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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.
CONCLUSIONS: 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.
BACKGROUND: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020212128.
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.
CONCLUSIONS: 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.
BACKGROUND: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020212128.
摘要：
目的：评估髌股疼痛（PFP）患者皮质和脊髓功能改变的证据。
方法：我们对数据库进行了全面搜索，以评估和分析2021年12月10日之前发表的研究，这些研究检查了使用霍夫曼反射（H反射）振幅测量的脊髓反射兴奋性。使用经颅磁刺激（TMS）引起的运动诱发电位（MEP）振幅测量的皮质脊髓兴奋性，电机阈值(MT)，或刺激-反应(SR)曲线，使用TMS皮质映射或结构磁共振成像（MRI）评估的皮质重组，或使用功能MRI（fMRI）评估PFP患者的大脑功能变化。
结果：有8项研究符合分析条件。虽然早期的研究表明疼痛对股四头肌的H反射幅度没有影响，最近的证据报道,PFP患者的股内侧肌(VM)H反射振幅降低.VMH反射幅度与疼痛相关，慢性，物理功能，PFP参与者的等距膝伸肌扭矩产生。据报道，PFP参与者的皮质脊髓兴奋性改变，观察到VM和股外侧肌（VL）肌肉的MT增加。此外,已经观察到皮质重组，皮质峰数量减少，移位和减少体积，以及VM的运动皮层表示的重叠增加，VL,据报道，PFP参与者的股直肌（RF）肌肉。
结论：有新的证据表明PFP患者的皮质和脊髓功能改变，然而,由于可用的文献有限，无法得出可靠的结论。需要进一步的研究来更好地了解该人群的大脑和脊髓的适应性。
背景：https://www.crd.约克。AC.英国/普华永道/，标识符：CRD42020212128。
方法：我们对数据库进行了全面搜索，以评估和分析2021年12月10日之前发表的研究，这些研究检查了使用霍夫曼反射（H反射）振幅测量的脊髓反射兴奋性。使用经颅磁刺激（TMS）引起的运动诱发电位（MEP）振幅测量的皮质脊髓兴奋性，电机阈值(MT)，或刺激-反应(SR)曲线，使用TMS皮质映射或结构磁共振成像（MRI）评估的皮质重组，或使用功能MRI（fMRI）评估PFP患者的大脑功能变化。
结果：有8项研究符合分析条件。虽然早期的研究表明疼痛对股四头肌的H反射幅度没有影响，最近的证据报道,PFP患者的股内侧肌(VM)H反射振幅降低.VMH反射幅度与疼痛相关，慢性，物理功能，PFP参与者的等距膝伸肌扭矩产生。据报道，PFP参与者的皮质脊髓兴奋性改变，观察到VM和股外侧肌（VL）肌肉的MT增加。此外,已经观察到皮质重组，皮质峰数量减少，移位和减少体积，以及VM的运动皮层表示的重叠增加，VL,据报道，PFP参与者的股直肌（RF）肌肉。
结论：有新的证据表明PFP患者的皮质和脊髓功能改变，然而,由于可用的文献有限，无法得出可靠的结论。需要进一步的研究来更好地了解该人群的大脑和脊髓的适应性。
背景：https://www.crd.约克。AC.英国/普华永道/，标识符：CRD42020212128。
