Síndrome Femoropatelar
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1) O documento discute a síndrome da dor femoropatelar, uma lesão comum no joelho que causa dor anterior. 2) As possíveis causas incluem desequilíbrios biomecânicos, fraqueza muscular, pronação excessiva do pé e fatores intrínsecos como IMC e flexibilidade reduzida. 3) O tratamento envolve exercícios para fortalecimento muscular, alongamento e correção da biomecânica, além de outros métodos como taping no curto prazo. Cirurgia
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Síndrome Femoropatelar
- 1. Síndrome da Dor Femoropatelar no Esporte David Sadigursky M.D. MSc
- 2. LESÕES ESPORTIVAS Entesite patelar Sd Banda iliotibial Sd dor femoropatelar BIOMECÂNICA Sd Estresse Tibial David Sadigursky
- 3. LESÕES ESPORTIVAS Dor Anterior do Joelho Condromalácia da Patela Síndrome da Dor Femoropatelar Síndrome da Hiperpressão Patelar David Sadigursky
- 4. LESÕES ESPORTIVAS David Sadigursky Síndrome da Dor Femoropatelar "Black hole of Orthopedics”. Dye. Sports Med Arthro Review. 94
- 5. LESÕES ESPORTIVAS Matzkin et al. J Am Acad Orthop Surg. 2015 David Sadigursky
- 6. Dor Anterior do Joelho no Esporte Síndrome da dor femoropatelar "Joelho do Corredor" David Sadigursky
- 7. Dor Anterior do Joelho no Esporte Síndrome da dor femoropatelar Causa mais frequente de dor no joelho – 25% população Sexo feminino - 2x1 1 em 4 indivíduos Provoca o afastamento das atividades Lesão por hiperpressão Stefansyn et al. AJSM 2006 David Sadigursky
- 8. Dor Anterior do Joelho no Esporte Síndrome da dor femoropatelar Coppack at al, Am J Sports Med. 2011 David Sadigursky
- 9. Dor Anterior do Joelho no Esporte CAUSAS Desequilíbrio biomecânico Largura da pelve Joelho Valgo Frouxidão ligamentar Displasias David Sadigursky
- 10. Dor Anterior do Joelho no Esporte FATORES ASSOCIADOS David Sadigursky
- 11. Dor Anterior do Joelho no Esporte 2012 Fatores Predisponentes David Sadigursky Limitada flexibilidade do quadríceps e do gastrocnêmio Fraqueza dos extensores do joelho e abdutores do quadril Triagem de clínica da populações com alto risco - Avaliar a força, flexibilidade e Alinhamento dinâmico Variáveis antropométricas - Não prevê a SDFP
- 12. Dor Anterior do Joelho no Esporte Fatores Extrínsecos Frequência e intensidade Terreno Erros de treinamento Cohen et al. 2008 Fatores Intrínsecos Índice de massa corpórea Falta de flexibilidade do Quadríceps Atrofia muscular ETIOLOGIA David Sadigursky
- 14. Dor Anterior do Joelho no Esporte Características funcionais Dinâmicas Pronação excessiva do pé Fraqueza dos Músculos do quadril Excessiva rotação tibial interna Strauss et al. J Am Acad Orthop Surg. 2011 ETIOLOGIA David Sadigursky
- 15. Desalinhamento estático ou dinâmico? Ângulo Q – papel incerto Desalinhamento dinâmico – Funcional Mecanismo biomecânico e neuromuscular 2013 David Sadigursky
- 16. 2013 Instabilidade e fraqueza dos abdutores do quadril Rotação interna do fêmur – Deficiência: Rotadores externos e abdutores do quadril (Glúteo Médio e Mínimo) Valgismo na aterrissagem do salto (Glúteo Médio e Máximo) David Sadigursky
- 17. 2011 David Sadigursky A SDFP - Associado à redução da força do quadril - Especificamente nos abdutores e rotadores externos. - Quadriceps
- 18. 2013 Pronação excessiva do pé Aumento da abdução do antepé Aumento da eversão durante o choque do calcanhar Rotação interna da tíbia David Sadigursky
- 19. David Sadigursky 2013 Contratura do trato Iliotibial Influência no valgo dinâmico Debates em relação ao seu envolvimento na literatura Encurtamento
- 20. David Sadigursky 2013 Desequilíbrio e controle dos Isquiotibiais Contração arbitrária entre IQTS laterais e mediais Maior co-contração do Quadríceps e IQTS
- 21. Dor Anterior do Joelho no Esporte DIAGNÓSTICO Exame físico Ângulo Q Contraturas ou atrofias Manobra de OBER Manobra de Thomas Manobra de Ely David Sadigursky
- 22. Dor Anterior do Joelho no Esporte Exame físico Alinhamento dos MMII Valgo Rotação tibial externa Anteversão femoral Pronação do pé Mobilidade da patela Altura patelar DIAGNÓSTICO David Sadigursky
- 23. Dor Anterior do Joelho no Esporte IMAGEM RADIOGRAFIA Frente Perfil 20˚ – Altura da patela Displasia da tróclea Axial 45˚ - Âng. Sulco Inclinação Displasia DIAGNÓSTICO David Sadigursky
- 24. Dor Anterior do Joelho no Esporte IMAGEM RESSONÂNCIA MAGNÉTICA DIAGNÓSTICO David Sadigursky
- 25. Dor Anterior do Joelho no Esporte David Sadigursky Kevin E. Wilk. Patellofemoral Rehab: What Should be the Focus. Orthopedic Summit. 2015
- 26. Dor Anterior do Joelho no Esporte David Sadigursky Kevin E. Wilk. Patellofemoral Rehab: What Should be the Focus. Orthopedic Summit. 2015
- 27. Dor Anterior do Joelho no Esporte TRATAMENTO David Sadigursky
- 28. Dor Anterior do Joelho no Esporte TRATAMENTO David Sadigursky Resultado bem sucedido SATISFAÇÃO DO PACIENTE E PROFISSIONAIS
- 29. Dor Anterior do Joelho no Esporte Correção biomecância do MMII - Neuromuscular - Valgo/Varo dinâmico Fortalecimento Quadríceps CORE Abdutores Alongamento TRATAMENTO David Sadigursky
- 30. Dor Anterior do Joelho no Esporte TRATAMENTO David Sadigursky Erros de treinamento Aumento abrupto da distância na corrida Terrenos - Irregulares / escorregadios / inclinados Calçados inadequados? Strauss et al. J Am Acad Orthop Surg. 2011 - Mecanismo de proteção eficiente - Confortáveis X Minimalistas Fatores combinados
- 31. Dor Anterior do Joelho no Esporte Calçados Elevação do calcanhar - Diminuir o ângulo de flexão na corrida - Ataque do pé Palmilhas – Supinada ou Pronada Evidências ??? Sadigursky D. et al, 2016 TRATAMENTO David Sadigursky
- 32. 2011 Calçados específicos Divergências de resultados na literatura Pode reduzir a tensão na fáscial plantar Sem mudanças: Eversão do retropé Rotação interna da tíbia Ângulo do arco longitudinal medial Efeito sinérgico com fisioterapia
- 33. 2013 Taping David Sadigursky Eficaz para redução da dor Evidências atuais suportam o uso: - Tratamento temporário - Melhores resultados associados a programas de Exercícios Maioria dos estudos de curto prazo Sem comparação adequada com placebo – Efeito proprioceptivo e sensorial
- 34. 2017 David Sadigursky Efeito positivo na SDFP _ Quando associada ao tratamento fisioterápico com correção da biomecânica dos MMII Apenas Taping = Sem eficácia x
- 35. 2013Órteses Patelares Alívio temporário da dor e ativição do quadríceps Direcionamento medial da força sobre a patela David Sadigursky Evidências escassas
- 36. DAJ – Relação com disfunção muscular • Quadril • Tronco 2011 David Sadigursky MM. Abdutores do Quadril Agachamento unilateral Tratamento – Fortalecer
- 37. 2014 Agachamento Movimento primitivo e fundamental - Atividades habituais - Melhora da performance e melhora da qualidade física Ferramenta de avaliação e reabilitação - Controle Neuromuscular - Força, estabilidade e mobilidade David Sadigursky Treinamento progressivo
- 40. 2011 David Sadigursky Programa de reabilitação – corrigir desalinhamento mecânico *8 Semanas – 8 a 15 sessões / 30 a 60’ + Exercícios em domicílio 3x/sem Melhora da dor e capacidade funcional - CORE Lateral - Abdutores e rotadores externos do quadril - Diminuição momento abdutor do joelho
- 41. Dor Anterior do Joelho no Esporte TRATAMENTO David Sadigursky Treinamento contínuo
- 42. Atividades comuns – DAJ Programa de treinamento NM Melhora da dor e diminuição do afastamento das atividades 2011 David Sadigursky
- 43. Dor Anterior do Joelho no Esporte David Sadigursky Após esgotar todos os métodos de tratamento conservador atuais Avaliar causas associadas - Instabilidade Patelofemoral - Retração do retináculo lateral - Deformidade do eixo anatômico - Rotação tibial ou femoral - Displasia da Tróclea
- 44. Dor Anterior do Joelho no Esporte TRATAMENTO CIRÚRGICO LESÕES OSTEOCONDRAIS Cartilagem • Microfraturas • Transplante autólogo Osteocondral • Transplante de condrócitos • MACI – Tela de colágeno Alinhamento Osteotomia Varizante Valgo excessivo Instabilidade • Reconstrução do L. Patelofemoral Medial • Osteotomia de Medialização da TAT • TrocleoplastiaDavid Sadigursky
- 45. Dor Anterior do Joelho no Esporte TRATAMENTO CIRÚRGICO LESÕES OSTEOCONDRAIS Cartilagem • Microfraturas • Transplante autólogo Osteocondral • Transplante de condrócitos • MACI – Tela de colágeno David Sadigursky
- 46. Dor Anterior do Joelho no Esporte TRATAMENTO CIRÚRGICO LESÕES OSTEOCONDRAIS Alinhamento Osteotomia Varizante Valgo excessivo David Sadigursky
- 47. Dor Anterior do Joelho no Esporte TRATAMENTO CIRÚRGICO LESÕES OSTEOCONDRAIS Instabilidade • Reconstrução do Ligamento Patelofemoral Medial • Osteotomia de Medialização da TAT • Trocleoplastia David Sadigursky
- 48. Dor Anterior do Joelho no Esporte David Sadigursky Ivkovic et al. Sports Medicine Journal. 2017
- 49. Síndrome da Dor Femoropatelar no Esporte David Sadigursky M.D. MSc
Notas do Editor
- Context: Patellofemoral pain syndrome (PFPS) is one of the most common overuse injuries. Objective: To assess the collective evidence of predisposing factors to PFPS. Data Sources: MEDLINE (1960–June 2010), EMBASE (1980–June 2010), and CINAHL (1982–June 2010). Study Selection: Studies were included if patients were asymptomatic at baseline testing (free of PFPS) and were prospectively followed for the development of the disorder. Only studies that assessed at least 1 variable that can be measured at a typical clinic were included. After duplicates were removed, 973 studies were assessed from their titles or abstracts, 20 from the full text, and from these, 7 met the inclusion criteria. Data Extraction: Data were extracted for age, weight, height, sample size, patient type (military vs civilian), follow-up periods, diagnostic methods, and diagnostic criteria. Means and standard deviations were extracted for all outcome variables. Results: Meta-analyses were performed for height, weight, leanness, Q angle, number of sit-ups, knee extension strength, and peak knee valgus angle during landing. Lower knee extension strength was the only variable that was predictive of PFPS (P < 0.01). Other variables that were identified as predictive of PFPS by single studies were vertical jump, pushups, knee flexion and hip abduction strength, thumb-to-forearm flexibility, quadriceps and gastrocnemius flexibility, genu varum, navicular drop, knee valgus moment at initial contact during landing, social support, and palliative reaction. Conclusions: It appears that anthropometric variables are not associated with PFPS, while knee extension strength deficits appear to be predictors of PFPS. Keywords: anterior knee pain; etiology; clinical
- Ferretti et al15 have shown that there is a linear relationship between training volume and prevalence of jumper’s knee among volleyball players and that the harder the floor type they trained on, the higher the prevalence of jumper’s knee
- Abstract Context: Patellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS. Data Sources: MEDLINE (1950–September 2010), CINAHL (1982–September 2010), and SPORTDiscus (1830–September 2010) were searched to identify relevant research to this report. Study Selection: Studies were included assessing hip strength, lower extremity kinematics, or both in relation to PFPS were included. Data Extraction: Studies included randomized controlled trials, quasi-experimental designs, prospective epidemiology, case-control epidemiology, and cross-sectional descriptive epidemiology in a scientific peer-reviewed journal. Results: PFPS is associated with decreased hip strength, specifically at the abductors and external rotators. There is a correlation between PFPS and faulty hip mechanics (adduction and internal rotation). Conclusions: There is a link between the strength and position of the hip and PFPS. These patients have a common deficit once symptomatic. Hip strengthening and a coordination program may be useful in a conservative treatment plan for PFPS.
- Abstract Context: Patellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS. Data Sources: MEDLINE (1950–September 2010), CINAHL (1982–September 2010), and SPORTDiscus (1830–September 2010) were searched to identify relevant research to this report. Study Selection: Studies were included assessing hip strength, lower extremity kinematics, or both in relation to PFPS were included. Data Extraction: Studies included randomized controlled trials, quasi-experimental designs, prospective epidemiology, case-control epidemiology, and cross-sectional descriptive epidemiology in a scientific peer-reviewed journal. Results: PFPS is associated with decreased hip strength, specifically at the abductors and external rotators. There is a correlation between PFPS and faulty hip mechanics (adduction and internal rotation). Conclusions: There is a link between the strength and position of the hip and PFPS. These patients have a common deficit once symptomatic. Hip strengthening and a coordination program may be useful in a conservative treatment plan for PFPS.
- Abstract Context: Patellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS. Data Sources: MEDLINE (1950–September 2010), CINAHL (1982–September 2010), and SPORTDiscus (1830–September 2010) were searched to identify relevant research to this report. Study Selection: Studies were included assessing hip strength, lower extremity kinematics, or both in relation to PFPS were included. Data Extraction: Studies included randomized controlled trials, quasi-experimental designs, prospective epidemiology, case-control epidemiology, and cross-sectional descriptive epidemiology in a scientific peer-reviewed journal. Results: PFPS is associated with decreased hip strength, specifically at the abductors and external rotators. There is a correlation between PFPS and faulty hip mechanics (adduction and internal rotation). Conclusions: There is a link between the strength and position of the hip and PFPS. These patients have a common deficit once symptomatic. Hip strengthening and a coordination program may be useful in a conservative treatment plan for PFPS.
- Context: Patellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS. Data Sources: MEDLINE (1950–September 2010), CINAHL (1982–September 2010), and SPORTDiscus (1830–September 2010) were searched to identify relevant research to this report. Study Selection: Studies were included assessing hip strength, lower extremity kinematics, or both in relation to PFPS were included. Data Extraction: Studies included randomized controlled trials, quasi-experimental designs, prospective epidemiology, case-control epidemiology, and cross-sectional descriptive epidemiology in a scientific peer-reviewed journal. Results: PFPS is associated with decreased hip strength, specifically at the abductors and external rotators. There is a correlation between PFPS and faulty hip mechanics (adduction and internal rotation). Conclusions: There is a link between the strength and position of the hip and PFPS. These patients have a common deficit once symptomatic. Hip strengthening and a coordination program may be useful in a conservative treatment plan for PFPS.
- increased forefoot abduction and increased rear-foot eversion. / These disorders include delayed timing of peak rear-foot eversion, increased rear-foot eversion at heel strike and reduced rear-foot eversion range
- Dynamic valgus may also have influence on the length of the iliotibial tract. Other studies about the role of the iliotibial in PFPS patients are lacking.
- Dynamic valgus may also have influence on the length of the iliotibial tract. O have shown that patients with PFPS have greater co-contraction of the quadriceps and hamstrings compared to controls without symptoms of PFPSther studies about the role of the iliotibial in PFPS patients are lacking.
- músculos abdominais, da região lombar, pelve e quadril. - Bíceps femoral, transverso abdominal, multífidios, adutor, eretor da espinha, oblíquo interno e externo, íliopsoas, glúteo máximo e reto abdominal. Os músculos locais são aqueles responsáveis pela estabilização antes do movimento ser iniciado, estes músculos são recrutados milésimos de segundos antes dos demais músculos. Já os músculos globais são recrutados logo após a estabilização necessária das estruturas não contráteis. Esse equilíbrio entre os dois grupos do core permite um movimento eficiente e seguro.
- músculos abdominais, da região lombar, pelve e quadril. - Bíceps femoral, transverso abdominal, multífidios, adutor, eretor da espinha, oblíquo interno e externo, íliopsoas, glúteo máximo e reto abdominal. Os músculos locais são aqueles responsáveis pela estabilização antes do movimento ser iniciado, estes músculos são recrutados milésimos de segundos antes dos demais músculos. Já os músculos globais são recrutados logo após a estabilização necessária das estruturas não contráteis. Esse equilíbrio entre os dois grupos do core permite um movimento eficiente e seguro.
- músculos abdominais, da região lombar, pelve e quadril. - Bíceps femoral, transverso abdominal, multífidios, adutor, eretor da espinha, oblíquo interno e externo, íliopsoas, glúteo máximo e reto abdominal. Os músculos locais são aqueles responsáveis pela estabilização antes do movimento ser iniciado, estes músculos são recrutados milésimos de segundos antes dos demais músculos. Já os músculos globais são recrutados logo após a estabilização necessária das estruturas não contráteis. Esse equilíbrio entre os dois grupos do core permite um movimento eficiente e seguro.
- músculos abdominais, da região lombar, pelve e quadril. - Bíceps femoral, transverso abdominal, multífidios, adutor, eretor da espinha, oblíquo interno e externo, íliopsoas, glúteo máximo e reto abdominal. Os músculos locais são aqueles responsáveis pela estabilização antes do movimento ser iniciado, estes músculos são recrutados milésimos de segundos antes dos demais músculos. Já os músculos globais são recrutados logo após a estabilização necessária das estruturas não contráteis. Esse equilíbrio entre os dois grupos do core permite um movimento eficiente e seguro.
- músculos abdominais, da região lombar, pelve e quadril. - Bíceps femoral, transverso abdominal, multífidios, adutor, eretor da espinha, oblíquo interno e externo, íliopsoas, glúteo máximo e reto abdominal. Os músculos locais são aqueles responsáveis pela estabilização antes do movimento ser iniciado, estes músculos são recrutados milésimos de segundos antes dos demais músculos. Já os músculos globais são recrutados logo após a estabilização necessária das estruturas não contráteis. Esse equilíbrio entre os dois grupos do core permite um movimento eficiente e seguro.
- Therefore, foot orthosis might be a treatment option for patients with the combination of disorders of foot posture and PFPS. However, more well-designed studies are needed to examine the efficacy of foot orthoses and to identify subgroup patients which would benefit from the treatment with foot orthoses.
- Another meta-analysis was published by Warden et al. [70 ] in 2008. This study showed that medially directed tape produces a clinically meaningful reduction in knee pain in patients with PFPS. This study, however, has also shown that even sham tape application has a positive effect on pain reduction in PFPS patients. Therefore, placebo, proprioceptive or sensory skin effects may contribute to the beneficial tape effects. The data analysis, however, revealed that these effects only explain approximately half of the pain reduction associated with medially directed tape only [70 ]. However, it should be noted that the tape effect on pain reduction has only been investigated in short-termstudies (12- week follow-up). Long-term effects of tape on anterior knee pain have not been established. Therefore, the current evidence supports the use of tape as a temporary pain-relieving treatment of anterior knee pain in PFPS patients [70 ]. The positive influence of the tape on pain and function probably explains the synergistic effect of tape and physiotherapy. The simultaneous application of a restraining tape and a physiotherapy exercise programme achieved a better role as the sole tape system. tape effect on pain reduction has only been investigated in short-termstudies (12- week follow-up). Long-term effects of tape on anterior knee pain have not been established.
- Five RCTs with 235 total patients with multiple intervention arms were included. Taping strategies included McConnell and Kinesiotaping. Visual analog scale (VAS) scores indicated improvement in all 3 comparison groups (group 1: 91 patients, 39% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 66 [placebo taping + exercise]; group 2: 56 patients, 24% of total, mean VAS improvement 66 [placebo taping + exercise] vs 47.6 [exercise alone]; and group 3: 112 patients, 48% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 14.1 [taping alone]). Conclusion: This systematic review supports knee taping only as an adjunct to traditional exercise therapy for PFPS; however, it does not support taping in isolation. Finally, the current literature of RCTs with clinically pertinent outcomes is limited and inadequate to determine the effects of taping conclusively. The strength of this study would be bolstered if more consistent functional outcome measures had been available for analysis. given the ease of identifying the taping strategy by the treating therapist or patient, a common methodological problem among all articles was the lack of blinding of the treating therapist or patient. This could lead to heightened performance bias among patients or assessment bias if the treating therapist was also the assessor of outcome
- Therefore, we conclude that better designed studies should be performed to evaluate the effect of braces on pain and function in patients with PFPS. Due to the low quality of the studies, the authors concluded that this evidence should be regarded as limited. In this meta-analysis, only one of three studies found an effect of a medially directed patella brace, whereas in two studies, the effect was not significant. In these studies, no difference was found difference between orthoses which can apply a medially directed force on the patella and sham orthoses.
- Exercícios de fortalecimento – Quadríceps e CORE Alongamentos
- Exercícios de fortalecimento – Quadríceps e CORE Alongamentos
- Exercícios de fortalecimento – Quadríceps e CORE Alongamentos
- It is hypothesized that patients with patellofemoral pain syndrome (PFPS) have hip and core muscle weakness leading to dynamic malalignment of the lower extremity. Thus, hip strengthening is a common PFPS treatment approach. Purpose: To determine changes in hip strength, core endurance, lower extremity biomechanics, and patient outcomes after proximally focused rehabilitation for PFPS patients. Study Design: Case series; Level of evidence, 4. Methods: Nineteen women (age, 22.68 6 7.19 years; height, 1.64 6 0.07 m; mass, 60.2 6 7.35 kg) with PFPS participated in an 8-week program to strengthen the hip and core muscles and improve dynamic malalignment. Paired t tests were used to compare the dependent variables between prerehabilitation and postrehabilitation. The dependent variables were pain; functional ability; isometric hip abduction and external rotation strength; anterior, lateral, and posterior core endurance; joint range of motion (ROM; rearfoot eversion, knee abduction and internal rotation, and hip adduction and internal rotation); and peak internal joint moments (rearfoot inversion, knee abduction, and hip abduction and external rotation) during the stance phase of running. Results: Significant improvements in pain, functional ability, lateral core endurance, hip abduction, and hip external rotation strength were observed. There was also a significant reduction in the knee abduction moment during running, although there were no significant changes in joint ROM. Conclusion: An 8-week rehabilitation program focusing on strengthening and improving neuromuscular control of the hip and core musculature produces positive patient outcomes, improves hip and core muscle strength, and reduces the knee abduction moment, which is associated with developing PFPS.
- Exercícios de fortalecimento – Quadríceps e CORE Alongamentos