Holistic approach to understanding anterior knee pain. Clinical implications

Abstract

Anterior knee pain is one of the most frequent reasons for consultation within knee conditions. The aetiology is not well known, which explains the sometimes unpredictable results of its treatment. Normally, when we see a patient in the office with anterior knee pain, we only study and focus on the knee. If we do this, we are making a big mistake. We must not forget to evaluate the pelvis and proximal femur, as well as the psychological factors that modulate the course of the illness. Both the pelvifemoral dysfunction as well as the psychological factors (anxiety, depression, catastrophization and kinesiophobia) must be included in our therapeutic targets of the multidisciplinary treatment of anterior knee pain. We must not only focus on the knee, we must remember to "look up" to fully understand what is happening and be able to solve this difficult problem. The aetiology of anterior knee pain is multifactorial. Therefore, diagnosis and treatment of patellofemoral disorders must be individualized. Our findings stress the importance of tailoring physiotherapy, surgery and psycho-educational interventions to each patient.

Effect of Combined Fibular Osteotomy on the Pressure of the Tibiotalar and Talofibular Joints in Supramalleolar Osteotomy of the Ankle: A Cadaveric Study

“…Additionally, the force transmission in the tibiotalar joint decreased with an increasing tibial osteotomy gap, but the force transmission in the talofibular joint increased with an increasing tibial osteotomy gap. Increased contact and peak pressure in the talofibular joint can lead to subfibular pain because focal bone overload causes pain by mechanical stimulation of the nerve endings in the subchondral bone (15,16). Therefore, our results support those of previous studies (5,9) hypothesizing that the fibula might contribute to the load transfer and valgus angulation of the hindfoot after medial openingwedge supramalleolar osteotomy can cause lateral subfibular pain.…”

Pain sensitization in arthritis: cause or effect of chronic pain?

“…Subject-specific cognitive and emotional processes determine how pain is perceived in a chronic pain scenario, which may exacerbate catastrophizing and kinesiophobia [25]. Conversely subjects who do not see pain as a threat, who do not suffer from anxiety or depression, may continue to perform their daily activities and are more likely to improve [25,26]. Preliminary evidence also suggests that a reduction of catastrophizing and kinesiophobia is associated with a clinically relevant change in pain intensity and disability [27].…”

Vitamin D Levels of Patients with Patellofemoral Pain Syndrome

“…PFAS hastalarında ağrının kaynağı tam olarak aydınlatılamamıştır. Yoğun bir inervasyona sahip olan lateral ve medial retinakulum, peripatellar sinovya, infrapatellar yağ yastığı, subkondral kemik gibi dokuların ağrının kaynağı olabileceği düşünülmektedir (7,8).…”

“…Nöral miksoid dejenerasyon ise ağrı ile ilişkili değildir, ancak propriyoseptif inervasyonda disfonksiyon sonucu instabiliteye neden olabileceği düşünülmektedir (9). Nitekim pek çok çalışmada PFAS hastalarında propriyosepsiyonda bozulma gösterilmiştir (7,11,12).…”