The influence of asymmetric quadriceps loading on patellar tracking — An in vitro study

Lorenz, Andrea; Müller, Otto; Köhler, Philipp; Wünschel, Markus; Wülker, Nikolaus; Leichtle, Ulf

doi:10.1016/j.knee.2012.04.011

Cited by 30 publications

(40 citation statements)

References 20 publications

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“…Our study using a more detailed knee model also found a reduction in the medial patella force with VM strengthening, and also predicted a notable medial shift in the patella center of pressure. It is interesting to note that altered quadriceps load distributions induced relatively minor changes in lateral patella translation (<0.5 mm) and tilt (~2 deg), a result that has also been observed in vitro (Lorenz et al, 2012a). Thus, it would seem challenging to assess patella kinematics with sufficient resolution to infer underlying contact pressure patterns.…”

Section: Discussionsupporting

confidence: 54%

“…Indeed, vastus medialis weakness and atrophy (Botanlioglu et al, 2013; Pattyn et al, 2011) and patellar maltracking (Pal et al, 2013; Pal et al, 2011) have been observed in patients exhibiting patellofemoral pain. Additionally, in vitro studies suggest that VM weakness can laterally shift the patella (Lorenz et al, 2012b; Sakai et al, 2000). A prior biomechanical running simulation found that weakness or an onset delay in the VM could increase the medial force acting on the patella, though the effects were relatively modest (Neptune et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Other treatment strategies for PFP have focused more locally on facilitating balanced quadriceps loading (Choi et al, 2011; Clijsen et al, 2014; van der Heijden et al, 2015). The underlying idea is that weakness or diminished activity in the vastus medialis may result in the patella tracking and tilting laterally, inducing localized stress concentrations (Chester et al, 2008; Goh et al, 1995; Lorenz et al, 2012b). Diminished activation of the vastus medialis has been observed in patients exhibiting patellar maltracking (Lin et al, 2010; Owings and Grabiner, 2002; Pal et al, 2012), though others have questioned the influence of quadriceps load distributions on joint loading patterns and pain (Cavazzuti et al, 2010; MacIntyre and Robertson, 1992; Sawatsky et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Influence of step rate and quadriceps load distribution on patellofemoral cartilage contact pressures during running

Lenhart

Vignos

et al. 2015

Journal of Biomechanics

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Interventions used to treat patellofemoral pain in runners are often designed to alter patellofemoral mechanics. This study used a computational model to investigate the influence of two interventions, step rate manipulation and quadriceps strengthening, on patellofemoral contact pressures during running. Running mechanics were analyzed using a lower extremity musculoskeletal model that included a knee with six degree-of-freedom tibiofemoral and patellofemoral joints. An elastic foundation model was used to compute articular contact pressures. The lower extremity model was scaled to anthropometric dimensions of 22 healthy adults, who ran on an instrumented treadmill at 90%, 100% and 110% of their preferred step rate. Numerical optimization was then used to predict the muscle forces, secondary tibiofemoral kinematics and all patellofemoral kinematics that would generate the measured hip, knee and ankle joint accelerations. Mean and peak patella contact pressures reached 5.0 and 9.7 MPa during the midstance phase of running. Increasing step rate by 10% significantly reduced mean contact pressures by 10.4% and contact area by 7.4%, but had small effects on lateral patella translation and tilt. Enhancing vastus medialis strength did not substantially affect pressure magnitudes or lateral patella translation, but did shift contact pressure medially toward the patellar median ridge. Thus, the model suggests that step rate tends to primarily modulate the magnitude of contact pressure and contact area, while vastus medialis strengthening has the potential to alter mediolateral pressure locations. These results are relevant to consider in the design of interventions used to prevent or treat patellofemoral pain in runners.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of step rate and quadriceps load distribution on patellofemoral cartilage contact pressures during running

Lenhart

Vignos

et al. 2015

Journal of Biomechanics

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“…The VM is known to play an important role in biomechanical stabilization of the femoropatellar joint by pulling the patella medially, keeping contact pressure in the lateral patella facet within limits, and preventing the patella from lateral (sub)luxation relative to the trochlear groove (Elias et al, 2009). Yet, several studies reported that VM strength variation had only a limited effect on patello-femoral biomechanics (Lee et al, 2002; Lorenz et al, 2012). However, the VM and VL have also been proposed to have antagonistic functions with regard to rotating the femur relative to the tibia; and have been suggested to maintain rotational stability of the knee and to be important in prevention of knee injuries (Schmitt and Mittelmeier, 1978).…”

Section: Introductionmentioning

confidence: 99%

Relative distribution of quadriceps head anatomical cross-sectional areas and volumes—Sensitivity to pain and to training intervention

Sattler

Dannhauer

Ring-Dimitriou

et al. 2014

Annals of Anatomy - Anatomischer Anzeiger

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SUMMARY Introduction Quadriceps heads are important in biomechanical stabilization and in the pathogenesis osteoarthritis of the knee. This is the first study to explore the relative distribution of quadriceps head anatomical cross-sectional areas (ACSA) and volumes, and their response to pain and to training intervention. Methods The relative proportions of quadriceps heads were determined in 48 Osteoarthritis Initiative participants with unilateral pain (65% women; age 45–78y). Quadriceps head volumes were also measured in 35 untrained women (45–55y) before and after 12 week training intervention. Cross-sectional areas of the vastus medialis (VM), inter-medius (VIM), and lateralis (VL), and of the rectus femoris (RF) were determined from axial T1-weighted MR images. Results The proportion of the VM on the total quadriceps ACSA increased from proximal to distal. The difference in quadriceps ACSA of painful (vs. pain-free) limbs was −5.4% for the VM (p<0.001), −6.8% for the VL (p<0.01), −2.8% for the VIM (p=0.06), and +3.4% for the RF (p=0.67) but the VM/VL ratio was not significantly altered. The muscle volume increase during training intervention was +4.2% (p<0.05) for VM, +1.3% for VL, +2.0% for VIM (p<0.05) and +1.6% for RF. Conclusion The proportion of quadriceps head relative to total muscle ACSA and volume depends on the anatomical level studied. The results suggest that there may be a differential response of the quadriceps heads to pain-induced atrophy and to training-related hypertrophy. Studies in larger samples are needed to ascertain whether the observed differences in response to pain and training are statistically and clinically significant.

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“…Patella · Instability · Maltracking · Osteotomy · Knee teralisiert (Typ 3a; [11,16]). Der M. vastus medialis obliquus (VMO) hat in strecknaher Beugung bis zu 30 % Anteil an der Stabilisierung der Patella und kann damit auch bei defizitärer Funktion erheblich zur mediolateralen Destabilisierung beitragen [25].…”

Section: Introductionunclassified

Plastik des medialen patellofemoralen Ligaments

Frings

Akoto

Müller

et al. 2017

Trauma Berufskrankh

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The influence of asymmetric quadriceps loading on patellar tracking — An in vitro study

Cited by 30 publications

References 20 publications

Influence of step rate and quadriceps load distribution on patellofemoral cartilage contact pressures during running

Influence of step rate and quadriceps load distribution on patellofemoral cartilage contact pressures during running

Relative distribution of quadriceps head anatomical cross-sectional areas and volumes—Sensitivity to pain and to training intervention

Plastik des medialen patellofemoralen Ligaments

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