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. 2022 Feb 7:16:791719.
doi: 10.3389/fnint.2022.791719. eCollection 2022.

Brain and Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review and Meta-Analysis

Kai-Yu Ho  1 , Jing Nong Liang  1 , Savanna Budge  1 , Austin Madriaga  1 , Kara Meske  1 , Derrick Nguyenton  1
Affiliations

Brain and Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review and Meta-Analysis

Kai-Yu Ho et al. Front Integr Neurosci. .

Abstract

Objective: To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP).

Methods: We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP.

Results: Eight studies were eligible for analyses. While an earlier study showed that pain had no effect on the H-reflex amplitude of the quadriceps muscle, more recent evidence reported a decrease in vastus medialis (VM) H-reflex amplitude in participants with PFP. VM H-reflex amplitude was correlated with pain, chronicity, physical function, and isometric knee extensor torque production in participants with PFP. Altered corticospinal excitability was reported in participants with PFP, observed as increased MT in the VM and vastus lateralis (VL) muscles. In addition, cortical reorganization has been observed, where decreased number of cortical peaks, shifts and reduced volumes, and increased overlap of motor cortex representations for the VM, VL, and rectus femoris (RF) muscles were reported in participants with PFP.

Conclusion: There is emerging evidence on altered cortical and spinal cord functions in individuals with PFP, however, solid conclusions cannot be drawn due to limited literature available. Further research is needed to better understand the adaptations of the brain and spinal cord in this population.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020212128.

Keywords: H-reflex; brain; cortical reorganization; corticospinal excitability; neurophysiological adaptation; patellofemoral pain; spinal cord.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of PRISMA depicting each step of study selection.
Figure 2
Figure 2
Risk-of-bias assessment for evaluating following items: (1) Random sequence generation (selection bias), (2) Allocation concealment (selection bias), (3) Blinding of participants and personnel (performance bias), (4) Blinding of outcome assessment (detection bias): self-reported outcomes, (5) Blinding of outcome assessment (detection bias): objective measures, (6) Incomplete outcome data (attrition bias), (7) Selective reporting (reporting bias), and (8) No asymptomatic control group (other bias).
Figure 3
Figure 3
Meta-analysis for VM H-reflex amplitude. *Heterogeneity: Tau2 = 0.00, Chi2 = 0.91, df = 1 (P = 0.34), I2 = 0%. Test for overall effect: Z = 4.87 (P < 0.00001). IV, inverse variance; SMD, standardized mean difference.
See this image and copyright information in PMC

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