A Recreational Runner’s Guide to Knee Pain

The most common pain runners experience is associated with the knee joint. However, if you do an Internet search for “knee pain,” there is no telling what will come up or how accurate the information might be. On the other hand, scouring research articles for more fact-based recommendations can be time consuming and confusing. With this guide, the research has been done for you and a list of references is readily available at the end of the document if you want to look further into a specific topic. You shouldn’t need a degree in exercise science or anatomy to have an idea of what it going on with your knee pain. The goal of this guide is to provide the tools necessary to learn more about your knee pain and some strategies for overcoming that pain in a single, easy to navigate format

An intratendious ganglion cyst of the patellar tendon - A rare cause of anterior knee pain

Ganglion cysts in the knee region can manifest as anterior knee pain. Unlike synovial cysts, these lesions lack synovial epithelial lining and occur secondary to mucoid degeneration of connective tissue because, often in response to chronic irritation and repetitive traumas. However, an intratendinous location is a rare finding. In the knee region, infrapatellar fat pad, the alar folds, and the anterior cruciate ligament are recognized to degenerate into ganglion. There are few case reports describing an involvement of the patellar tendon. We present the clinical case of a 72 years old male patient suffering from anterior knee pain attributed to an intratendinous ganglion cyst of the patellar tendon, obviously after a single traumatic event. After aspiration of the ganglion cyst the patient reported no complaints, and there has been no recurrence during the latest follow-up examination

MRI of lower extremity impingement and friction syndromes in children

Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon–lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data

An Investigation of Differential Diagnosis of Patellofemoral Pain Syndromes

Dysfunction of the patellofemoral joint has long been a topic of discussion and debate for caregivers of patients with this syndrome. Various diagnosis related to the patellofemoral joint of the knee have been reported. Patellofemoral pain refers to the clinical presentation of pain in the anterior region of the knee. It is one of the most common musculoskeletal complaints in children, adolescents, and adults. It is a major source of pain and dysfunction in both genders, but is more common in females. The purpose of this literature review is to help distinguish between several differential diagnosis included as part of patellofemoral pain syndromes. These include plica syndrome, chondromalacia patellae, extensor mechanism or tracking problems, and instability problems of subluxation and dislocations. Aspects of each of the above conditions will be discussed in the manner of definition, presentation, clinical signs and symptoms, and special tests specific to each syndrome along with a brief diagnosis and treatment for each condition. I will conclude my findings by comparing and contrasting each condition

Comparison between Iliotibial Band and Lateral Patellar Retinaculum Stretching on Lateral Patellar Shift in Young Females

Introduction: Patellar malalignment, particularly lateral patellar shift, is a common contributor to patellofemoral pain syndrome (PFPS), especially among young females. It results from imbalanced forces acting on the patella, often due to tight lateral structures such as the iliotibial band (ITB) and lateral patellar retinaculum. Addressing these imbalances through targeted stretching may help restore normal patellar tracking and prevent PFPS Objectives: To compare the effect of Iliotibial Band (ITB) stretching and Lateral Patellar Retinaculum (LPR) stretching on reducing lateral patellar shift in females. Methods: Twenty female participants aged 17–24 years with lateral patellar shift were randomly assigned to two groups: Group A (ITB stretching) and Group B (LPR stretching). Participants underwent 3 sessions per week for 3 weeks, with 3 repetitions per session. Lateral patellar shift was measured pre- and post-intervention using a Vernier caliper in a supine lying position. Statistical analysis was done using SPSS; unpaired t-tests were applied with a significance level set at p<0.05. Results: Both groups showed a reduction in lateral patellar shift post-intervention. However, the difference in improvement between Group A and Group B was not statistically significant. Conclusion: Both ITB and LPR stretching were found to be equally effective in reducing lateral patellar shift. This suggests that addressing either of the tight lateral structures may help in improving patellar alignment Conclusions: Both ITB and LPR stretching significantly reduced lateral patellar shift in young females. Since no significant difference was found between them, either technique can be effectively used to address patellar malalignment. DOI: https://doi.org/10.52783/jchr.v15.4.9329

Association between patellofemoral joint alignment and morphology to superlateral Hoffa's fat pad edema

BACKGROUND: Osteoarthritis is a leading cause of disability in people of 65 and older. Researches have shown several possible factors leading to knee osteoarthritis development. Patellofemoral joint maltracking has been thought to be associated with or caused edema in the knee; which is thought to be the early signs of osteoarthritis. Hoffa's fat pad is an intra-articular component of knee located under the kneecap. It has also been suggested as one marker for osteoarthritis, when MRI shows a presence of edema in it. Recently, edema in the superolateral region of Hoffa's fat pad has been hypothesized as a distinct signal than the edema on other regions. There is an interest in finding the relation of this superolateral edema with other factors of osteoarthritis development. OBJECTIVE: This thesis research project is aimed to assess the relation of kneecap-thighbone (patellofemoral) joint alignment, femoral trochlea morphology, and patellar height to edema in the superolateral region of Hoffa’s fat pad especially in the population with average age above 65 years old. The hypothesis is that the flatter trochlear morphology and abnormal patella alignment will have higher risk of superolateral edema. METHODS: This is a cross-sectional study using a subset data from Multicenter Osteoarthritis (MOST) study, specifically at 60-month visit. This study measured the patellofemoral measurements (sulcus angle, lateral and medial trochlear inclination angle, trochlear angle, Insall-Salvati ratio, patellar tilt angle, and bisect offset) as the predictor variables, and semiquantitative scoring of MRI edema in superolateral Hoffa’s fat pad as the outcome variable. Logistic regression analyses were performed to find the strongly associated patellofemoral measurements to superolateral Hoffa’s fat pad edema. RESULTS: From the logistic regression analysis, trochlear angle, Insall-Salvati ratio, and bisect offset were highly associated with the superolateral edema. A further analysis, by categorizing the measurements to quartiles, was found that only the highest quartiles of both bisect offset and trochlear angle are associated with superolateral Hoffa’s fat pad edema when compared to the reference quartile. All quartiles of Insall-Salvati ratio are strongly associated with superolateral edema when compared to the reference quartile. CONCLUSION: Current study presents that people above 65 years old with high trochlear angle, extreme lateral patellar translation or bisect offset, and high patella riding have high risk of having superolateral Hoffa’s fat pad edema

Patello-femoral joint biomechanics during knee flexion: an in-silico investigation

openThe objective of this study was to develop a Finite Element (FE) model of the knee joint with different configurations of patella height to analyse the biomechanics of the patellofemoral joint (PF) during knee flexion. The PF joint is of key importance in the biomechanics of the knee. The primary role of the patella is to evenly distribute the load of the quadriceps and facilitate efficient knee extension. When the patella deviates from its normal tracking, it causes elevated strains on the PF ligaments, potential damage to soft tissues, and knee pain. Furthermore, this misalignment can result in excessive joint reaction forces and elevated stress on the articular cartilage, increasing the probability of cartilage wear and the formation of bone abnormalities that contribute to the development of osteoarthritis. An FE model of the knee joint was developed with 3D geometry reconstructed from patient-specific medical images and considering the mechanical behavior of bones (considering cortical and cancellous bone), cartilage, menisci, ligaments, and tendons in a healthy native condition. After the validation of the model under physiological conditions, the position of the native patella was modified to simulate the high-riding patella syndrome (patella alta) and the low-riding patella syndrome (patella baja). In the literature, the patellar height is considered a factor that could impair patellofemoral contact force, contact area and contact pressure. Patella alta can occur as a consequence of sports-related trauma; however, it appears to be a predominantly congenital/developmental condition, not related to traumatic events. The exact pathophysiology remains unclear, but it is hypothesized that abnormally elongated patellar tendons represent one of the etiologic factors contributing to the development of high patella. On the contrary, patella baja can be caused by a variety of factors, including surgical interventions, traumatic events, or congenital abnormalities. From a biomechanical perspective, it decreases the lever arm of the quadriceps tendon, requiring increased quadriceps force to achieve complete knee extension. This inefficiency in muscle function can result in modified joint loading and increased stress on the patellofemoral joint. Different FE models are developed, based on the anatomy of a subject with physiological patellar height and modifying the anatomical structure of the knee joint by increasing or decreasing the patella height with respect to the reference case along a superior (alta) or an inferior (baja) axis to achieve a different Blackburne-Peel index, which measures various anatomical relationships between the patella and the proximal tibia and is one of the most widely used methods of evaluating patella height. The flexion motion was performed for all three models within a knee flexion range of 0° to 90°. The comparison between numerical results under different conditions, namely physiological and modified patellar heights, allows one to quantify the differences in contact pressure and areas in a healthy and pathological state. Specifically, it can be observed that the patella alta exhibits the highest overall contact area and the lowest force attributable to contact pressure. This phenomenon arises because the point of contact with the femur is located more distally than in the native and patella baja configurations, and because the patella engages with the trochlear groove at deeper degrees of flexion (beyond 90°). The results contribute to our understanding of the underlying mechanisms of patellofemoral disorders and can guide the development of more effective diagnostic and treatment approaches. Furthermore, the FE models developed in this study can serve as a valuable tool for future research in patellofemoral biomechanics and related research areas.The objective of this study was to develop a Finite Element (FE) model of the knee joint with different configurations of patella height to analyse the biomechanics of the patellofemoral joint (PF) during knee flexion. The PF joint is of key importance in the biomechanics of the knee. The primary role of the patella is to evenly distribute the load of the quadriceps and facilitate efficient knee extension. When the patella deviates from its normal tracking, it causes elevated strains on the PF ligaments, potential damage to soft tissues, and knee pain. Furthermore, this misalignment can result in excessive joint reaction forces and elevated stress on the articular cartilage, increasing the probability of cartilage wear and the formation of bone abnormalities that contribute to the development of osteoarthritis. An FE model of the knee joint was developed with 3D geometry reconstructed from patient-specific medical images and considering the mechanical behavior of bones (considering cortical and cancellous bone), cartilage, menisci, ligaments, and tendons in a healthy native condition. After the validation of the model under physiological conditions, the position of the native patella was modified to simulate the high-riding patella syndrome (patella alta) and the low-riding patella syndrome (patella baja). In the literature, the patellar height is considered a factor that could impair patellofemoral contact force, contact area and contact pressure. Patella alta can occur as a consequence of sports-related trauma; however, it appears to be a predominantly congenital/developmental condition, not related to traumatic events. The exact pathophysiology remains unclear, but it is hypothesized that abnormally elongated patellar tendons represent one of the etiologic factors contributing to the development of high patella. On the contrary, patella baja can be caused by a variety of factors, including surgical interventions, traumatic events, or congenital abnormalities. From a biomechanical perspective, it decreases the lever arm of the quadriceps tendon, requiring increased quadriceps force to achieve complete knee extension. This inefficiency in muscle function can result in modified joint loading and increased stress on the patellofemoral joint. Different FE models are developed, based on the anatomy of a subject with physiological patellar height and modifying the anatomical structure of the knee joint by increasing or decreasing the patella height with respect to the reference case along a superior (alta) or an inferior (baja) axis to achieve a different Blackburne-Peel index, which measures various anatomical relationships between the patella and the proximal tibia and is one of the most widely used methods of evaluating patella height. The flexion motion was performed for all three models within a knee flexion range of 0° to 90°. The comparison between numerical results under different conditions, namely physiological and modified patellar heights, allows one to quantify the differences in contact pressure and areas in a healthy and pathological state. Specifically, it can be observed that the patella alta exhibits the highest overall contact area and the lowest force attributable to contact pressure. This phenomenon arises because the point of contact with the femur is located more distally than in the native and patella baja configurations, and because the patella engages with the trochlear groove at deeper degrees of flexion (beyond 90°). The results contribute to our understanding of the underlying mechanisms of patellofemoral disorders and can guide the development of more effective diagnostic and treatment approaches. Furthermore, the FE models developed in this study can serve as a valuable tool for future research in patellofemoral biomechanics and related research areas