Kinematic and Neuromuscular Deficiencies Phenotypes Associated With Patellofemoral Pain Syndrome

Study Overview
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Brief Summary
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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
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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.

Official Title
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Kinematic and Neuromuscular Deficiencies Phenotypes Associated With Patellofemoral Pain Syndrome : a Cross-sectional Interventional Study

Conditions
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Patellofemoral Pain Syndrome

Intervention / Treatment
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* Other: EOS Radiation
* Behavioral: Semi-structured interview


Participation Criteria
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Eligibility Criteria
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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)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patellofemoral pain syndrome<br>Kinematic and neuromuscular assessment | Other: EOS Radiation<br>* One EOS exam of lower extremities<br>* Other names: EOS X-ray exams;Behavioral: Semi-structured interview<br>* Semi-structured interview to identify factors influencing patient adherence behavior for a sub-group of 15 patients. By phone, between 1 to 3 months after inclusion.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Amplitude of rotation | Amplitude of rotation of the femur with respect to the tibia in the bearing phase in the 3 planes of space | Day of inclusion (up to 10 days) | 

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Patellofemoral pain syndrome, 3D Kinematics, assessment, clinical phenotypes, dynamic deficiencies