Fairouz Hatem Ameen, Mohamed M M Essa, Doaa Saeed, Mina Magdy Wahba, Abd El-Hamied Ibrahim El-Sayed Mohammad El-Sherbini, Bishoy S Lobbos, Shereen Mohamed Said
Both DN and MFR reduced pain effectively in females with chondromalacia patellae. However, MFR combined with exercise produced superior improvements in quadriceps muscle strength and H/Q muscle balance, suggesting greater enhancement of neuromuscular function during rehabilitation.
BACKGROUND: Chondromalacia patellae is a common cause of anterior knee pain in adult females and is associated with patellofemoral pain syndrome. Conservative management focuses on pain reduction and restoration of muscle function; however, limited evidence directly compares the effectiveness of myofascial release (MFR) and dry needling (DN).
HYPOTHESIS: Both MFR and DN would reduce pain and improve quadriceps function, with MFR producing greater improvements in neuromuscular performance.
STUDY DESIGN: Randomized controlled clinical trial.
LEVEL OF EVIDENCE: Level 2.
METHODS: Adult females (N = 45; age, 18-50 years) with magnetic resonance imaging-confirmed chondromalacia patellae were allocated randomly to 1 of 3 groups: DN plus exercise, MFR plus exercise, or exercise alone (control). Participants received 2 weekly treatment sessions for 3 weeks. Pain intensity was assessed using the visual analog scale, whereas the quadriceps peak torque and the hamstring-to-quadriceps (H/Q) peak torque ratio were measured using isokinetic dynamometry before and after treatment. Statistical analyses were performed using 1-way analysis of variance (P < 0.05).
RESULTS: Pain intensity decreased significantly in all 3 groups after treatment (all P < 0.001). Both intervention groups demonstrated greater pain reduction than the control group (P = 0.006 and P < 0.001, respectively), with no significant difference between the 2 intervention groups (P > 0.99). Quadriceps peak torque increased significantly in the MFR plus exercise (P < 0.001) and control (P < 0.001) groups but not in the DN plus exercise group (P = 0.95). The MFR plus exercise group demonstrated greater quadriceps peak torque than the DN group (P = 0.001). The H/Q peak torque ratio improved significantly in all groups, with the MFR plus exercise group demonstrating greater improvement than the control group (P = 0.04).
CONCLUSION: Both DN and MFR reduced pain effectively in females with chondromalacia patellae. However, MFR combined with exercise produced superior improvements in quadriceps muscle strength and H/Q muscle balance, suggesting greater enhancement of neuromuscular function during rehabilitation.
CLINICAL RELEVANCE: MFR combined with exercise may be considered a valuable conservative intervention when treatment goals extend beyond pain relief to improving muscle performance and dynamic knee stability.