Patellofemoral pain is one of the most common musculoskeletal presenting conditions, particularly among young, athletic females and can be caused by maltracking of the patella in the trochlear groove during flexion and extension of the knee joint. Vastus lateralis (VL) and vastus medialis (VM), two muscles of the quadriceps femoris group, are key to maintaining normal patellar tracking during movement, and imbalance, either through hypertrophy of vastus lateralis or insufficiency of vastus medialis can cause lateralisation of the patella, and thus disrupt normal patellar tracking during movement of the knee, causing patellofemoral pain. In such cases, the first line treatment usually involves exercises targeting these two muscles, either to stretch the hypertrophied VL or to strengthen the VM. The aim of my thesis is to describe the use of ultrasound scanning to visualise the architecture (fibre angle and insertion sites) of these two muscles, and to recommend best practice in the subsequent physiotherapy programme to optimise patient outcome. My research has shown that suitable subjects for such intervention can be identified in clinic by an ultrasound scan, and equally, that progress, as measured by changes in muscle fibre angle, can be monitored by follow-up scans. Ultrasound is a safe, non-invasive, inexpensive imaging modality, and has the potential to provide a powerful tool in the clinic to measure initial VL and VM muscle fibre angle in PFP cases, identify suitable patients for this type of treatment, and monitor their progress.
I retired in March 2021 after teaching anatomy to students on a wide variety of healthcare programmes at St George's, University of London, for nearly twenty years. Before St George's, I taught at Queen Mary, University of London, and prior to that was a Production Manager for the Tissue Services arm of the National Blood Service, retrieving tissues including bone, skin, and tendons from donors post-mortem, for use as allografts in surgical procedures.
My two main areas of research are musculoskeletal anatomy, with a particular emphasis on the lower limb, and the surgical anatomy of the orbit, and I have published over 30 papers on these topics. Although now retired from full-time teaching, I keep busy with writing and editing: I am Editor-in-Chief of ‘The Journal of Plastination' and UK Editor of ‘Clinical Anatomy' and am in the process of publishing a clinical anatomy textbook, in collaboration with a team of St George's staff and past students.
A selection of recently published papers:
Iwanaga Joe, Singh V, Ohtsuka A, Hwang Y, Kim H-J, Mory? J, Adds PJ et al. 2020. Acknowledging the Use of Human Cadaveric Tissues in Research Papers: Recommendations from Anatomical Journal Editors. Clin Anat 10.1002/ca.23671
Bayley M, Cnudde P, Adds P J, Jones S A, Williams RL. 2020 does medial overhang of the greater trochanter influence femoral stem position during cemented hip arthroplasty? A retrospective radiological review. Cureus 12(10): e10968. doi:10.7759/cureus.10968
Adds PJ, Javed K. 2020 Anatomical association between articularis genus and vastus medialis oblique: a cadaveric investigation. Int J Cadaver Stud Ant Var 1(1) 20-26
Ward MH, Williams RL, Bekvalac J, Bajada S, Maheson M, Adds PJ. 2021 The innominate tubercle of the femur is a consistent surgical landmark and shows no variation between sex and side: an osteological study. Clin Anat 34(5):742-747 https://doi.org/10.1002/ca.23714
Van, Phung Thao Minh, Killingback, Alban, Hamilton, Duncan Lee and Adds, Philip J. (2022) Supraclavicular nerves : is there a "safe zone" for surgical fixation of the clavicle? A cadaveric study. International Journal of Cadaveric Studies and Anatomical Variations, 3(1), pp. 11-17. ISSN (online) 2563-7142
Torrente, Queenie Mae, Killingback, Alban, Robertson, Claire and Adds, Philip J (2022) The effect of self-myofascial release on the pennation angle of the vastus medialis oblique and the vastus lateralis in athletic male individuals : an ultrasound investigation. International Journal of Sports Physical Therapy, 17(4), pp. 636-642. ISSN (online) 2159-2896
Bethel, Jordan, Killingback, Alban, Robertson, Claire and Adds, Philip J (2022) The effect of stretching exercises on the fibre angle of the vastus lateralis and vastus medialis oblique : an ultrasound study. Journal of Physical Therapy Science, 34(2), pp. 161-166. ISSN (print) 0915-5287
Adds, Philip (2022) Investigations into the architecture of the gastrocnemius, vastus medialis, and vastus lateralis, and monitoring changes in response to physiotherapy. (PhD thesis), Kingston University, .
Van M, Hamilton D, Killingback A, Adds PJ. 2019. Can ultrasound be used to identify the supraclavicular nerves pre-operatively in open fixation of fractures of the clavicle? Clin Anat 33(2): E118.
Van M, Hamilton D, Adds PJ. 2019. Supraclavicular nerves: is there a "safe zone" for surgery following fracture of the clavicle? Clin Anat 33(2): E119
Kwan A, Adds PJ, et al. 2020. Hip Adduction and Patellar Tilt: an ultrasound investigation and cadaveric validation study. Clin Anat 33(2): E116
Cheung A, Adds PJ, et al. 2020. Three-dimensional reconstruction of the retrobulbar orbital fat septa: a comparative study. Clin Anat 33 (2): E5
Javed K, Adds PJ. 2021. Articularis genu: anatomy and function of an enigmatic muscle. Clin Anat 34: E100
Lamdin D, Adds P, et al. 2021. An osteological study investigating the correlation of the apex of the femoral bow and the length of the femur. Clin Anat 34: E101