Abstract
Thirty patients with unilateral patello-femoral symptoms and a hypotrophic vastus medialis muscle were treated with transcutaneous electrical stimulation of the vastus medialis obliquus and stretching of the lateral thigh muscles twice daily for 10 weeks. Before and after treatment the position of the patella at fixed knee flexion angles and the area of the vastus medialis and vastus lateralis muscles were studied by computed tomography. Isokinetic quadriceps torque was registered with a Cybex II Dynamometer. An evaluation with a functional knee score was carried out. The healthy contralateral leg served as control in all the examinations. Clinically two-thirds of the patients had improved after 10 weeks of treatment and this improvement remained at follow-up 3.5 years later. The area of the vastus medialis and the quadriceps torque of the treated leg increased significantly, while the area of the vastus lateralis and the position of patella did not change. We conclude that transcutaneous electrical muscle stimulation of the vastus medialis and stretching of the lateral thigh muscles might be of benefit in patients with patello-femoral symptoms and a hypotrophic vastus medialis. An improvement after 10 weeks of treatment seems to predict a good long-term result.
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Aglietti P, Buzzi R, Pisaneschi A (1990) Patella pain. J Sports Traumatol Relat Res 12 (3): 131–150
Arvidsson I, Arvidsson H, Eriksson E, Jansson E (1986) Prevention of quadriceps wasting after immobilization — an evaluation of the effect of electrical stimulation. Orthopedics 9: 1519–1528
Arvidsson I, Eriksson E, Knutsson E, Arnér S (1986) Reduction of pain inhibition on voluntary muscle activation by epidural analgesia. Orthopedics 9: 1415–1419
Bentley G, Dowd G (1984) Current concepts of etiology and treatment of chondromalacia patellae. Clin Orthop Relat Res 189: 209–228
Brattström H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray anatomical investigation. Acta Orthop Scand [Suppl] 68: 53–78
Cabric M, Appell HJ (1987) Effect of electrical stimulation of high and low frequency on maximum isometric force and some morphological characteristics in men. Int J Sports Med 8: 256–260
DeHaven KE, Dolan WA, Mayer PJ (1979) Chondromalacia patellae in athletes. Am J Sports Med 7: 5–11
Devereaux MD, Lachmann SM (1984) Patello-femoral arthralgia in athletes attending a sports injury clinic. Br J Sports Med 18: 18–21
Devereaux MD, Parr GR, Lachmann SM, Page Thomas DP, Hazleman BL (1986) Thermographic diagnosis in athletes with patellofemoral arthralgia. J Bone Joint Surg [Br] 68: 42–44
Engebretsen L, Arendt E (1991) Patellofemorale smerter: diagnostikk og behandling (Patello-femoral pain: diagnosis and treatment). Tidsskr Nor Laegeforen 111: 1949–1952
Fairbank J, Pynsent P, Poortvliet J van, Phillips H (1984) Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg [Br] 66: 685–693
Fox TA (1975) Dysplasia of the quadriceps mechanism, hypoplasia of the vastus medialis as related to the hypermobile patella syndrome. Surg Clin North Am 55: 199–226
Fulkerson JP, Shea KP (1990) Current concepts review disorders of patellofemoral alignment. J Bone Joint Surg [Am] 72: 1424–1429
Garrick JG (1989) Anterior knee pain (chondromalacia patellae). Physician Sports Med 17: 75–84
Gobelet C, Perentes E, Deriaz JP, Leyvraz PJ, Volken H, Livio JJ (1989) Modification musculaire après entrainement électrique chez l'homme. Méd Sport 63: 310–312
Goldberg B (1991) Chronic anterior knee pain in the adolescent, Pediatr Ann 20: 186–193
Gransberg L, Knutsson E, Litton J-E (1980) A computer programed system for analysis of active and passive isokinetic movements. IEE Proceedings of 2nd Annual Conference of the Engineering in Medicine and Biology Society, 1980, Frontiers of Engineering Health Care, pp 192–195
Gruber MA (1979) The conservative treatment of chondromalacia patellae. Orthop Clin North Am 10: 105–115
Hughston JC (1968) Subluxation of the patella. J Bone Joint Surg [Am] 50: 1003–1026
Hunter-Griffin LY (1990) The patellofemoral stress syndrome. Physician Sports Med 3 (2): 9–14
Insall J (1982) Current concepts review: Patellar pain. J Bone Joint Surg [Am] 64: 147–152
Jacobson KE, Flandry FC (1989) Diagnosis of anterior knee pain. Clin Sports Med 8: 179–195
Jensen K-U, Strich W, Hille E (1989) Dynamische Veränderungen des Patellagleitweges unter isolierter M. vastus med. Stimulation. Arthroskopie 2: 8–15
Laurin CA, Dussault R, Levesque HP (1979) The tangential X-ray investigation of the patello-femoral joint: X-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res 144: 16–26
Laurin CA, Levesque HP, Dussault R, Labelle H, Peides JP (1978) The abnormal lateral patellofemoral angle. A diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg [Am] 60: 55–60
Lieb F, Perry J (1971) Quadriceps function. J Bone Joint Surg [Am] 53: 749–758
Macintyre JG, Taunton JE, Clement DB, Lloyd-Smith DR, McKenzie DC, Morrel RW (1991) Running injuries: a clinical study of 4,173 cases. Clin J Sport Med 1: 81–87
Mariani PP, Caruso I (1979) An electromyographic investigation of subluxation of the patella. J Bone Joint Surg [Br] 61: 169–171
Martinez S, Korobkin M, Fondren FB, Hedlung LW, Goldner JL (1983) Computed tomography of the normal patellofemoral joint. Invest Radiol 18: 249–253
Martinez S, Korobkin M, Fondren FB, Hedlund LW, Goldner JL (1983) Diagnosis of patellofemoral malalignment by computed tomography. J Comput Assist Tomogr 7: 1050–1053
McNeal DR, Baker LL, Hammer D, Martin C, Mori K (1986) Optimizing electrode placements and joint angle for ES programs at the knee. Phys Ther 66: 807
Merchant A, Mercer R, Jacobsen R, Cool C (1974) Roentgenographic analysis of patello-femoral congruence. J bone Joint Surg [Am] 56: 1391–1396
Möller BN, Krebs B (1986) Dynamic knee brace in the treatment of patello-femoral disorders. Arch Orthop Trauma Surg 104: 377–379
Möller BN, Krebs B, Tidemand-Dal C, Aaris K (1986) Isometric contractions in the patello-femoral pain syndrome. Arch Orthop Trauma Surg 105: 24–27
O'Neill DB, Micheli LJ, Warner JP (1992) Patellofemoral stress. A prospective analysis of exercise treatment in adolescents and adults. Am J Sports Med 20: 151–156
Percy EC, Strother RT (1985) Patellalgia. Physician Sports Med 13: 43–59
Portney LG, Sullivan PE, Daniell JL (1986) EMG activity of vastus medialis obliquus and vastus lateralis in normals and patients with patellofemoral arthralgia. Phys Ther 66: 808
Reynolds L, Levin TA, Medeiros JM, Adler NS, Hallum A (1983) EMG activity of the vastus medialis oblique and the vastus lateralis in their role in patellar alignment. Am J Phys Med 62: 61–70
Rota JJF de, Sanado L, Laidler L, Guerado E, de Llano AQ (1988) CT-scan in the diagnosis of patellar malalignment. Int Orthop 12: 223–227
Schutzer SF, Ramsby GR, Fulkerson JP (1986) The evaluation of patellofemoral pain using computerized tomography. A preliminary study. Clin Orthop Relat Res 204: 286–293
Steadman JR (1979) Nonoperative measures for patellofemoral problems. Am J Sports Med 7: 374–375
Veau BF le, Rogers C (1980) Selective training of the vastus medialis muscle using EMG biofeedback. A review article. Phys Ther 60: 1410–1415
Whitelaw GP, Rullo DJ, Markowitz HD, Marandola MS, DeWaele MJ (1989) A conservative approach to anterior knee pain. Clin Orthop Relat Res 246: 234–237
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Werner, S., Arvidsson, H., Arvidsson, I. et al. Electrical stimulation of vastus medialis and stretching of lateral thigh muscles in patients with patello-femoral symptoms. Knee Surg, Sports traumatol, Arthroscopy 1, 85–92 (1993). https://doi.org/10.1007/BF01565458
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DOI: https://doi.org/10.1007/BF01565458