Kinematic and Neuromuscular Deficiencies Phenotypes Associated with Patellofemoral Pain Syndrome

Not Applicable

Completed

• Conditions: Patellofemoral Pain Syndrome
• Interventions: Other: EOS Radiation; Behavioral: Semi-structured interview

• Registration Number: NCT05441332
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

The purpose of this study is to describe and compare the kinematic deficiencies specifically associated with each of the 3 main clinical phenotypes of patellofemoral pain syndrome. The prevalence of patellofemoral pain is high with a high rate of chronicity and recurrence and an overrepresentation of young, athletic and female populations. There are multiple classifications of patellofemoral pain syndrome. A pragmatic classification distinguishes 3 main clinical phenotypes of patellofemoral pain syndrome: with objectively displaceable patella, with extra-patellar alignment problems and without alignment problems.

The pathophysiology of patellofemoral pain syndrome is multifactorial involving static and dynamic dysfunctions of the hip, knee and foot, which remain incompletely elucidated to date. The links between the clinical and biomechanical aspects are still unclear and the kinematic and neuromuscular deficiencies associated with the 3 main clinical phenotypes are poorly understood. A validated non-invasive device allows the 3D evaluation of femorotibial rotations during walking.

Detailed Description

The diagnostic process is based on clinical examination. The evolution of measuring tools like radios, RMI and kinematics device allows a more precise diagnostic of patellofemoral Pain syndrome. We still don't know what kind of gait parameters could help to categorize the different phenotypes. With a better understanding of these phenotypes the investigators will be able to propose a better personalized rehabilitation.

Patellofemoral pain syndrome is defined as an anterior knee pain in front of and around the patella. The diagnosis of patellofemoral pain syndrome is based on clinical examination and standard imaging.

The pathophysiology of the patellofemoral pain syndrome is multifactorial involving static and dynamic dysfunctions of the hip, knee and foot, which remain incompletely elucidated to date. The prevalence of patellofemoral pain is high with a high rate of chronicity and recurrence and an overrepresentation of young, athletic and female populations. A pragmatic classification distinguishes 3 main clinical phenotypes of patellofemoral pain syndrome: with objectively displaceable patella, with extra-patellar alignment problems and without alignment problems.

The links between the clinic and biomechanics are still unclear and the kinematics and neuromuscular impairments associated with the 3 main clinical phenotypes are poorly understood.

The KneeKG is an optoelectronic kinematic assessment device using non-invasive sensors and dedicated to real-time measurement of 3D femoro-tibial position and rotations. The kinematic, neuro-muscular, postural and proprioceptive assessments will allow us to better understand the pathophysiology of the patellofemoral pain syndrome, to establish a more accurate diagnosis of the disease, and provide a better understanding of its causes.

Several studies have shown that better adherence to exercise is associated with greater benefit in terms of pain and function in chronic pathologies.

Semi-structured interviews will enable the investigators to assess the impact of information derived from kinematic examination of the knees on adherence to treatment.

Study Timeline

• Study First Submitted: 2022-06-14
• Study First Submitted QC: 2022-06-27
• Study First Posted: 2022-07-01
• Study Start: 2022-12-09
• Primary Completion: 2024-09-27
• Study Completion: 2025-02-27
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-24
• Last Update Posted: 2025-03-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 45

Inclusion Criteria

• Medical diagnosis of SDFP :
• Anterior pain of the knee, mechanical, in front of and around the patella noted at more than 3/10 on a simple numerical scale (ligament or meniscal damage, synovial plicae, tendinopathies, apophysitis, neuromas, and osteoarthritis FT are differential diagnoses),
• Pain during any of the following activities: Going up / down stairs, squats, jumps, jogging, sitting, crouching.
• Duration of knee anterior pain greater than 1 month
• Affiliation to a social insurance
• Signature of the consent to participate

Exclusion Criteria

• Neurological disorders affecting the lower extremities
• Radiographic FT osteoarthritis
• History of surgery or trauma to the lower limb less than 1 year old
• Intra-articular knee infiltration ≤ 2 months
• Cognitive or behavioral problems making it impossible to assess
• Participates in intervention research or is in the exclusion period following a previous research, if applicable
• Unable to speak, read and write French
• Patients under guardianship or curatorship,
• Patients receiving AME (French State Medical aid)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Patellofemoral pain syndrome	EOS Radiation	Kinematic and neuromuscular assessment
Patellofemoral pain syndrome	Semi-structured interview	Kinematic and neuromuscular assessment

Primary Outcome Measures

Name	Time	Method
Amplitude of rotation	Day of inclusion (up to 10 days)	Amplitude of rotation of the femur with respect to the tibia in the bearing phase in the 3 planes of space

Secondary Outcome Measures

Name	Time	Method
Total work (N.m)	Day of inclusion (up to 10 days)	Hamstrings isokinetic strenght
Average torque (N.m)	Day of inclusion (up to 10 days)	Hip abductors static strenght
Length measures	Day of inclusion (up to 10 days)	EOS femoro-tibial alignment
Varus valgus(in degree)	Day of inclusion (up to 10 days)	EOS femoro-tibial alignment
Time for reaching peak (s)	Day of inclusion (up to 10 days)	Hip abductors static strenght
Q angle (in degree)	Day of inclusion (up to 10 days)	EOS femoro-tibial alignment
Peak torque (N.m)	Day of inclusion (up to 10 days)	Hip abductors static strenght
Quadriceps/Hamstring ratio : 2 measure/leg	Day of inclusion (up to 10 days)
Eccentric step-down test	Day of inclusion (up to 10 days)	Static and dynamic unipodal balance
Lateral step down test	Day of inclusion (up to 10 days)	Static and dynamic unipodal balance
Navicular drop test	Day of inclusion (up to 10 days)	Foot static
Visual Analog Scale	Day of inclusion (up to 10 days)	Determine pain / No pain = 0, maximal pain =100
Anterior knee pain scale (AKPS)	Day of inclusion (up to 10 days)	Questionnaire to determine pain / 13 questions, minimum score = 0 point, maximum score = 100 points
Unipodal stabilometric evaluation	Day of inclusion (up to 10 days)	Static and dynamic unipodal balance
Foot posture index	Day of inclusion (up to 10 days)	Foot static
Semi-structured interview	From month 1 to month 3	Semi-structured interview for a sub-group of 15 patients identify factors influencing patient adherence behavior.
Time difference in the onset between the m.vastus lateralis and m.vastus medialis contraction in ms	Day of inclusion (up to 10 days)	Activity of the quadriceps measured. Electromyogram was used to quantify the electric potential of quadriceps and referred to as 'quadriceps muscle EMG activity' throughout
Y test	Day of inclusion (up to 10 days)	Static and dynamic unipodal balance
Ober's test	Day of inclusion (up to 10 days)	Muscle hypoextensibility. Quadriceps, harmstrings, calves,
12-Item Short Form Survey (SF-12)	Day of inclusion (up to 10 days)	Quality of life, to determine pain

Trial Locations

Locations (1)

Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis - Hôpital Cochin; 🇫🇷 Paris, Ile de France, France