Effect of bracing on patellar kinematics in patients with patellofemoral joint pain.

PURPOSE Bracing is commonly used to correct patellar malalignment syndromes. However, there are little objective data documenting the effect of such supports on patellofemoral joint relationships. The purpose of this study was to assess the effectiveness of an elastic patellofemoral sleeve brace in altering patellar tracking in subjects with patellofemoral pain. METHODS Ten female subjects (12 patellofemoral joints) between the ages of 17 and 46 participated in this study. All subjects had a diagnosis of patellofemoral pain and demonstrated lateral patellar tracking based on magnetic resonance imaging (MRI) assessment. Each subject underwent kinematic MRI of the patellofemoral joint through a range of 45 to 0 degrees of knee flexion against a resistance of 15% body weight. Imaging was performed with and without a patellofemoral joint brace (Bauerfeind Genutrain P3 brace, Atlanta, GA). Measurement of medial/lateral patellar displacement, medial/lateral patellar tilt, and the depth of the trochlear groove (sulcus angle) were obtained with midpatellar image sections at 45, 36, 27, 18, 9 and 0 degrees of knee flexion. RESULTS No statistically significant differences in medial/lateral patellar displacement or tilt were found between braced and unbraced trials across all knee flexion angles (P < 0.05). A small but statistically significant increase in sulcus angle was found across all knee flexion angles with the braced trials (P > 0.05). CONCLUSIONS These results do not support the hypothesis that the brace used in this study corrects patellar tracking patterns in subjects with patellofemoral pain. However, the increased sulcus angle indicates a change in patella position within the trochlea. It is possible that the clinical improvements seen with bracing may be the result of subtle differences in joint mechanics and not gross changes in alignment.

[1]  L. Paulos,et al.  Bracing for patellar instability. , 1990, Clinics in Sports Medicine.

[2]  M. Puniello.  Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. , 1993, The Journal of orthopaedic and sports physical therapy.

[3]  F G Shellock,et al.  Quantification of patellar tracking using kinematic MRI , 1998, Journal of magnetic resonance imaging : JMRI.

[4]  W. Hayes,et al.  Force ratios in the quadriceps tendon and ligamentum patellae , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[5]  R Huiskes,et al.  The three‐dimensional tracking pattern of the human patella , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[6]  G. Molenaers,et al.  Patella alta in patellofemoral instability. , 1989, Acta orthopaedica Belgica.

[7]  I. Fiebert,et al.  EMG Biofeedback as Treatment for Patellofemoral Pain Syndrome*. , 1984, The Journal of orthopaedic and sports physical therapy.

[8]  W. Hanten,et al.  Exercise effect on electromyographic activity of the vastus medialis oblique and vastus lateralis muscles. , 1990, Physical therapy.

[9]  Shelton Gl.  Conservative management of patellofemoral dysfunction. , 1992, Primary Care.

[10]  F G Shellock,et al.  Patellar tracking abnormalities: clinical experience with kinematic MR imaging in 130 patients. , 1989, Radiology.

[11]  T A Fox,et al.  Dysplasia of the quadriceps mechanism: hypoplasia of the vastus medialis muscle as related to the hypermobile patella syndrome. , 1975, The Surgical clinics of North America.

[12]  F G Shellock,et al.  Kinematic MR imaging of the patellofemoral joint: comparison of passive positioning and active movement techniques. , 1992, Radiology.

[13]  L. Y. Hunter.  Braces and taping. , 1985, Clinics in sports medicine.

[14]  J Perry,et al.  Are patellofemoral pain and quadriceps femoris muscle torque associated with locomotor function? , 1997, Physical therapy.

[15]  F. Shellock,et al.  Effect of a patellar realignment brace on patellofemoral relationships: Evaluation with kinematic MR imaging , 1994, Journal of magnetic resonance imaging : JMRI.

[16]  Michael T. Gross,et al.  Comparison of Vastus Medialis Obliquus:Vastus Lateralis Muscle Integrated Electromyographic Ratios Between Healthy Subjects and Patients with Patellofemoral Pain , 1991 .

[17]  E. Salvati,et al.  Recurrent dislocation and the high-riding patella. , 1972, Clinical orthopaedics and related research.

[18]  P.M. Palumbo.  Dynamic patellar brace: A new orthosis in the management of patellofemoral disorders , 1981, The American journal of sports medicine.

[19]  M Heller,et al.  Patellar tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging. , 1993, Radiology.

[20]  I. Hvid,et al.  Chondromalacia Patellae: The Relation to Abnormal Patellofemoral Joint Mechanics , 1981 .

[21]  J. Perry,et al.  Timing and intensity of vastus muscle activity during functional activities in subjects with and without patellofemoral pain. , 1996, Physical therapy.

[22]  F G Shellock,et al.  Patellofemoral joint: identification of abnormalities with active-movement, "unloaded" versus "loaded" kinematic MR imaging techniques. , 1993, Radiology.

[23]  H. W. Lenz.  Women at the Military Academies Women's Sports and Fitness Programs at the US Naval Academy. , 1979, The Physician and sportsmedicine.

[24]  F. Noyes,et al.  Patellar malalignment: a treatment rationale. , 1980, Physical therapy.

[25]  G. Ramsby,et al.  Computerized tomography of the patellofemoral joint before and after lateral release or realignment. , 1987, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[26]  A. Tria,et al.  Conservative care for patellofemoral pain. , 1992, The Orthopedic clinics of North America.

[27]  B. Maldague,et al.  Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. , 1989, Radiology.

[28]  G. Karst,et al.  Electromyographic analysis of exercises proposed for differential activation of medial and lateral quadriceps femoris muscle components. , 1993, Physical therapy.

[29]  W. M. Walsh,et al.  Patellar tracking problems in athletes. , 1992, Primary care.