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#005- Articles on Patellofemoral Pain and Tibial Plateau Fracture

ByAl-Jallad

Covered Topics:

1. Effective Methods to Prevent Patellofemoral Pain (PFP).

2. Early ROM and Weight Bearing is Encouraged After Tibial Plateau Fracture.

Estimated reading time: 5 minutes, 27 seconds.

Articles

Effective Methods to Prevent Patellofemoral Pain (PFP)

This systematic review and meta analysis aimed to find which interventions reduce the incident of PFP.

13 RCT involving 8210 Participant

Interventions and Results:

  • Patellofemoral braces (2 Trials)
    • Genutrain silicon ring knee brace worn during physical activity or On-track (Donjoy Orthopaedics), dynamic patellofemoral braces (bilateral) (knee patches with Velcro and a neoprene sleeve).
    • Low certainty evidence suggests that Patellofemoral braces may reduce the risk of patellofemoral pain.
      • Due to cost, inconvenience, non-adherence and low certainty evidence, the authors do NOT recommend the use of braces outside of military and intensive training settings.
  • Running technique retraining (1 Trial)
    • Running retraining on a treadmill with visual biofeedback (instantaneous ground reaction force signal) aiming to reduce the vertical impact peak using the verbal cue “run softer”.
    • Low certainty evidence suggests that it may reduce the risk of patellofemoral pain.
    • A 2-week (eight session) running retraining program was successful in reducing patellofemoral pain risk by 79% over a 12-month observation period.
      • Note that the incidence of other overuse injuries increased with the new running technique such as Achilles tendinitis and shin splints indicating a potential risk of changing running technique too quickly.
  • Multicomponent exercise (4 Trials)
    • Warm-up to practice/games: running: active lower-limb stretches and strength, plyometrics, balance, agility (focus on quality of movement), Warm-up to training: close chain quadriceps and gluteal strengthening and warm-down stretching of quadriceps, ITB, hamstrings and calf, Warm-up to PE lessons: progressive neuromuscular training aerobic session (10min) and core/lower limb strength/balance training (5min) and Progressive strengthening: squats, lunges, hip abduction/external rotation, forefoot lift, coordination and quadriceps stretches.
    • Low to very low certainty evidence suggests that Multicomponent exercise may NOT significantly reduce the risk of patellofemoral pain.
  • Foot orthoses (4 Trials)
    • ‘Formthotics’ prefabricated foot orthoses, Customized orthoses, ‘Thermo+Camel’ orthotic insoles and Flat insoles.
    • Low to very low certainty evidence suggests that it may NOT significantly reduce the risk of patellofemoral pain.
  • Stretching (1 Trial)
    • Bilateral stretches before all physical training sessions (gastrocnemius, soleus, hamstring, quadriceps, hip adductor, hip flexor).
    • Low to very low certainty evidence suggests that it may NOT significantly reduce the risk of patellofemoral pain.
  • Running program that progressed intensity (1 Trial)
    • Running intensity schedule (increase time spent at ≥88% VO2 max after each 4-week block).
    • Low to very low certainty evidence suggests that it may NOT significantly reduce the risk of patellofemoral pain.

In conclusion, patellofemoral braces and running retraining (to run softer) might be used to effectively reduce the incident (60%–79%) of patellofemoral pain in active young adults.

Early ROM and Weight Bearing is Encouraged After Tibial Plateau Fracture

This systematic review aimed to investigate the effectiveness of range of motion exercises post-surgery, immobilization, weight-bearing status and the ongoing rehabilitation after tibial plateau fracture fixation.

Included 39 Articles (Did not report the design or quality of articles)

ROM Exercise:

  • ROM is important after surgery, ROM can be passive, active or active-assisted exercises
  • Depends on surgery technique:
    • If the knee joint is bridged with the frame, the start of the range of motion exercises of the knee is delayed until after the distal femoral ring is removed (usually 6–8 weeks after the application of the frame).
    • If the knee is not bridged with the circular frame, the range of motion exercises of the knee joint is encouraged as early as possible.
    • Continuous passive motion (CPM) effectiveness is unclear.

Immobilisation

The authors concluded that immobilization using brace does not provide any advantage, the authors came to this conclusion from 3 articles:

  1. A scope review, only a third of the studies included in the review recommended immobilization.
  2. Prospective, comparative, randomized trial: found no differences in clinical subjective reported and radiological outcomes between brace and no brace.
  3. Case series: found that the patients who were immobilized for more that 6 weeks post-operatively had poorer functional outcomes at their final follow-up, so they proposed not to immobilize the patients more than 2 weeks post-operatively.

Weight bearing

This is the most controversial topic, after reading that section of the article for a few times, the answer is, it depends on the surgeon, anyway here are some options

  • Immediate weight bearing as pain allows after internal fixation.
  • Non-weight bearing from 4 to 12 weeks. (Most preferred by surgeons)
  • Partial weight bearing for 6–12 weeks.

Ongoing Rehabilitation

  • There is lack of studies in the literature, studies indicated that gait impairments might last more than 3 years.
  • Recommends quadriceps strengthening and proprioception exercises.

Note:

Dealing with fractures specially fractures like tibial Plateau fractures is complicated, while working in a hospital that had many fracture patients, I found that my plan was dependent on a good communication with the surgeon, this was difficult at times when some surgeons were too busy or simply bad surgeons, that’s my reason for including this article, although I was hesitant to do so.

Final Note

  • Knee brace and running modification might prevent Patellofemoral Pain.
  • I’m glad that we are getting more research than ever investigating physiotherapy after fractures.

Trends

  • During 2020 patellofemoral pain syndrome was most searched by people in Canada, New Zealand, USA, Australia and Norway, those same people also searched for manga series. (could people with the same condition have the same taste in entertainment ??‍♀️)
  • Tibial Plateau fracture was most searched in Tanzania, Myanmar (Burma), Nepal, Tunisia and Malaysia, they also searched for abscess which makes sense, since abscess can be a secondary complication to surgical incisions.

References

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