Scholarlink

Objective <p>To systematically evaluate the safety of generalized quadriceps training versus the efficacy of individualized, vastus medialis obliquus (VMO)-targeted rehabilitation in patients with radiologically confirmed patellofemoral dysplasia (PFD).</p> Design <p>Systematic review conducted in accordance with the PRISMA guidelines.</p> Data sources <p>PubMed, Cochrane Library, Embase, and Web of Science were searched from inception to December 2024.</p> Eligibility criteria <p>Randomized controlled trials (RCTs) and prospective cohort studies involving patients with radiologically confirmed PFD, comparing quadriceps training interventions, and reporting objective patellar stability outcomes.</p> Results <p>Twelve studies (7 RCTs, 5 prospective cohorts) involving 1,876 participants were included. Generalized quadriceps training significantly increased the risk of patellar instability by 2.1- to 4.5-fold compared to VMO-targeted rehabilitation combined with hip abductor strengthening. The highest risk (4.5-fold) was observed with deep flexion exercises (&gt; 60°) in patients with severe trochlear dysplasia (Dejour types C/D), consistent with biomechanical models of elevated joint contact pressures. In contrast, VMO-targeted training within a 0°–30° arc reduced patellar lateralization by a mean of 1.9&#xa0;mm. Combined VMO and hip abductor strengthening yielded superior outcomes, with a 2.1&#xa0;mm reduction in patellar lateralization and a 2.4° reduction in dynamic knee valgus. This efficacy is attributed to the VMO's synergy with medial stabilizers and the correction of proximal hip deficits. A risk-stratification framework was developed to guide intervention selection.</p> Conclusion <p>Moderate-certainty evidence suggests that generalized quadriceps training may increase patellar instability risk in patients with radiologically confirmed PFD, particularly in those with severe trochlear dysplasia. Precision rehabilitation targeting the VMO-hip synergy is preferred, as it demonstrates meaningful improvements in patellar stability. The proposed risk-stratification framework provides a practical tool for individualized care.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

From general to precision rehabilitation: a systematic review of VMO-Targeted versus general quadriceps strengthening in patellofemoral dysplasia

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月19日

查看全文
  • Ying Xiao,
  • Minzhi Yang,
  • Fangfang Li,
  • Wenting Zhao,
  • Xiaojun Fei,
  • Qin Liu,
  • Huan Du

摘要

Objective

To systematically evaluate the safety of generalized quadriceps training versus the efficacy of individualized, vastus medialis obliquus (VMO)-targeted rehabilitation in patients with radiologically confirmed patellofemoral dysplasia (PFD).

Design

Systematic review conducted in accordance with the PRISMA guidelines.

Data sources

PubMed, Cochrane Library, Embase, and Web of Science were searched from inception to December 2024.

Eligibility criteria

Randomized controlled trials (RCTs) and prospective cohort studies involving patients with radiologically confirmed PFD, comparing quadriceps training interventions, and reporting objective patellar stability outcomes.

Results

Twelve studies (7 RCTs, 5 prospective cohorts) involving 1,876 participants were included. Generalized quadriceps training significantly increased the risk of patellar instability by 2.1- to 4.5-fold compared to VMO-targeted rehabilitation combined with hip abductor strengthening. The highest risk (4.5-fold) was observed with deep flexion exercises (> 60°) in patients with severe trochlear dysplasia (Dejour types C/D), consistent with biomechanical models of elevated joint contact pressures. In contrast, VMO-targeted training within a 0°–30° arc reduced patellar lateralization by a mean of 1.9 mm. Combined VMO and hip abductor strengthening yielded superior outcomes, with a 2.1 mm reduction in patellar lateralization and a 2.4° reduction in dynamic knee valgus. This efficacy is attributed to the VMO's synergy with medial stabilizers and the correction of proximal hip deficits. A risk-stratification framework was developed to guide intervention selection.

Conclusion

Moderate-certainty evidence suggests that generalized quadriceps training may increase patellar instability risk in patients with radiologically confirmed PFD, particularly in those with severe trochlear dysplasia. Precision rehabilitation targeting the VMO-hip synergy is preferred, as it demonstrates meaningful improvements in patellar stability. The proposed risk-stratification framework provides a practical tool for individualized care.