BACKGROUND:Patellar pathologies are a common manifestation of musculoskeletal disorders. Digital health applications (DiGA), such as Mawendo, offer an alternative therapeutic approach to physiotherapy. AIM OF THE STUDY:This study aimed to evaluate the effectiveness of the DiGA-Mawendo compared to conventional physiotherapy in patients with patellofemoral pain, based on the KOOS subscales. METHODS:A total of 253 participants were randomly assigned to either a DiGA or physiotherapy group over a period of 12 weeks. The primary endpoints were the KOOS subscales, which were analyzed descriptively and using ANCOVA models. RESULTS:DiGA-Mawendo showed significantly better outcomes in all subscales, exceeding the minimum clinically important difference (MCID) in each case. DISCUSSION:DiGA demonstrated a clinically relevant, multidimensional therapeutic effect across all subscales. Its flexible use and high effectiveness support its complementary role in healthcare delivery.

Pathologien der Patella stellen ein häufiges Beschwerdebild im Bereich muskuloskelettaler Erkrankungen dar. Digitale Gesundheitsanwendungen (DiGA), wie Mawendo, bieten eine neue alternative Therapieform zur Physiotherapie. In dieser Arbeit wurde die Wirksamkeit der DiGA Mawendo im Vergleich zur klassischen Physiotherapie anhand der KOOS-Subskalen bei patellofemoralen Beschwerden untersucht. 253 Teilnehmende wurden randomisiert einer DiGA- oder Physiotherapiegruppe über 12 Wochen zugewiesen. Primäre Endpunkte waren die KOOS-Subskalen, analysiert wurden diese deskriptiv und mittels ANCOVA. Die DiGA Mawendo erzielte in allen Subskalen signifikant bessere Ergebnisse mit Überschreitung der minimalen klinisch relevanten Differenz (MCID) für jede Subskala. Die DiGA zeigte einen klinisch relevanten, multidimensionalen Therapieeffekt über alle Subskalen. Ihre flexible Anwendung und hohe Effektivität sprechen für den (ergänzenden) Einsatz in der Regelversorgung.

Zusammenfassung Der „AGA Therapiealgorithmus der Patellainstabilität“ (ATAPI) basiert auf der klinischen Untersuchung, der Bildgebung und dem daraus resultierenden Risikoprofil. Im ersten Schritt wird eine mögliche Flake-Fraktur mittels Bildgebung detektiert. Im zweiten Schritt wird das individuelle Risiko einer Reluxation in Abhängigkeit der vorliegenden anatomischen und epidemiologischen Parameter erfasst. Bei niedrigem Risikoprofil ohne Flake-Fraktur wird primär die konservative Therapie empfohlen. Bei vorhandener Flake-Fraktur wird eine Refixation des Fragments angestrebt. Eine zusätzliche Rekonstruktion des medialen patellofemoralen Ligaments (MPFL) senkt das Reluxationsrisiko deutlich und wird auch als Grundpfeiler der operativen Therapie gesehen. Je nach Risikoprofil werden weitere Zusatzeingriffe in Erwägung gezogen. Somit besteht auch bei Patellaluxation ohne Flake-Fraktur aber hohem Risikoprofil die Indikation zur Operation.

Patellofemorale Symptomatiken können meist schon durch eine detaillierte Anamnese von anderen Kniegelenksbeschwerden abgegrenzt werden. Schmerzen und Funktionsstörungen sind zentrale Symptome und sollten gezielt bezüglich Qualität, Lokalisation und Verlauf differenziert werden. Bei einer systematisch durchgeführten Anamnese können validierte Patientenfragebögen hilfreich sein, z. B. Kujala-Score, BPI 2.0, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) 2000, visuelle Analogskala (VAS) Schmerz. Von Bedeutung für die weitere Diagnostik und Therapie sind aber auch die medizinische Vorgeschichte, Lebensumstände, Belastungssituationen und Erwartungshaltung des Patienten. Eine weitere spezifische Anamnese kann hinweisend auf spezielle Krankheitsbilder sein. So wird eine patellofemorale Instabilität häufig als solche erkannt, wobei Differenzialdiagnosen (hypermobiler einklemmender Außenmeniskus – Ereignis in tiefer Beugung, chronische Instabilität des vorderen Kreuzbands – klinische Untersuchung) beachtet werden müssen. Sehr unterschiedlich kann dagegen die Anamnese bei patellofemoralen Knorpelschäden ausfallen. Zu finden sind hier starke Schmerzen bei mittelgradigem bis hin zur Schmerzfreiheit bei starkem Substanzverlust. Ansatztendinopathien treten häufig nach Stoßbelastungen auf, sollten erkannt und konsequent behandelt werden, um Chronifizierungen vorzubeugen. Unspezifische patellofemorale Schmerzen treten oft bilateral auf und lassen sich morphologisch bei blandem bildgebendem Befund nicht eindeutig zuordnen. Hier sind Verlegenheitsdiagnosen (z. B. Plica-Syndrom) zu vermeiden.

An acute patellofemoral dislocation is the most common acute knee injury in children. Recent studies suggest up to 40% of immature patients may develop recurrent instability. MPFL reconstruction has become a mainstay for the treatment of patellofemoral instability. Aim of the recent study is to show our experiences of MPFL reconstruction in patellar instability in immature patients using a gracilis autograft in respect to return to sport, growth plate disorders and short-term results. A total of 101 patients (50 females, 51 males) were included in this retrospective study. Mean age at time of operation was 14.8 ± 1.6 years. Primary outcome measures included patient satisfaction, Kujala score, recurrent instability, return to normal activity, return to sports, clinical leg axis and complications. Mann–Whitney U test was used for statistical analysis and alpha was set at p < 0.05 to declare significance. At a mean follow-up of 32.0 ± 12.1 months 90/101 patients could be followed-up. 84% of all patients were satisfied or very satisfied with the result at latest follow-up. 86.6% of all patients were able to return to sports, 2.3% had a relevant deviation of the clinical leg axis, but symmetrical. In sum complication rate was 2.9%. Redislocation rate was 0.9% (1/101). Kujala Score improved significantly from 47.1 preoperatively to 85.3 postoperatively (p < 0.01). Anatomic MPFL reconstruction using gracilis tendon allograft tissue is a safe procedure in children and adolescents with low risk of recurrent instability.

Background Patellar instability has a high incidence and occurs particularly in young and female patients. If the patella dislocates for the first time, treatment is usually conservative. However, this cautious approach carries the risk of recurrence and of secondary pathologies such as osteochondral fractures. Moreover, there is also risk of continuous symptoms apparent, as recurrent patella dislocation is related to patellofemoral osteoarthritis as well. An initial surgical treatment could possibly avoid these consequences of recurrent patella dislocation. Methods A prospective, randomized-controlled trial design is applied. Patients with unilateral first-time patella dislocation will be considered for participation. Study participants will be randomized to either conservative treatment or to a tailored patella stabilizing treatment. In the conservative group, patients will use a knee brace and will be prescribed outpatient physical therapy. The surgical treatment will be performed in a tailored manner, addressing the pathologic anatomy that predisposes to patella dislocation. The Banff Patellofemoral Instability-Instrument 2.0, recurrence rate, apprehension test, joint degeneration, and the Patella Instability Severity Score will serve as outcome parameters. The main analysis will focus on the difference in change of the scores between the two groups within a 2-year follow-up. Statistical analysis will use linear mixed models. Power analysis was done for the comparison of the two study arms at 2-year follow-up with regard to the BPII Score. A sample size of N = 64 per study arm (128 overall) provides 80% power (alpha = 0.05, two-tailed) to detect a difference of 0.5 standard deviations in a t-test for independent samples. Discussion Although several studies have already dealt with this issue, there is still no consensus on the ideal treatment concept for primary patellar dislocation. Moreover, most of these studies show a unified surgical group, which means that all patients were treated with the same surgical procedure. This is regarded as a major limitation as surgical treatment of patella dislocation should depend on the patient’s anatomic pathologies leading to patellar instability. To our knowledge, this is the first study investigating whether patients with primary patella dislocation are better treated conservatively or operatively with tailored surgery to stabilize the patella. Trial registration The study will be prospectively registered in the publicly accessible database www.ClinicalTrials.gov .

Background: The operative therapy of patellofemoral arthritis requires an individual approach depending on the underlying injury. However, the literature lacks recommendations for its course of action. Purpose: To generate an expert recommendation of therapy for different patellofemoral abnormalities in patients suffering from isolated patellofemoral arthritis. Study Design: Consensus statement. Methods: To generate recommendations, the AGA Patellofemoral Committee performed a consensus process using the Delphi method based on the available literature on isolated patellofemoral arthritis. Results: In most statements and recommendations, a high percentage of consensus could be found. However, also in the expert group of the AGA Patellofemoral Committee, some controversies on the treatment of patellofemoral arthritis exist. Conclusion: The operative therapy of isolated patellofemoral arthritis is a challenging topic that leads to controversial discussions, even in an expert group. With this consensus statement of the AGA Patellofemoral Committee, recommendations on different operative treatment options were able to be generated, which should be considered in clinical practice.

Patellofemoral instability (PFI) is one of the most common knee pathologies in children and adolescents. The high risk of re-dislocation necessitates a targeted risk analysis. A high-riding patella and a changed pulling direction of the extensor apparatus, which can be determined from the TTTG distance, are the main risk factors of PFI, also in a young population. The indication for surgical treatment, which is increasingly based on evidence, does not differ significantly from that of adults. However, due to the risk of disturbance of the growth plates, tibial tubercle osteotomy cannot be performed with open physis, which means that the surgical techniques must be adapted to the circumstances. A correction of a high-riding patella and an increased TTTG distance is possible with distal soft tissue procedures without impairing the growth plates, even in children and adolescents, and leads to better results compared with isolated MPFL reconstructions if the cut-off values of risk factors are exceeded and the indication is correct.

ZusammenfassungDie patellofemorale Instabilität (PFI) ist eine typische Erkrankung im Kindes- und Jugendalter. Aufgrund des hohen Reluxationsrisikos ist eine gezielte Risikoanalyse notwendig. Die Patella alta und eine veränderte Zugrichtung des Streckapparates, die über den TTTG-Abstand ermittelt werden kann, stellen auch im jungen Alter Hauptrisikofaktoren der PFI dar. Die zunehmend evidenzbasierte Indikationsstellung unterscheidet sich nicht wesentlich von der Erwachsener. Aufgrund der Gefahr einer gestörten Wachstumslenkung kann bei offenen Fugen ein Tuberositas-Transfer jedoch nicht erfolgen, sodass die operativen Techniken den Gegebenheiten angepasst werden müssen. Eine Korrektur der Patella alta und eines erhöhten TTTG-Abstands ist mit weichteiligen distalen Eingriffen ohne Beeinträchtigung der Wachstumsfugen auch im Kindes- und Jugendalter möglich und verbessert die Ergebnisse gegenüber isolierten MPFL-Rekonstruktionen bei Überschreiten von Grenzwerten der Risikofaktoren und korrekter Indikationsstellung.

Introduction The aim of this study is to evaluate the effects of a 12-week home exercise therapy program on pain, function and neuromuscular activity of the vastus medialis and vastus lateralis. Materials and methods Fifty patients with patellofemoral pain syndrome were treated with a 12-week online home exercise program. The primary outcomes of pain and function were assessed at the 12-week follow-up using the Visual Analog Scale and Kujala Score, respectively. Secondary outcomes were the muscle onset time and the ratio of vastus medialis and vastus lateralis during different daily activities. Results After 12 weeks, patients showed significant ( p < 0.05) improvements of 27 points on the Visual Analog Scale and 10 points on Kujala Score. Differences in pre-post comparison regarding both temporal and amplitude-related neurophysiological differences between the vastus medialis and lateralis were only found when the subjects were divided into groups of different electromyographic patterns. Then changes in the pre-post comparison were particularly evident in the patient group with a delayed vastus medialis onset and a lower activity of the vastus medialis compared to the VL. Conclusion Pain and function improved significantly after a home exercise therapy program in patients with patellofemoral pain syndrome. In addition, patients with a delayed onset or reduced activity of the vastus medialis compared to the vastus lateralis experienced a reduction in this imbalance.

INTRODUCTION:The aim of this randomized controlled trial was to investigate immediate effects of a patellar brace on pain, neuromuscular activity, and knee kinematics in subjects with patellofemoral pain syndrome. MATERIALS AND METHODS:Fifty subjects with a diagnosis of patellofemoral pain syndrome completed 6 activities each with and without a patellar brace in a randomized order. The subjects were asked to rate their perceived pain on a Visual Analog Scale after each activity. During the activities, neuromuscular activity of vastus medialis and vastus lateralis, as well as knee angles were measured. RESULTS:Subjects showed a statistically significant pain reduction of 33-56% on the Visual Analog Scale during all activities while wearing the brace. Two groups with different onset patterns for vastus medialis and vastus lateralis were identified: one group who activated vastus medialis prior to vastus lateralis, and one who activated vastus medialis after vastus lateralis. In the subgroup of subjects activating vastus lateralis prior to vastus medialis, bracing resulted in a significantly (p = 0.048) earlier onset of vastus medialis by 56 ms. In all but one activity, the vastus medialis/vastus lateralis ratio without the patellar brace was < 1.0 and inverted with the patellar brace > 1.0. Knee angles in the sagittal plane increased significantly with the patellar brace in two activities. CONCLUSION:Patellofemoral bracing results in an immediate decrease of pain, an earlier onset of vastus medialis and inverted vastus medialis/vastus lateralis ratio and altered knee kinematics.

The aim of this study was to adapt, translate, and validate the Banff Patella Instability Instrument (BPII) 2.0 into German, enabling its use by German-speaking professionals for the evaluation of patients who present with patellofemoral instability.

Die Beurteilung der Lebensqualität und der Ergebnisse operativer Verfahren mit Verwendung spezifischer Fragebögen ist in der orthopädischen Chirurgie von besonderer Wichtigkeit. Zur Lebensqualitätsbewertung für Patienten mit einer patellofemoralen Instabilität hat sich der Fragebogen Banff Patellofemorales Instabilitäts-Instrument (BPII) 2.0 als valides und reliables Instrument herausgestellt. Die Validierung der deutschsprachigen Version erfolgte in Deutschland, Österreich und der Schweiz an 64 Patienten mit einer nachgewiesenen patellofemoralen Instabilität. Hierbei zeigte sich eine ausgezeichnete Test-Retest-Reliabilität und interne Konsistenz (Cronbachs α). Es bestanden statistisch signifikante Korrelationen des Banff 2.0 mit dem Kujala-Score, NPI-Score, SF-36 und einer visuellen Analogskala (VAS) für Schmerzen und Funktionseinschränkungen. Die Anwendung der deutschsprachigen Version des Banff 2.0 ist somit zu empfehlen.

To prospectively evaluate the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures and to test for possible relationships between associated meniscal lesions and patient demographics or injury characteristics.

Medial transfer of the tibial tubercle has become a standard procedure in cases of patella instability caused by an increased tuberositas tibae-trochlear groove (TT-TG) distance. However, the TT-TG distance has always been assessed as an absolute value without taking individual joint size into consideration. It was assumed that the pathological influence of the TT-TG distance correlates with individual joint size. Aim of the current study therefore was to develop a method to express TT-TG distance in relation to these joint variables.

Patellofemoral instability is influenced by ligamentous, boney and neuromuscular factors. The most important variables are trochlea geometry, medial patellofemoral ligament (MPFL), patella height, tibial tuberosity–trochlea groove distance (TT–TG) and the extensor muscles. Treatment is complicated by these multifactorial conditions. This prospective study examined the influence of risk factors on clinical results and athletic activities where treatment was confined to ligamentous procedures only.

Zusammenfassung Die noch relativ junge Sportart Trampolinturnen wird im Einzelwettbewerb seit 2000 bei den Olympischen Spielen ausgeubt, die Disziplinen Synchron- und Doppel-Mini-Trampolin sind bei den World Games vertreten. Bei Sprunghohen von ca. 6 m treten Beschleunigungskrafte bis 8-12 G auf. Am haufigsten treten Verletzungen auf dem Sprungtuch selbst auf. Die Verletzungslokalisation wird durch die Korperposition zur Zeit des Impacts beeinflusst. Meist ist die obere Extremitat betroffen. Bandverletzungen und Verstauchungen sind die fuhrenden Verletzungsarten. Praventiv konnen neben Schutzvorrichtungen die Beaufsichtigung junger Sportler, ein gezieltes muskulares Training sowie weitere Verhaltensregeln wirksam werden.