Clinical Study On Treatment Of Patellofemoral Arthritis With Manipulation Of Tendon And Kneecap And Analysis Of Its Mechanism

The innovation of this study lies in the application of the holistic therapeutic concept of "laying equal stress on the muscles and bones,placing equal stress on the muscles and bones" through manipulation from the muscles and bones,and then from bones to tendons,it is the first time to analyze the mechanical mechanism of stress distribution in the patellofemoral joint caused by tendon-moving patellar manipulation by combining imaging and three-dimensional finite element technique.The manipulation of regulating tendon and moving kneecap plays an important role in the prevention and treatment of knee osteoarthritis,which embodies the academic thought of"treating pre-disease" in traditional Chinese medicine.In line with the current medical cost reduction,re-clinical,stress the effect of the trend,is conducive to the tendon movement of the promotion and application of Patella manipulation.Analyzing the mechanics mechanism by finite element analysis technique can enhance the persuasiveness of manipulation itself in clinical application.And can further improve and standardize the shortcomings of the technique,to further improve clinical efficacy.1 Imaging study on treatment of patellofemoral arthritis with manipulation of tendon and kneecap.1.1 ObjectiveIn order to evaluate the clinical effect of the manipulation of Tendon Movement on patellofemoral arthritis caused by abnormal patellar movement track,the imaging data of patellofemoral arthritis treated by Tendon Movement manipulation were observed,it also provides the data base for the further three-dimensional finite element analysis of the stress distribution on the articular surface of patellofemoral arthritis.1.2 Subject and method of study1.2.1 SubjectThis study was conducted in early stage patellofemoral arthritis patients,aged from 40 to 55 years,who were admitted to the bone injury center and Bone Injury Research Institute of Wangjing Hospital,Chinese Academy of Traditional Chinese medicine in December 2019,2020.1.2.2 MethodIn this study,30 patients with early patellofemoral arthritis were treated by the manipulation of tendon and kneecap,3-5 times a week,5 weeks as a course,and were followed up for 2 months.Before and after treatment,Patella Tilt Angle and Patella displacement were compared,and SPSS20 software was used to analyze and compare the data before and after treatment.1.3 ResultAfter clinical treatment and follow-up,the imaging data of the knee joint of the patients were changed accordingly,as follows:The angle of patellofemoral anastomosis before and after treatment was 16.43±1.36,the difference was statistically significant(15.14±1.34,p<0.05),and the difference was statistically significant(3.12±0.15,2.92±0.18,p<0.05)The treatment of patellofemoral arthritis in early stage by manipulation of tendon and kneecap can improve the movement track of patella to some extent.1.4 ConclusionBased on the theory of "laying equal stress on the muscles and bones,by the muscles and bones" in traditional Chinese medicine(TCM),using the manipulation of rearranging the muscles and moving the Patella to intervene the patellofemoral joint caused by the abnormal track of the patellofemoral joint in the early stage can obtain good patellofemoral joint alignment,and the corresponding changes in imaging data before and after treatment can be observed through imaging technology,it provides a good data base for further research on the mechanical mechanism of the stress distribution in the articular surface of patellofemoral arthritis caused by the tendon-tendon-moving Patella manipulation.2 Finite Element Analysis Of The Mechanical Mechanism Of Treating Patellofemoral Arthritis With Tendon-activating Patella2.1 ObjectiveThrough the three-dimensional finite element technique,the mechanism of the treatment of early patellofemoral arthritis with tendon-fi xing patellar manipulation is further explored from the mechanical point of view,which provides the mechanical basis and the persuasive force of research data for the clinical application and popularization of the manipulation,through further analysis,we can improve the effectiveness and standardize the clinical operation of the manipulation,which is beneficial to the unification and standardization of the manipulation.2.2 MethodThe right knee of a 44-year-old woman with patellofemoral arthritis(165 cm,55 kg)was selected as the initial data of the study,the finite element software processing system was used to process the CT data and extract the bone and ligament of knee joint and other related structures.Then the geometric figure of knee joint is established by inverse processing,and the related properties of unit,material and geometric shape are defined,the related functions and boundary conditions of unit are defined,and then the related loads are simulated,finish the construction of finite element model.The validity of the model was verified by consulting relevant literatures and the validity of the model intervention was demonstrated by means of manipulation imaging data.The average tensile force of quadriceps femoris tendon was 200N according to the related literature.At the knee flexion position of 90°,according to the image data of patellofemoral arthritis in the early stage treated by manipulation,the model value was intervened,then the tibiofibula was fixed,and the femur was gradually straightened along the longitudinal axis of the knee joint,the related data were collected at 60°and 30°respectively,and then the stress data of patellofemoral joint surface were compared at 90°,60°and 30°flexion.The biomechancal mechanism of the treatment of patellofemoral arthritis in the early stage with the manipulation of reflexology and kneecap is expounded through the changes of the results.2.3 ResultWhen the knee flexion was 90°,60°and 30°,the stress peak value of the articular surface of patellar cartilage in the intervention group decreased 0.47Mpa,0.99Mpa and 1.81 Mpa,respectively,compared with that in the non-intervention Group The stress peak value of articular surface of trochlear cartilage in intervention group decreased 0.72 Mpa,0.73 Mpa and 1.64Mpa,respectively,compared with that in non-intervention group.With the reduction of knee flexion angle,the stress of patellofemoral articular cartilage decreased more obviously.With the decrease of stress peak and the increase of stress contact area on the patellofemoral surface,the abnormal stress distribution and stress concentration on the patellofemoral surface improved obviously.The improvement of stress distribution and the decrease of peak stress concentration on the patellofemoral joint surface of these finite element models.it can be explained that by improving the movement track of the Patella,the manipulation of Tendon Movement can obviously relieve the symptoms of early patellofemoral arthritis and improve the stress state of abnormal patellofemoral joint surface.2.4 ConclusionThe manipulation of strengthening tendon and moving Patella can improve the stress distribution on the articular surface of patellofemoral arthritis in early stage,and can correct the movement track of patellofemoral abnormality to some extent.It can reduce the stress in the stress concentration area of the joint surface,reduce the damage of cartilage and promote the repair of cartilage,and increase the stress in the stress deficient area of the joint surface,so as to nourish the cartilage,to prevent the pathological process of degeneration and disintegration of chondrodystrophy.Thus is advantageous in the early patellofemoral arthritis prevention and treatment.