The non-operative treatment of anterior knee pain

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.

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.

Primary Care: Clinics in Office Practice, 2004

MOJ sports medicine, 2023

Wallis 5 claims patellofemoral pain to be a common musculoskeletal condition with an estimated prevalence of between 23% and 29% in adult and adolescent populations. According to Ummels 6 one in four athletes, of which 70% are between the ages of 16 and 25, will have to deal with this PFPS or AKP. Women seem to have a higher risk of developing a PFPS than men. 55% of all women develop these complaints. If we look at the Dutch data, we see that of the general population about 22.7% have patellofemoral complaints. In adolescents this is 28.9% (69% female). 6 An analysis of the Pearl Diver record database (a large national database of orthopaedic conditions) 7,8 reported a prevalence of PFP diagnoses between 1.5% and 7.3% of all patients seeking medical care. Patellofemoral pain occurs across the life span, but the highest prevalence of PFP appears to be in those between 12 and 19 years of age. The Pearl Diver 8 data analysis however reported the highest percentage of PFP diagnosis in the 50-to-59-year age group. The discrepancy in prevalence related to age may be due to activity level, or treatment in a sports clinic versus in a general practice office. Aetiology The exact cause of PFPS, except due to a trauma, is not known, but the literature shows that it is believed to be an abnormal compression of the patellofemoral joint. Gulati 9 classified the cause into two categories: patellar mal-alignment and patellar mal-tracking. According to Collado 10 PFPS seems to be multi factorial, resulting from a complex interaction among intrinsic anatomic and external training factors. The pain symptoms can be originated on various patellofemoral structures: the subchondral bone, the infrapatellar adipose tissue, the retinaculum, and ligamentous structures. In his review Lankhorst 11 summarised factors associated with PFPS, comparing patients and controls, such as a larger Q-angle, sulcus angle and patellar tilt angle, less hip abduction strength, lower knee extension peak torque and less hip external rotation strength. Possible predictive risk factors for PFPS were identified by Neal et al., 12 He stated that Q-angle was not, but quadriceps weakness and increased hip abduction strength in adolescents were a risk factor for future PFPS.

https://ijshr.com/IJSHR_Vol.7_Issue.1_Jan2022/IJSHR-Abstract.038.html, 2022

Background: Anterior knee pain (AKP) is a common musculoskeletal complaint including pathologies like patellofemoral pain syndrome (PFPS), patellar or quadriceps tendinopathy and patellar instability. PFPS is the commonest of all, described as retro-patellar or anterior knee aching with diffuse pain most prominent when ascending or descending stairs, squatting, or sitting for prolonged periods with the knees flexed. It is a multifactorial condition with various treatment approaches being suggested. However, there is no clear physiotherapy protocol to be followed for the same. Objectives: This review aimed at finding recent advances in rehabilitation approaches (nonsurgical and non-pharmaceutical) for patients with PFPS in last 5 years. Methods: 35 published articles were found from Google scholar, PubMed (NLM) and PEDrO databases and 19 studies were included in this reviewed. Conclusion: Five treatment protocols emerged from the reviewed articles: hip and knee muscle strengthening, core muscle strengthening, patellar taping, stretching and spinal mobilization. The current review suggested that a multimodal conservative management is more beneficial in these kinds of patients.

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.

2011

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Knee Surgery, Sports Traumatology, Arthroscopy, 2005

Reviewing the literature, one regularly finds inconsistent results among different research studies on the effect of non-operative treatment of patients with patellofemoral pain syndrome (PFPS) . A possible reason for these conflicting results might be lack of a clear classification system of PFPS patients. In the past, several classification systems have been proposed in the literature 71]. In the present study, we have used and

Sports Medicine - Open

Anterior knee pain (AKP) is one of the most common conditions to bring active young patients to a sports injury clinic. It is a heterogeneous condition related to multiple causative factors. Compared to the general population, there appears to be a higher risk of development of patellofemoral osteoarthritis in patients with AKP. AKP can be detrimental to the patient’s quality of life and, in the larger context, significantly burdens the economy with high healthcare costs. This study aims to present a comprehensive evaluation of AKP to improve clinical daily practice. The causes of AKP can be traced not only to structures within and around the knee, but also to factors outside the knee, such as limb malalignment, weakness of specific hip muscle groups, and core and ligamentous laxity. Hence, AKP warrants a pointed evaluation of history and thorough clinical examination, complemented with relevant radiological investigations to identify its origin in the knee and its cause. Conservati...

Clinics in Sports Medicine, 2014