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Patellofemoral pain (PFP) is a chronic condition characterized by retro- or peri-patellar pain during everyday activities that load the patellofemoral joint, such as sitting, jumping, or walking. PFP is one of the most common knee conditions affecting the general population, affects approximately 1 out of 4 school aged youth and is more common in females. The pain associated with PFP adversely affects daily activities, reduces physical activity, and may contribute to patellofemoral osteoarthritis. Participants with PFP exhibit aberrant biomechanics during functional movement which may be, in part, due to altered brain activity in response to movement-associated pain. Participants with knee injuries do exhibit depressed sensorimotor brain activity in response to patella displacement relative to healthy controls, but these findings are limited as patella displacement is dissimilar to functional movement (e.g., flexing the knee and hip to get out of a chair). Our investigators have successfully developed paradigms to assess knee motor control during functional movement (see methods below) using functional magnetic resonance imaging (fMRI) in healthy participants with no knee pain. The investigators aim to replicate these paradigms in those with PFP to assess this populations' neurophysiologic response to knee movement. Results from this investigation will assist in refining subsequent training and prevention programs to promote more adaptive neuroplasticity.
All MRI scanning will be performed on 3 Tesla Philips MRI scanners (3T Achieva in S-Building and 3T Ingenia in T-Building) located in Imaging Research Center (IRC) in the Cincinnati Children's Hospital Research Foundation (CCHRF). Sedation will not be used for any of the test visits. The entire MRI protocol will include high resolution T1-weighted 3D images, a 61 direction diffusion tensor imaging sequence, resting state fMRI, and task-based fMRI. The fMRI tasks will be focused on motor function, participants will be asked to lower extremity movements such as hip and knee flexion and extension. Also, for 15 minutes, the researcher will place one hand above the participants' knee and apply intermittent pressure to their quadriceps and medial aspect of the patella. VAS scales will be administered after every fMRI task to assess subjective perceptions of pain. The MR scan will be completed in 75 minutes or less. Peripheral pulse oximetry and respiration waveforms will be collected for data analysis in order to minimize the potential confounding effect from the physiological changes. A practice session of the fMRI paradigms will be completed just prior to scanning to allow the participant to ask any questions and be familiar with the protocol.
The hardware and software are not FDA cleared, but also not FDA regulated as they are not medical devices. According to the FDA, a medical device is intended to diagnosis and or treat diseases while affecting the structure or function of any part of the body (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/ClassifyYourDevice/u cm051512.htm). This is not the case for our study as participants will already be diagnosed with PFP by a medical professional and the protocol will not alter any function or structure of the human body. the leg press task is simply used to facilitate naturally occurring movement of the leg and hip and not intended to treat patellofemoral pain. This method is simply to further understanding of the neural mechanisms underlying natural movement in this population.
Patellofemoral Pain Syndrome
Cincinanti Childrens Hospital Medical Center
Children's Hospital Medical Center, Cincinnati
Published on BioPortfolio: 2019-09-26T05:42:34-0400
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A syndrome characterized by retropatellar or peripatellar PAIN resulting from physical and biochemical changes in the patellofemoral joint. The pain is most prominent when ascending or descending stairs, squatting, or sitting with flexed knees. There is a lack of consensus on the etiology and treatment. The syndrome is often confused with (or accompanied by) CHONDROMALACIA PATELLAE, the latter describing a pathological condition of the CARTILAGE and not a syndrome.
A degeneration of the ARTICULAR CARTILAGE of the PATELLA, caused by a decrease in sulfated MUCOPOLYSACCHARIDES in the ground substance. When accompanied by pain, it is sometimes considered part of or confused with PATELLOFEMORAL PAIN SYNDROME.
Muscular pain in numerous body regions that can be reproduced by pressure on trigger points, localized hardenings in skeletal muscle tissue. Pain is referred to a location distant from the trigger points. A prime example is the TEMPOROMANDIBULAR JOINT DYSFUNCTION SYNDROME.
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