PainSci summary of Pattyn 2011?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
It is an article of faith for many professionals that the inner portion of the quadriceps muscle group (VMO) is weak and atrophied in patients with patellofemoral pain, “despite very little objective evidence” according to this paper. For the first time, researchers used MRI to measure the size of the vastus medialis obliquus muscle in patients with and without patellofemoral pain syndrome, and found that it was 9% smaller in PFPS patients. There was a 4% chance that the results are coincidental — a statistically significant result, but only just — and of course it is “not clear whether this atrophy is a result or a cause of PFPS.” However, that wise disclaimer is contradicted by the following statement that VMO is a “contributing factor in PFPS” — a troubling inconsistency in the paper’s abstract.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Quadriceps atrophy and in particular atrophy of the vastus medialis obliquus (VMO) muscle have been frequently related with patellofemoral pain syndrome (PFPS), despite very little objective evidence.
HYPOTHESIS: Patients with PFPS exhibit atrophy of the VMO in comparison with healthy controls.
STUDY DESIGN: Case-control study; Level of evidence, 3.
METHODS: Forty-six patients with PFPS and 30 healthy control persons with similar age, gender, body mass index, and activity index distributions underwent magnetic resonance imaging (MRI) of the quadriceps. The muscle size was determined by calculating the cross-sectional area of the total quadriceps and its components.
RESULTS: The cross-sectional area (CSA) of the VMO was significantly smaller in the PFPS group than in the control group (16.67 ± 4.97 cm(2) vs 18.36 ± 5.25 cm(2)) (P = .040). A tendency was noted for a smaller total quadriceps CSA for the PFPS patients at midthigh level (66.99 ± 15.06 cm(2) vs 70.83 ± 15.30 cm(2)) (P = .074).
CONCLUSION: This is the first study to examine VMO size in PFPS patients by MRI. Patients with patellofemoral problems exhibited atrophy of the VMO. Although it is not clear whether this atrophy is a result or a cause of PFPS, the results of this study do show that atrophy of the VMO is a contributing factor in PFPS. Longitudinal, prospective studies are needed to establish the cause-effect relation of VMO atrophy and PFPS.
- “Structural parameters of the vastus medialis muscle and its relationship to patellofemoral joint deterioration,” J Peeler and J E Anderson, Clinical Anatomy, 2007.
- “Vastus medialis obliquus muscle morphology in primary and recurrent lateral patellar instability,” Peter Balcarek, Swantje Oberthür, Stephan Frosch, Jan Philipp Schüttrumpf, and Klaus Michael Stürmer, Biomed Res Int, 2014.
One article on PainScience.com cites Pattyn 2011 as a source:
- PS Save Yourself from Patellofemoral Pain Syndrome! — Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.