Patellofemoral pain: is it time for a rethink?

British Journal of Sports Medicine, 2014

Journal of Orthopaedic & Sports Physical Therapy, 2012

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Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi

The Open Sports Medicine Journal, 2015

Background: Literature has shown a growing number of published studies on Patellofemoral Pain Syndrome every year. The increasing evidence base has revealed a significant number of reviews which makes it confusing for clinicians and researchers to choose from the best evidence. This study aimed to gather the reviews on Patellofemoral Pain Syndrome and provide information about the most common clinical tests, risk factors, exercise treatment and outcome measures. In addition, secondary questions aimed to report the study settings and patient characteristics of the primary included studies.

2015

Merchants classification (1988), is the clinical entity of pain on- activity, on patellofemoral joint examination and on stair climbing, squatting, pseudo locking, prolonged sitting etc [1]. Varieties of conservative treatments are suggested, including quadriceps strengthening, patellar taping, stretching, electrotherapy and biofeedback with no single intervention being most effective. Hence, comparison between the two techniques patellar taping and the conventional method was undertaken to determine their effectiveness with respect to pain and function. Methods: 20 subjects diagnosed with unilateral PFPS knee were randomly selected and allocated into two group- Group A (Mc Connell taping and vastus medialis obliques (VMO exercises) and Group B (Short Wave Diathermy and VMO exercises). Treatment was continued for two weeks with pre and post Pain and Function recorded. Students t test was used for statistical analy-sis. Results: Both groups showed statistically significant pain relie...

PLOS ONE, 2020

Patellofemoral pain (PFP) is commonly caused by abnormal pressure on the knee due to excessive load while standing, squatting, or going up or down stairs. To better understand the pathophysiology of PFP, we conducted a noninvasive patellar tracking study using a Carm computed tomography (CT) scanner to assess the non-weight-bearing condition at 0k nee flexion (NWB0˚) in supine, weight-bearing at 0˚(WB0˚) when upright, and at 30(WB30˚) in a squat. Three-dimensional (3D) CT images were obtained from patients with PFP (12 women, 6 men; mean age, 31 ± 9 years; mean weight, 68 ± 9 kg) and control subjects (8 women, 10 men; mean age, 39 ± 15 years; mean weight, 71 ± 13 kg). Six 3D-landmarks on the patella and femur were used to establish a joint coordinate system (JCS) and kinematic degrees of freedom (DoF) values on the JCS were obtained: patellar tilt (PT,˚), patellar flexion (PF,˚), patellar rotation (PR,˚), patellar lateral-medial shift (PT x , mm), patellar proximal-distal shift (PT y , mm), and patellar anterior-posterior shift (PT z , mm). Tests for statistical significance (p < 0.05) showed that the PF during WB30˚, the PT y during NWB0˚, and the PT z during NWB0˚, WB0˚, and WB30˚showed clear differences between the patients with PFP and healthy controls. In particular, the PF during WB30˚(17.62˚, extension) and the PT z during WB0˚(72.50 mm, posterior) had the largest rotational and translational differences (JCS Δ = patients with PFP-controls), respectively. The JCS coordinates with statistically significant difference can serve as key biomarkers of patellar motion when evaluating a patient suspected of having PFP. The proposed method could reveal diagnostic biomarkers for accurately identifying PFP patients and be an effective addition to clinical diagnosis before surgery and to help plan rehabilitation strategies.

Sports Medicine, 1999

Gait & Posture, 2011

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.