Factors associated with patellofemoral pain syndrome: a systematic review

Abstract

This review systematically summarises factors associated with patellofemoral pain syndrome (PFPS). A systematic literature search was conducted. Studies including ≥20 patients with PFPS that examined ≥1 possible factor associated with PFPS were included. A meta-analysis was performed, clinical heterogeneous data were analysed descriptively. The 47 included studies examined 523 variables, eight were pooled. Pooled data showed a larger Q-angle, sulcus angle and patellar tilt angle (weighted mean differences (WMD) 2.08; 95% CI 0.64, 3.63 and 1.66; 95% CI 0.44, 2.77 and 4.34; 95% CI 1.16 to 7.52, respectively), less hip abduction strength, lower knee extension peak torque and less hip external rotation strength (WMD -3.30; 95% CI -5.60, -1.00 and -37.47; 95% CI -71.75, -3.20 and -1.43; 95% CI -2.71 to -0.16, respectively) in PFPS patients compared to controls. Foot arch height index and congruence angle were not associated with PFPS. Six out of eight pooled variables are associated with PFPS, other factors associated with PFPS were based on single studies. Further research is required.

People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study

“…In the pain literature, whether through fear-avoidance, or catastrophisation, these behavioural responses are consistently associated with worse function [25]. The majority of evidenced physical treatments for patellofemoral pain are exercise based, primarily aimed at increasing strength [26]. Negative belief systems such as those exhibited in this investigation leading to avoidant behaviour need to be noted by physiotherapists as they are in direct conflict with the usual aims of physiotherapy intervention.…”

A Systematic Review of Reviews in Patellofemoral Pain Syndrome. Exploring the Risk Factors, Diagnostic Tests, Outcome Measurements and Exercise Treatment

“…No level of evidence was reported for the four reviews which were not systematic or meta-analysis. The results showed two clinical test reviews of high quality systematic reviews of case control or cohort studies [34,35], one high quality meta-analysis of RCT's [36] and three high quality systematic reviews of case control or cohort studies on risk factors [9,17,37], three high quality meta-analyses or systematic reviews of RCT's [11,38,39] and three high quality systematic reviews of case control or cohort studies on exercise treatment [12,13,40] and two high quality systematic reviews of case control or cohort studies on outcome measures [41,42].…”

“…The reason was that this study reported to have a priori design (AMSTAR question-1, PRISMA checklist item-5). On the opposite side, the two studies from Lankhorst et al [9,36] were the only studies which assessed the likelihood of publication bias (AMSTAR Question-10, PRISMA checklist item-15). All studies performed a comprehensive literature search (question 3 AMSTAR) which was anticipated because this criterion was one of the inclusion criteria for the current review.…”

“…Lately, researchers and decision makers have started to confront an overflow of reviews [5,6]. From July 2012 to March 2013 the British Journal of Sport Medicine alone has published 4 systematic reviews on PFPS [7][8][9][10]. Because there are several reviews on similar topics and because it is likely for reviews to be of varied scope and quality, a growing interest of systematic review of reviews (RoR) has been called for [3].…”

“…Because there are several reviews on similar topics and because it is likely for reviews to be of varied scope and quality, a growing interest of systematic review of reviews (RoR) has been called for [3]. For example, there are several reviews on PFPS conservative/non-operative treatment [11,12], suggested exercises for PFPS treatment [13,14], clinical tests for PFPS diagnosis [15,16], and factors associated with PFPS [9,17]. Only one previous RoR on PFPS has been published to date and that was about the quality of the systematic reviews on nonpharmacological conservative treatment for patellofemoral pain syndrome [18].…”