The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain

Abstract

BackgroundAnterior knee pain (AKP) or patellofemoral pain syndrome is common and may limit an individual’s ability to perform common activities of daily living such as stair climbing and prolonged sitting. The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis. It is therefore most commonly a diagnosis that is made once other pathologies have been excluded.ObjectivesThe aim of this study was to create an evidence-based checklist for researchers and clinicians to use for the diagnosis of AKP.MethodsA systematic review was conducted in July 2016, and an evidence-based checklist was created based on the subjective and objective findings most commonly used to diagnose AKP. For the subjective factors, two or more of the systematic reviews needed to identify the factor as being important in the diagnosis of AKP.ResultsTwo systematic reviews, consisting of nine different diagnostic studies, were identified by our search methods. Diagnosis of AKP is based on the area of pain, age, duration of symptoms, common aggravating factors, manual palpation and exclusion of other pathologies. Of the functional tests, squatting demonstrated the highest sensitivity. Other useful tests include pain during stair climbing and prolonged sitting. The cluster of two out of three positive tests for squatting, isometric quadriceps contraction and palpation of the patella borders and the patella tilt test were also recommended as useful tests to include in the clinical assessment.ConclusionA diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting. Research is needed to establish the causes of AKP as it is difficult to diagnose a condition with unknown aetiology.

Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

“…This loading incorporates a high load with a high number of repetitions to cause maximum stress to the area, often resulting in fatigue and increase in symptoms for 24-hrs 3,6,7,9 . This technique has proved successful, but results can take 8 weeks of consistent management before symptoms change and adaptation noted 7,10 . Implementation of an isometric strength focussed conservative rehabilitation programme returned the current case study to light training at week 21, full training week 24 and playing competitively at week 30.…”

“…The patella tendon can be disrupted in both the central portion and para-tendon, where repeated stress and load effect the collagen proteins within the tendon leading to pain and reduced function [5][6][7] . Insertional and mid tendon irritation can occur within the structure and present with similar symptoms that require comparable treatment [8][9][10] . Within elite sport, acute and chronic forms of patella tendinopathy are seen where athletes are subject to spikes and changes in load 11,12 .…”

Joint position sense in individuals with anterior knee pain

“…Potential participants emailed the research team and completed the screening questionnaire. Participants who complied with the AKP screening tool and the diagnostic checklist (Leibbrandt & Louw 2017 ), which was based on a systematic review of diagnostic studies and developed specifically for our study, were considered for inclusion.…”

Patients’ perceptions of recovery following a 6-week exercise intervention for the treatment of patellofemoral pain: A mixed methods study

“…Adverts were displayed at the campus physiotherapy clinics, on noticeboards and on advertising screens on the medical campus of Tygerberg and the main campus of Stellenbosch University. The included participants were screened according to an evidence-based screening tool that had been developed specifically for the project (Leibbrandt & Louw 2017). This tool was developed to ensure standardised diagnosis and exclusion of other pathologies, based on an up-to-date evidence synthesis of systematic reviews.…”