Patellofemoral Pain

Willy, Richard W.; Hoglund, Lisa T.; Barton, Christian J; Bolgla, Lori A.; Scalzitti, David A.; Logerstedt, David; Lynch, Andrew D.; Snyder‐Mackler, Lynn; McDonough, Christine M.

doi:10.2519/jospt.2019.0302

Cited by 241 publications

(216 citation statements)

References 299 publications

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“…Examples of such interventions may include improving patient education, weight management, treatments targeting pain perception and neuroplasticity, or psychological support [63]. Non-physical approaches such as these will likely be most effective in combination with an exercise-based approach, which is recommended as a core treatment for PFP and PFOA [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…We used the former protocol to select databases to search, resulting in five additional databases. We limited types of study designs to RCT only, in order to align with current best practices [26]. We included all types of control interventions, including wait-list or placebo.…”

Section: Methodsmentioning

confidence: 99%

“…Primary care clinicians prescribe pharmaceuticals to 25% or more of patients presenting with knee complaints such as PFP and PFOA, with underlying inflammation or structural features presumed to cause symptoms [12,22]. These prescriptions may be made in combination with exercise advice or referrals to physical therapy [12], which are recommended for evidence-based management of PFP and PFOA [23][24][25][26][27]. In addition to pharmaceutical agents, nutraceuticals are reported to be of therapeutic benefit in certain musculoskeletal conditions [28].…”

Section: Introductionmentioning

confidence: 99%

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Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review

Macri

Hart

Thwaites

et al. 2020

JCM

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Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making. Methods: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention. Results: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from −0.3 (95% CI −0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (−0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery. Conclusions: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review

Macri

Hart

Thwaites

et al. 2020

JCM

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“…The copyright holder for this this version posted September 18, 2020. ; https://doi.org/10.1101/2020.09.17.20196741 doi: medRxiv preprint Evaluation of ICD-9 selection for chronic knee pain conditions would provide insight into the included codes for this study and future epidemiological studies. Recent clinical practice guidelines for patellofemoral pain 39 This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Anterior Knee Pain Risk Differs Between Male and Female Military Tactical Athletes

Glaviano

Boling

Fraser

2020

Preprint

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Background: Anterior knee pain (AKP) is commonly diagnosed in military members and is a threat to operational readiness. AKP includes a range of conditions, with localized pain around the patella being a frequent location of pain and disability. Mechanical overuse is one suggested etiology for many of these conditions, suggesting occupational demands in the military may influence AKP frequency amongst the service members. Previous research suggests females are at a greater risk for AKP, however, it is unknown how occupation affects AKP risk. Study Design: Epidemiological cohort. Level of Evidence: Level 2. Methods: The Defense Medical Epidemiology Database was queried for the number of individuals with ICD-9 diagnosis codes on their initial encounter from 2006 to 2015. Diagnoses were categorized into anterior or retropatellar pain, patellar instability, knee tendinopathy, as well the sum of the three groups which was defined as AKP. Relative risk (RR) and chi-square statistics were calculated in the assessment of sex and occupational category. Regressions were calculated to determine association between service branch, sex, and AKP across time. Results: From 2006-2018, a total of 151, 263 enlisted and 14,335 officer services members were diagnosed with AKP. The incidence rate was 13.2 in enlisted members and 6.2 in in officers. Females were significantly at greater risk of developing AKP compared to males within both the enlisted (relative risk=1.32) and officer (relative risk=2.01) service members. Differences in risk were also noted across military occupation for both enlisted and officer service members, p<.05. Conclusion: Sex and military occupation were salient factors for AKP risk. Evaluation of training requirements and developing interventions programs across military occupation could serve as a focus for future research aiming to decrease the incidence of chronic knee pain.

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“…The relationship of foot and ankle characteristics with knee symptoms and function, which may assist clinicians in making informed treatment decisions to improve symptoms and function associated with PFOA, is not known. For instance, knowledge of foot and ankle characteristics in other knee conditions such as PFP, are known to influence treatment decisions regarding in-shoe interventions such as foot orthoses [ 21 , 22 ]. Therefore, the objective of this study was to explore cross-sectional relationships between weightbearing ankle dorsiflexion range of motion, foot posture, and midfoot mobility with knee symptoms and function in individuals with clinically diagnosed predominant PFOA.…”

Section: Introductionmentioning

confidence: 99%

Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis

Tan

Crossley

Munteanu

et al. 2020

Journal of Foot and Ankle Research

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Background Foot and ankle characteristics are associated with patellofemoral pain (PFP) and may also relate to patellofemoral osteoarthritis (PFOA). A greater understanding of these characteristics and PFOA, could help to identify effective targeted treatments. Objectives To determine whether foot and ankle characteristics are associated with knee symptoms and function in individuals with PFOA. Methods For this cross-sectional study we measured weightbearing ankle dorsiflexion range of motion, foot posture (via the Foot Posture Index [FPI]), and midfoot mobility (via the Foot Measurement Platform), and obtained patient-reported outcomes for knee symptoms and function (100 mm visual analogue scales, Anterior Knee Pain Scale [AKPS], Knee injury and Osteoarthritis Outcome Score, repeated single step-ups and double-leg sit-to-stand to knee pain onset). Pearson’s r with significance set at p < 0.05 was used to determine the association between foot and ankle charateristics, with knee symptoms and function, adjusting for age. Results 188 participants (126 [67%] women, mean [SD] age of 59.9 [7.1] years, BMI 29.3 [5.6] kg/m2) with symptomatic PFOA were included in this study. Lower weightbearing ankle dorsiflexion range of motion had a small significant association with higher average knee pain (partial r = − 0.272, p < 0.001) and maximum knee pain during stair ambulation (partial r = − 0.164, p = 0.028), and lower scores on the AKPS (indicative of greater disability; partial r = 0.151, p = 0.042). Higher FPI scores (indicating a more pronated foot posture) and greater midfoot mobility (foot mobility magnitude) were significantly associated with fewer repeated single step-ups (partial r = − 0.181, p = 0.023 and partial r = − 0.197, p = 0.009, respectively) and double-leg sit-to-stands (partial r = − 0.202, p = 0.022 and partial r = − 0.169, p = 0.045, respectively) to knee pain onset, although the magnitude of these relationships was small. The amount of variance in knee pain and disability explained by the foot and ankle characteristics was small (R2-squared 2 to 8%). Conclusions Lower weightbearing ankle dorsiflexion range of motion, a more pronated foot posture, and greater midfoot mobility demonstrated small associations with worse knee pain and greater disability in individuals with PFOA. Given the small magnitude of these relationships, it is unlikely that interventions aimed solely at addressing foot and ankle mobility will have substantial effects on knee symptoms and function in this population. Trial registration The RCT was prospectively registered on 15 March 2017 with the Australia and New Zealand Clinical Trials Registry (ANZCTRN12617000385347).

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Patellofemoral Pain

Cited by 241 publications

References 299 publications

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review

Anterior Knee Pain Risk Differs Between Male and Female Military Tactical Athletes

Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis

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