Rehabilitation following first-time patellar dislocation: A randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises

Abstract

Purpose: Define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscles strengthening following first-time patellar dislocation (FTPD).Methods: Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or to a specific-VM exercise and rehabilitation regime (n=25).Primary outcome was the Lysholm Knee Score, secondary outcomes included the Tegner Level of Activity Scale, the Norwich Patellar Instability (NPI) Score, and isometric knee extensions strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12 months.Results: There were statistically significant differences in functional outcome and activity levels through the Lysholm Knee Score and Tegner Level of Activity Scale at 12 months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% CI: -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI Score and isometric strength at any followup interval. The trial experienced substantial participant attrition (52% at 12 months). Conclusions:Whilst there was a statistical difference in Lysholm Knee Score and Tegner Level of Activity Score between general quadriceps and VM exercise groups at 12 months, this may not have necessarily been clinically important. This trial highlights that the recruitment and retention of participants from this population is a challenge and should be considered during the design of future trials in this population. Dislocation -Smith et al (2015) 3 Level of evidence: Therapeutic study, Level I Keywords: Quadriceps; vastus medialis oblique; exercise; patellar dislocation; trial VM versus General Quadriceps following Patellar Dislocation -Smith et al (2015) 4 VM versus General Quadriceps following Patellar IntroductionPatellar dislocation is a disabling musculoskeletal disorder which predominantly affects younger people who are engaged in multi-directional physically active pursuits [1]. The estimated incidence of patellar dislocation is between 7 [2] to 77 per 100,000 people per year [3], with a marginally greater incidence in females [2,4]. The term first-time patellar dislocation (FTPD) represents the first episode that the patella disengages completely from the femoral trochlear. It is sometimes termed primary patellar dislocation [5].Conservative (non-operative) treatment is the treatment of choice for FTPD. Quadriceps strengthening exercises are considered one of the principal management for people following FTPD [6,7]. A United Kingdom (UK) survey of physiotherapy practice has shown that quadriceps strengthening and specific-vastus medialis obliquus (VMO) or distal vastus medialis (VM) muscle strengthening or recruitment exercises were two of the most frequently used interventions for this population [1]. However, there remains controversy rega...

Translation, cross-cultural adaptation and validation of the Norwich Patellar Instability score for use in Brazilian Portuguese

“…[21][22][23] The Kujala patellofemoral disorder score 12 and the Lysholm knee score 10 are among the scores most used for evaluation of patellofemoral dysfunction in studies aiming to evaluate the efficacy of treatments for this condition. [24][25][26] Both of these scores contain only a single item on knee instability, and only the first of them has an item on patellofemoral instability. However, this latter item only presents low correlation with the NPI score.…”

Electromyographic Activity of Selected Muscles During Squat Exercise With and Without Upper Limb Assistance

“…Disposable Ag/AgCl adhesive electrodes were used. Before placement of the electrode, hair was shaved in the [11]. The electrodes were placed in the interface between the nerve center of the muscle and distal tendon.…”

“…Another possible cause of patellofemoral pain syndrome has been reported to be the lower activity ratio of the Vastus Medialis to the Vastus Lateralis (VM/VL) [11]. Moreover, the lower activity ratio of Hamstring to Quadriceps (H/Q) is associated with the anterior cruciate ligament injury [12][13][14].…”

I.S.Mu.L.T. first-time patellar dislocation guidelines

“…Therapeutic exercise seems to play a primary role in each stage of recovery. At present, there is no evidence about the choice of exercises [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] .…”