:773-783
34. Sevimli D, Kozanoglu E, Guzel R, Doganay A. The effects of aquatic, isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome. J Phys Ther Sci 2015;27:1781-1786