Clinic-Based Patellar Mobilization Therapy for Knee Osteoarthritis: A Randomized Clinical Trial

Abstract

PURPOSE We performed a phase 2 randomized clinical trial to evaluate the preliminary effectiveness of a clinic-based patellar mobilization therapy (PMT) in patients with knee osteoarthritis. METHODS We recruited 208 patients with knee osteoarthritis at primary care clinics in Hong Kong. Patients were randomly assigned (1:1) to the intervention group or the control group. The intervention group received 3 PMT treatment sessions from primary care physicians at 2-month intervals, with concomitant prescription of a home-based vastus medialis oblique muscle exercise. The control group received PMT after the study period. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Secondary outcomes included the WOMAC composite, function, and stiffness scores; the visual analog scale score for pain; objective physical function tests (30-s chair stand, 40-m walk test, timed up and go test, and EuroQol-5D). All outcomes were evaluated at baseline and at 24 weeks through intention-to-treat analysis. RESULTS We observed no baseline between-group differences. The WOMAC pain score showed greater improvement in the intervention group than in the control group at 24 weeks (between-group difference-15.6, 95% CI,-20.5 to-10.7, P <.001). All secondary outcomes also demonstrated significant betweengroup differences. CONCLUSIONS Patellar mobilization therapy has the potential to reduce pain and improve function and quality of life for patients with knee osteoarthritis. Future clinical trials with comparison to other active comparator controls will help determine the overall efficacy and facilitate the deployment of PMT in realworld practice.

Multiple Ligament Reconstructions of the Knee and Posterolateral Corner

“…Patellofemoral joint mobilizations and peripatellar soft tissue mobilizations along with frequent quadriceps contractions, which create proximal patellar translation, help minimize postoperative stiffness, which is a critical first step for maximizing recovery and long-term joint health. 19 , 20 , 21 In the case of biceps femoris repair, hamstring muscle strengthening should be delayed for the first 8 weeks to minimize disruption of initial tendon healing at the attachment site, then gentle isometrics may begin, followed by graduated loading progressions to stimulate the healing process. Resisted hamstring curling into knee flexion is prohibited until 4 months after surgery with PCL and PLC reconstructions to avoid excessive posterior tibial translation.…”

Osteoarthritis year in review 2019: rehabilitation and outcomes

“…Exercise was combined with physician consultation and selfmanagement 37,65,67 , as well as self-management alone 48 , manual therapy 30,57 , dry needling 55,56 , and bracing or taping 44,52 . Exercise was also combined with thermal 63,64 and electrical 34,51 modalities.…”

Measures of Physical Performance

“…Since the minimum core set of OARSI performance‐based tests for people with hip and/or knee OA recommended the use of the CST in 2013 (11), this test has been included as either a primary or secondary outcome in a number of clinical trials (17,23,28,31,49‐67) (Table 4).…”

“…The TUG was recommended in the OARSI performance‐based tests for people with hip and/or knee OA (11) and has been included as either a primary or secondary outcome in many clinical trials (23,28,31,49,52,53,55‐57,61,66,67,86,88,89,91,92,143,167,168) (Table 13).…”