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Muscle Functional MRI to Evaluate Quadriceps Dysfunction in Patellofemoral Pain


Medicine & Science in Sports & Exercise: June 2013 - Volume 45 - Issue 6 - p 1023–1029
doi: 10.1249/MSS.0b013e318282672c
Clinical Sciences

Purpose: A dysfunction of the quadriceps muscle group has often been suggested to play an important role in the pathophysiology of patellofemoral pain (PFP). However, consensus is lacking regarding the quadriceps recruitment pattern of patients with PFP. The aim of this study was to examine by muscle functional magnetic resonance imaging if patients with PFP actually exhibit an altered activation of the muscles that play a significant role in the dynamic balance of the patella.

Methods: Forty-six patients with PFP (25 female and 21 male, mean ± SD age = 25.0 ± 7.4 yr) and 30 healthy control subjects (17 female and 13 male, mean ± SD age = 21.6 ± 4.5 yr) underwent MRI of the quadriceps before and immediately after a squat exercise. The transverse relaxation time (T2) and the T2 shift were calculated for the vasti muscles.

Results: There were no significant differences in the T2 values at rest and the T2 shift values between the patient and the control groups, except for the T2 rest value of the VMVI of females (P = 0.007). The T2 shift of the VL was significantly smaller than the T2 shift of the VMVI in both study groups (male P < 0.001 and female P = 0.044), while in females, the T2 shift of the VMO was also significantly smaller than the T2 shift of the VMVI (P = 0.027).

Conclusions: The activation pattern of the quadriceps is not altered in patients with PFP for both males and females. Because the relative contribution of the quadriceps muscles to a functional activity has not been modified, there is no evidence for quadriceps dysfunction.

1Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, BELGIUM; 2Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, BELGIUM; 3Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, BELGIUM; and 4Department of Rehabilitation, Aspetar, Doha, QATAR

Address for correspondence: Els Pattyn, PT, PhD, Department of Rehabilitation Sciencesand Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3B3, B9000 Ghent, Belgium; E-mail:

Submitted for publication July 2012.

Accepted for publication December 2012.

©2013The American College of Sports Medicine