Botox for Non-surgical Lateral Release in Patellofemoral Pain
| Status: | Terminated |
|---|---|
| Conditions: | Chronic Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - 40 |
| Updated: | 10/25/2017 |
| Start Date: | May 2005 |
| End Date: | June 2008 |
The purpose of this study is to determine whether the use of botulinum toxin A injected into
the lateral thigh muscle improves knee function and reduces knee pain secondary to
patellofemoral syndrome. The study hypothesis is that botulinum toxin + specific exercises
will be superior to specific exercises alone in improving knee function and reducing knee
pain in individuals with patellofemoral syndrome.
the lateral thigh muscle improves knee function and reduces knee pain secondary to
patellofemoral syndrome. The study hypothesis is that botulinum toxin + specific exercises
will be superior to specific exercises alone in improving knee function and reducing knee
pain in individuals with patellofemoral syndrome.
Patellofemoral pain syndrome is a leading cause of knee pain in persons under 45 and is
particularly common in women. The prevailing theory for the etiology of patellofemoral pain
is an imbalance in force or timing of the pull of the knee extensor muscles on the patella
resulting in improper tracking of the patella in the femoral grove. Specifically, the vastus
medialis is thought to be ineffective in overcoming the lateral pull of the vastus lateralis.
When exercises designed to focus on improving strength and timing of activation of the vastus
medialis fail, surgical release of part of the attachment of the vastus lateralis to the
patella is considered.
Botulinum toxin temporarily blocks acetylcholine release from motor neurons and is used
clinically to produce muscle relaxation.
Subjects with patellofemoral syndrome will be recruited into the study. Half of the subjects
will be given a placebo injection while the other half will be given an injection of Botox
(Botulinum Toxin A, Allergen) into the vastus lateralis muscle. Group assignment will be
randomized and a double blind protocol used. Prior to injection, the subject will record
their level of knee pain, fill out several knee function questionnaires, and have the
strength and endurance of their knee extensor muscles tested. All subjects will be given an
exercise program designed to target strengthening of the medial thigh muscles as well as
stretching of lateral structures.
At 4, 6 and 12 weeks knee pain and knee function will again be assessed.
particularly common in women. The prevailing theory for the etiology of patellofemoral pain
is an imbalance in force or timing of the pull of the knee extensor muscles on the patella
resulting in improper tracking of the patella in the femoral grove. Specifically, the vastus
medialis is thought to be ineffective in overcoming the lateral pull of the vastus lateralis.
When exercises designed to focus on improving strength and timing of activation of the vastus
medialis fail, surgical release of part of the attachment of the vastus lateralis to the
patella is considered.
Botulinum toxin temporarily blocks acetylcholine release from motor neurons and is used
clinically to produce muscle relaxation.
Subjects with patellofemoral syndrome will be recruited into the study. Half of the subjects
will be given a placebo injection while the other half will be given an injection of Botox
(Botulinum Toxin A, Allergen) into the vastus lateralis muscle. Group assignment will be
randomized and a double blind protocol used. Prior to injection, the subject will record
their level of knee pain, fill out several knee function questionnaires, and have the
strength and endurance of their knee extensor muscles tested. All subjects will be given an
exercise program designed to target strengthening of the medial thigh muscles as well as
stretching of lateral structures.
At 4, 6 and 12 weeks knee pain and knee function will again be assessed.
Inclusion Criteria:
- retropatellar knee pain
- pain with two of: prolonged sitting, climbing stairs, squatting, running, kneeling,
hopping, jumping
- pain with patellar palpation
- symptoms minimum 1 month
- Visual Analog Scale for pain (VAS) usual pain 4 of 10 on VAS [0-10 scale, anchors 0 =
no pain, 10 = worst pain imaginable]
Exclusion Criteria:
- history knee surgery
- history patellar dislocation
- clinical evidence of meniscal lesion, ligamentous instability, traction apophysitis
around the patellofemoral complex, patellar tendon pathology, chondral damage,
osteoarthrosis, spinal referred pain
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Virginia Commonwealth University Since our founding as a medical school in 1838, Virginia Commonwealth University...
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