Anterior Knee Pain and Patellar Instability

2010

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The Knee, 2013

In this review the evidence for the management of patients with patellofemoral disorders is presented confined to anterior knee pain and patellar dislocation (excluding patellofemoral arthritis). Patients present along a spectrum of these two problems and are best managed with both problems considered. The key to managing these patients is by improving muscle function, the patient losing weight (if overweight), and judicious use of analgesics if pain is an important feature. Hypermobility syndrome should always be looked for since this is a prognostic indicator for a poor operative outcome. Operations should be reserved for those with correctable anatomical abnormalities that have failed conservative therapy. The current dominant operation is a medial patellofemoral ligament reconstruction.

The open orthopaedics journal, 2012

Anterior knee pain is a common presenting complaint, and in many cases no identifiable cause can be found. In these circumstances it is commonly known as anterior knee pain syndrome or patellofemoral pain syndrome. The management for this condition is most commonly non-operative. Treatment strategies include physiotherapy, pharmacotherapy, orthoses and combinations of the above. There are many described methods in the literature with a wide spectrum of outcomes, which in itself is testimony to the lack of any generally accepted gold standard of care for these patients. It is thus unclear to the health care professional treating these patients which is the best treatment to offer. In this review we aim to summarise historical and most up to date literature on the subject and in so doing allow the health care professional pick whichever treatment strategy they feel most beneficial and also provide a guide for appropriate patient education.

Journal of the American Academy of Orthopaedic Surgeons, 2005

Anterior knee pain is a frequent clinical problem. It provides a common challenge to diagnose and manage. Basic science studies have provided insight into the origin of anterior knee pain and refined understanding of the anatomy. Clinical evaluation has progressively focused on the contribution of the entire lower extremity to patellofemoral function. Nonsurgical management has been refined by the concept of the ″envelope of function″ and by increased understanding of the neuromuscular control of the knee. Indications for lateral release have been clarified and narrowed. Although anteromedial transfer of the tibial tuberosity is helpful in certain circumstances, reports of postoperative fracture have led to less aggressive rehabilitation protocols. Chondral resurfacing of the patellofemoral joint and patellofemoral arthroplasty are evolving. Emphasis should remain on nonsurgical management, which is sufficient in most patients.

Pharmaceuticals, 2021

Osteoarthritis is the most common musculoskeletal progressive disease, with the knee as the most commonly affected joint in the human body. While several new medications are still under research, many symptomatic therapy options, such as analgesics (opioid and non-opioid), nonsteroid anti-inflammatory drugs, symptomatic slow-acting drugs in osteoarthritis, and preparations for topical administration, are being used, with a diverse clinical response and inconsistent conclusions across various professional societies guidelines. The concept of pharmacogenomic-guided therapy, which lies on principles of the right medication for the right patient in the right dose at the right time, can significantly increase the patient’s response to symptom relief therapy in knee osteoarthritis. Corticosteroid intra-articular injections and hyaluronic acid injections provoke numerous discussions and disagreements among different guidelines, even though they are currently used in daily clinical practice...

Osteopathic Family Physician, 2017

The incidence of knee pain is increasing due to the rising prevalence of obesity, sedentary lifestyles, and aging baby boomer population in the United States. Both acute and chronic knee conditions can result in the increased utilization of pain medications and a decreased quality of life. A multimodal approach to knee pain management can thus greatly benefit the patient population and decrease the burden of knee conditions on the healthcare system. This article presents the epidemiology, clinically relevant anatomy, physiology and major risk factors associated with common knee pain conditions. An overview of etiologies is presented in terms of major clinical presentation, diagnostic testing, and treatments. Practical guidelines for an osteopathic approach to the examination and diagnosis of knee pain are then discussed, with a focus on the osteopathic structural exam and the use of special tests to discern and localize soft tissue injury. A novel diagnostic algorithm summarizing a ...

Primary Care: Clinics in Office Practice, 2004

Current Reviews in Musculoskeletal Medicine, 2019

Purpose of Review Patellofemoral pain is the most common cause of anterior knee pain. The purpose of this review is to examine the latest research on risk factors, physical examination, and treatment of patellofemoral pain to improve accuracy of diagnosis and increase use of efficacious treatment modalities. Recent Findings The latest research suggests patellofemoral pain pathophysiology is a combination of biomechanical, behavioral, and psychological factors. Research into targeted exercise therapy and other conservative therapy modalities have shown efficacy especially when used in combination. New techniques such as blood flow restriction therapy, gait retraining, and acupuncture show promise but require further well-designed studies. Summary Patellofemoral pain is most commonly attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training. Diagnosis can be made with a thorough assessment of clinical history and risk factors, and a comprehensive physical examination. The ideal treatment is a combination of conservative treatment modalities ideally individualized to the risk factors identified in each patient. Ongoing research should continue to identify biomechanical risk factors and new treatments as well as look for more efficient ways to identify patients who are amenable to treatments.

Revista Brasileira De Ortopedia, 2009

Clinical treatment for osteoarthritis (OA) is very important and is based on patient's self care and guided by the physician. Drug therapy is additional to losing weight, improving muscular strength, proprioception, flexibility and range of motion. Between the available drugs for osteoarthritis' treatment, some are basically analgesics and do not interfere on disease's progression; some are anti-inflammatory with good analgesic power but with side effects that compromise their prolonged usage; and the structure modifying drugs that slow down the progression of OA. The medications are presented in topic, We declare conflicts of interest with Aché, Genzyme, Merck Brazil, Solvay, TRB Pharma, Zambon, and Zodiac. In this article, we do not favor any commercial product. All information is based on the medical literature and there was no form of sponsorship for the completion of this article by the companies responsible for the medications cited.

International Journal of Health Sciences, 2014

Background: Osteoarthritis is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone. For the last ten years, majority of published review articles were not specific to osteoarthritis of the knee, and strength of evidence and clinical guidelines were not appropriately summarized.