Bone Mineral Density in the Chronic Patellofemoral Pain Syndrome

Leppälä, Jari; Kannus, Pekka; Natri, Antero; Sievänen, Harri; Järvinen, Markku; Vuori, Ilkka

doi:10.1007/s002239900477

Cited by 17 publications

(10 citation statements)

References 30 publications

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“…Also, the Lysholm score had a significant association with the relative BMDs of this site. These results confirm our previous findings that good muscle strength and limb function are of great importance for good post‐traumatic BMD 22, 34 . Smoking had a significant negative association with the relative BMD at the injured distal tibia, and this is in agreement with findings of the negative effect of smoking on the skeleton 35, 36 .…”

Section: Discussionsupporting

confidence: 92%

A Tibial Shaft Fracture Sustained in Childhood or Adolescence Does Not Seem to Interfere with Attainment of Peak Bone Density

Leppälä

Kannus

Sievänen

et al. 1999

Journal of Bone and Mineral Research

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High peak bone mass or density in early adulthood is an important protective factor against osteoporotic fractures in later life, but it is not known whether injuries on growing bones affect the attainment of peak bone mass and density. The purpose of this study was therefore to examine with dual-energy X-ray absorptiometry the areal bone mineral density (BMD) of the injured and uninjured extremity (the femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and distal tibia), lumbar spine, and distal radius of young adults with a history of early life tibial shaft fracture and to find out whether the fracture had affected the attainment of peak bone density of these patients. The second objective was to clarify whether any background or clinical follow-up variable would predict the BMD difference between the affected and unaffected extremity. Thus, the BMD and clinical status of 45 patients (34 men and 11 women), who had sustained a tibial shaft fracture in childhood or in adolescence (between 7 and 15 years of age) an average 11 years before the study, were examined. The results showed that the fracture had created a small but statistically significant injured-to-uninjured side BMD difference (proximal tibia −1.7%; p = 0.011, and distal tibia 2.6%; p = 0.014), while the other sites showed no significant side-to-side differences. There were neither significant differences in the spinal or radial BMDs between the patients and their age-, height-, and weight-matched healthy controls. A further analysis of the data showed that the better the muscle strength in the injured lower limb, the lower the side-to-side BMD deficit in the proximal tibia of the same limb (r = 0.51; p < 0.001). Smoking had a significant association with the relative BMD in the injured distal tibia (mean injured-to-uninjured side BMD difference: smokers 6.1% vs. nonsmokers −0.6%, p = 0.016). Also patient's age at the time of the injury showed an association: the younger the patient at the time of the injury, the lower the side-to-side BMD deficit in the injured distal tibia (r = −0.35; p = 0.048). In conclusion, this study indicates that early life tibial fracture leads to a small long-term BMD deficit in the fractured bone while the other sites of the skeleton seem not to be affected. Thus, a tibial shaft fracture sustained in childhood or adolescence seems to only marginally interfere the attainment of peak bone density, the important predictor of the osteoporotic fractures in later life. (J Bone Miner Res 1999;14:988-993)

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Section: Discussionsupporting

confidence: 92%

A Tibial Shaft Fracture Sustained in Childhood or Adolescence Does Not Seem to Interfere with Attainment of Peak Bone Density

Leppälä

Kannus

Sievänen

et al. 1999

Journal of Bone and Mineral Research

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“…The lower BMD was found only in the region corresponding to the pain and diffuse uptake on bone scintigraphy and increased after recovery. Leppälä et al 30 found significantly decreased BMD in the distal femur, the patella, and the proximal tibia in patients with PFPS. The differences were small and could result from a remodelling process during the resorption phase.…”

Section: Discussionmentioning

confidence: 98%

Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome

Odenbring

Näslund³

et al. 2005

Br J Sports Med

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Objectives: Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The aims of this study were to determine whether bone scintigrams of patients suffering from patellofemoral pain syndrome (PFPS) show diffuse uptake and in what bony compartment of the knee uptake, if any, was localised. Methods: Fifty eight patients with chronic PFPS were examined. All patients underwent a detailed clinical history and a thorough physical examination of the knee. Anterior and lateral static images of both knees were made using a gamma camera 3 h after injection of 550 MBq of 99m Tc-HMDP. Two experienced radiologists visually evaluated the scans blindly and separately. As 51 patients had bilateral pain, 109 painful knees are included in the results. Results: Diffuse uptake on bone scintigrams was found in 48 knees in 30 of the patients. In 33 knees the uptake was localised to only one bone compartment, in 10 knees diffuse uptake was found in two of the bones forming the knee joint, and in six knees all three bone compartments (the distal femur, the patella, and the proximal tibia) exhibited diffuse uptake. Conclusions: Scintigrams of approximately half of the patients with PFPS will show diffuse uptake in one or more of the bony compartments of the knee joint and radioactive tracer accumulation will occur as often in the proximal tibia as in the patella.

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“…9,11,22,26,29–31,46 Theories supporting a correlation between an increase in BMI and PFP include BMI and its relation to decreased joint space in the knee, and BMI and its relation to an increased q-angle in the lower extremity. 23,47 Leppälä et al 13 showed that BMI had no relation to decreased bone mineral density.…”

Section: Discussionmentioning

confidence: 99%

Is Body Composition Associated with an Increased Risk of Developing Anterior Knee Pain in Adolescent Female Athletes?

Foss

Hornsby

Edwards

et al. 2012

The Physician and Sportsmedicine

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Objective To determine the relationship between relative body composition and body mass to height, anterior knee pain, or patellofemoral pain (PFP) in adolescent female athletes. Background Patellofemoral pain is common in female athletes and has an undefined etiology. The purpose of this study was to examine whether there was an association among higher body mass index (BMI), BMI z-scores, and relative body fat percentage in the development of PFP in an adolescent female athlete population. We hypothesized that female athletes who developed PFP over the course of a competitive basketball season had higher relative body mass or body fat percentage compared with those who did not develop PFP. Methods Fifteen middle school basketball teams that consisted of 248 basketball players (mean age, 12.76 ± 1.13 years; height, 158.43 ± 7.78 cm; body mass, 52.35 ± 12.31 kg; BMI, 20.73 ± 3.88 kg/m2) agreed to participate in this study over the course of 2 basketball seasons, resulting in 262 athlete-seasons. Testing included the completion of the Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC) form, standardized history, physician-administered physical examination, maturational estimates, and anthropometrics. Results Of the 262 athlete-seasons monitored, 39 athletes developed PFP over the course of the study. The incidence rate of new PFP was 1.57 per 1000 athlete-exposures. The cumulative incidence of PFP was 14.9%. There was no difference in BMI between those who developed PFP (mean body mass, 20.2 kg/m2; 95% CI, 18.9–21.4) and those who did not develop PFP (mean body mass, 20.8 kg/m2; 95% CI, 20.3–21.3; P > 0.05). Body mass index z-scores were not different between those who developed PFP (mean, 0.3; 95% CI, 0.7–0.6) and those who did not develop PFP (mean, 0.4; 95% CI, 0.3–0.6; P > 0.05). A similar trend was noted in relative body fat percentage, with mean scores of similar ranges in those who developed PFP (mean body fat percentage, 22.2%; 95% CI, 19.4–24.9) to the referent group who did not (mean body fat percentage, 22.9%; 95% CI, 21.8–24.1; P > 0.05). Conclusions Our results do not indicate a relationship between relative body composition or relative body mass to height to the propensity to develop PFP in middle school–aged female basketball players. Although previous data indicate a relationship between higher relative body mass and overall knee injury, these data did not support this association with PFP specifically. These data suggest the underlying etiology of PFP may be neuromuscular in nature. Further research is needed to understand the predictors, etiology, and ultimate prevention of this condition.

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Bone Mineral Density in the Chronic Patellofemoral Pain Syndrome

Cited by 17 publications

References 30 publications

A Tibial Shaft Fracture Sustained in Childhood or Adolescence Does Not Seem to Interfere with Attainment of Peak Bone Density

A Tibial Shaft Fracture Sustained in Childhood or Adolescence Does Not Seem to Interfere with Attainment of Peak Bone Density

Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome

Is Body Composition Associated with an Increased Risk of Developing Anterior Knee Pain in Adolescent Female Athletes?

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