Objective To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome.Design Open label randomised controlled trial.Setting General practice and sport physician practice.Participants Patients with a new episode of patellofemoral pain syndrome recruited by their general practitioner or sport physician.Interventions The intervention group received a standardised exercise programme for 6 weeks tailored to individual performance and supervised by a physical therapist, and were instructed to practise the tailored exercises at home for 3 months. The control group were assigned usual care, which comprised a “wait and see” approach of rest during periods of pain and refraining from pain provoking activities. Both the intervention group and the control group received written information about patellofemoral pain syndrome and general instructions for home exercises.Main outcome measures The primary outcomes were self reported recovery (7 point Likert scale), pain at rest and pain on activity (0-10 point numerical rating scale), and function (0-100 point Kujala patellofemoral score) at 3 months and 12 months follow-up.Results A total of 131 participants were included in the study: 65 in the intervention group and 66 in the control group. After 3 months, the intervention group showed better outcomes than the control group with regard to pain at rest (adjusted difference −1.07, 95% confidence interval −1.92 to −0.22; effect size 0.47), pain on activity (−1.00, −1.91 to −0.08; 0.45), and function (4.92, 0.14 to 9.72; 0.34). At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain (adjusted difference in pain at rest −1.29, −2.16 to −0.42; effect size 0.56; pain on activity −1.19, −2.22 to −0.16; effect size 0.54), but not function (4.52, −0.73 to 9.76). A higher proportion of patients in the exercise group than in the control group reported recovery (41.9% v 35.0% at 3 months and 62.1% v 50.8% at 12 months), although the differences in self reported recovery between the two groups were not statistically significant. Predefined subgroup analyses revealed that patients recruited by sport physicians (n=30) did not benefit from the intervention, whereas those recruited by general practitioners (n=101) showed significant and clinically relevant differences in pain and function in favour of the intervention group.Conclusion Supervised exercise therapy resulted in less pain and better function at short term and long term follow-up compared with usual care in patients with patellofemoral pain syndrome in general practice. Exercise therapy did not produce a significant difference in the rate of self reported recovery.Trial registration ISRCTN83938749.

Analysis 4.1. Comparison 4 Delivery of exercise: supervised versus home exercise programme, Outcome 1 Usual pain

An occult hernia should be high on the list of differential diagnoses in undiagnosed chronic groin pain in athletes. Operative treatment can return the patient to his sport within 3 months.

The mainstay of patellofemoral pain (PFP) treatment is exercise therapy, often in combination with adjunct treatments such as patient education, orthoses, patella taping and stretching, making the intervention multimodal in nature. The vast majority of randomised controlled trials among patients with PFP have investigated the effect of treatment among adults (>18 years of age). So, while systematic reviews and meta-analyses provide evidence-based recommendations for treating PFP, these recommendations are largely based upon the trials in adults. In the present article, we have summarised the findings on the efficacy of multimodal treatment (predominantly exercise) from the three largest trials concerning patients with PFP, focusing on the long-term success-rate 1 year after receiving multimodal treatment, and with a particular focus on the success rate across the different age groups, including both adolescents, young adults and adults. The results of this paper show that there appears to be a difference in the success rate between adolescents and adults, despite providing similar exercise treatment and having similar exercise compliance. While PFP may present in a similar fashion in adolescence and adults, it may not be the same underlying condition or stage, and different treatments may be required. Collectively, this highlights the importance of increasing our understanding of the underlying pathology, pain mechanisms and why treatment may-or may not-work in adolescents and adults with PFP.

The majority of the hamstring reinjuries occurred in the same location as the index injury, early after RTS and with a radiologically greater extent, suggesting incomplete biological and/or functional healing of the index injury. Specific exercise programs focusing on reinjury prevention initiated after RTS from the index injury are highly recommended.

Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged <40 years, it also affects people of all activity levels and ages.(1 2) Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle.

Background: Since knee complaints are common among athletes and are frequently presented in general practice, it is of interest to investigate the type of knee complaints represented in general practice of athletes in comparison with those of non-athletes. Therefore, the aim of this study is to investigate the differences in type of knee complaints between sport participants, in this study defined as athletes, and non-sport participants, defined as non-athletes, presenting in general practice. Further, differences in the initial policy of the GP, medical consumption, and outcome at one-year follow-up were also investigated.

The aim of the study is to determine "the additional effect of... function" for patellofemoral pain syndrome (PFPS). The additional effect of orthotic devices over exercise therapy on pain and function. A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane and PEDro. Randomised controlled trials and controlled clinical trials of patients diagnosed with PFPS evaluating a clinically relevant outcome were included. Treatment had to include exercise therapy combined with orthotics, compared with an identical exercise programme with or without sham orthotics. Data were summarised using a best evidence synthesis. Eight trials fulfilled the inclusion criteria, of which three had a low risk of bias. There is moderate evidence for no additive effectiveness of knee braces to exercise therapy on pain (effect sizes (ES) varied from -0.14 to 0.04) and conflicting evidence on function (ES -0.33). There is moderate evidence for no difference between knee braces and exercise therapy versus placebo knee braces and exercise therapy on pain and function (ES -0.1-0.10). More studies of high methodological quality are needed to draw definitive conclusions.