Physiotherapy for Anterior Knee Pain -A Narrative Review

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...

British Journal of Medicine and Medical Research, 2017

Background: Patellofemoral pain syndrome (PFPS) refers to anterior or retropatellar pain in knees. It is amongst the widespread and commonly known knee disorders seen in orthopaedic clinics, especially in young adult. The majority of patients who have are initially treated non operatively and many non operative imitative are successful wherein physical exercise remains the basic approach to deal with the ailment. Amongst various physical therapies used; open kinetic chain exercises (OKCE) and closed kinetic chain exercises (CKCE) have gained prominence. Aim: The purpose of this study was to investigate the efficacy of closed versus open kinetic chain exercises in Saudi patients with PFPS, and to determine whether any of two programs offer any advantages over the other one.

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.

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.

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.

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.

2015

Patellofemoral pain syndrome (PFPS) is the most common type of knee pain. It is estimated that PFPS accounts for 25-30% of all knee pathologies. The condition can be very painful and the symptoms can take a long time to settle. There is general consensus that effective treatment strategies should be based on a thorough understanding of pathological changes of PFPS. This mini review briefly outlines biomechanical aspects of pathophysiology of the structures involved and describes current treatment strategies available in the literature, in particular it looks at muscle tightness and provides an insight into stretching techniques as an effective physiotherapy choice for the condition.

ASM Science Journal

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition, particularly among young adults. PFPS usually presents with anterior knee pain, weakness of gluteal muscles and impaired motor control during activities of daily living. A corrective exercise program (CEP) consisting of neuromuscular training and hip muscle strengthening in conjunction with Kinesio taping is an effective management strategy. Thirty patients with PFPS participated in this study design. Two groups were formed, one of which (n=15) received CEP and Kinesio Taping. The other group (n=15) received only Kinesio Taping. The outcome was measured using a Patient Specific Functional Scale and a Visual Analogue Scale. After a four-week program that included three sessions per week of CEP, it was observed that CEP combined with Kinesio Taping produced a more substantial and positive result than the other group. CEP in conjunction with Kinesio Taping was found to be an effective management strategy in PFPS...

BMC musculoskeletal disorders, 2015

Patellofemoral pain syndrome (PFPS), also known as Anterior Knee Pain, is a common cause of recurrent or chronic knee pain. The etiology is considered to be multifactorial but is not completely understood. At the current time the leading theory is that pathomechanics in the patellofemoral joint leads to PFPS. Traditionally, conservative treatment has focused on improving strength and timing in the quadriceps muscles. In recent years, evidence has been accumulating to support the importance of hip control and strengthening in PFPS. Two recent studies have shown promising results for hip strengthening as an isolated treatment for PFPS. The aim of this randomised controlled trial (RCT) is to compare isolated hip strengthening to traditional quadriceps-based training and a control group with free physical activity. An observer-blinded RCT will be performed. We intend to include 150 patients aged 16-40 years, referred from primary care practitioners to the department of Physical Medicine...

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...