Patellofemoral pain syndrome

Abstract

The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q‐angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear‐foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non‐operative therapy concept with short‐term use of NSAIDs, short‐term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non‐operative and should address the functional causes. Level of evidence V.

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References 76

1. 1.

   Al-Hakim W, Kumar Jaiswal P, Khan W, Johnstone D. The non-operative treatment of anterior knee pain. Open Orthop J. 2012;6(Suppl 2: M10):320-326.

   Not in our library10.2174/1874325001206010320

2. 2.

   Baldon R, Nakagawa TH, Muniz TB, Amorim CF, Maciel CD, Serrão FV. Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train. 2009;44(5):490-496.

   Not in our library10.4085/1062-6050-44.5.490

3. 3.

   Barton CJ, Levinger P, Crossley KM, Webster KE, Menz HB. The relationship between rearfoot, tibial and hip kinematics in individuals with patellofemoral pain syndrome. Clin Biomech (Bristol, Avon). 2012;27(7):702-705.

   Not in our library10.1016/j.clinbiomech.2012.02.007

4. 4.

   Barton CJ, Levinger P, Menz HB, Webster KE. Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture. 2009;30(4):405-416.

   Not in our library10.1016/j.gaitpost.2009.07.109

5. 5.

   Barton CJ, Levinger P, Webster KE, Menz HB. Walking kinematics in individuals with patellofemoral pain syndrome: a case-control study. Gait Posture. 2011;33(2):286-291.

   Not in our library10.1016/j.gaitpost.2010.11.022

6. 6.

   Barton CJ, Bonanno D, Levinger P, Menz HB. Foot and ankle characteristics in patellofemoral pain syndrome: a case control and reliability study. J Orthop Sports Phys Ther. 2010;40(5):286-296.

   Not in our library10.2519/jospt.2010.3227

7. 7.

   Barton CJ, Menz HB, Crossley KM. Effects of prefabricated foot orthoses on pain and function in patients with patellofemoral pain syndrome: a cohort study. Phys Ther Sport. 2011;12(2):70-75.

   Not in our library10.1016/j.ptsp.2010.09.002

8. 8.

   Barton CJ, Menz HB, Levinger P, Webster KE, Crossley KM. Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome. Br J Sports Med. 2011;45(9):697-701.

   Not in our library10.1136/bjsm.2010.077644

9. 9.

   Besier TF, Fredericson M, Gold GE, Beaupré GS, Delp SL. Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls. J Biomech. 2009;42(7):898-905.

   Not in our library10.1016/j.jbiomech.2009.01.032

10. 10.

    Blond L, Hansen L. Patellofemoral pain syndrome in athletes: a 5.7-year retrospective follow-up study of 250 athletes. Acta Orthop Belg. 1998;64:393-400.

    Not in our library

11. 11.

    Boldt AR, Willson JD, Barrios JA, Kernozek TW. Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome. J Appl Biomech. 2013;29(1):68-77.

    Not in our library10.1123/jab.29.1.68

12. 12.

    Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725-730.

    Not in our library10.1111/j.1600-0838.2009.00996.x

13. 13.

    Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2008;38(1):12-16.

    Not in our library10.2519/jospt.2008.2462

14. 14.

    Brent JL, Myer GD, Ford KR, Hewett TE. A longitudinal examination of hip abduction strength in adolescent males and females. Med Sci Sports Exerc. 2008;39:34-45.

    Not in our library10.1249/01.mss.0000320771.90732.52

15. 15.

    Cavazzuti L, Merlo A, Orlandi F, Campanini I. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Gait Posture. 2010;32(3):290-295.

    Not in our library10.1016/j.gaitpost.2010.06.025

16. 16.

    Chen HY, Chien CC, Wu SK, Liau JJ, Jan MH. Electromechanical delay of the vastus medialis obliquus and vastus lateralis in individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2012;42(9):791-796.

    Not in our library10.2519/jospt.2012.3973

17. 17.

    Christou EA. Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain. J Electromyogr Kinesiol. 2004;14(4):495-504.

    Not in our library10.1016/j.jelekin.2003.10.007

18. 18.

    Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. Br J Sports Med. 2009;43(3):169-171.

    Not in our library10.1136/bmj.a1735

19. 19.

    Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001;82(2):183-189.

    Not in our library10.1053/apmr.2001.19022

20. 20.

    Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. Clin J Sport Med. 2002;12(6):339-347.

    Not in our library10.1097/00042752-200211000-00004

21. 21.

    Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39:866-873.

    Not in our library10.1177/0363546510395456

22. 22.

    D’hondt NE, Struijs PA, Kerkhoffs GM, Verheul C, Lysens R, Aufdemkampe G, Van Dijk CN (2002) Orthotic devices for treating patellofemoral pain syndrome. Cochrane Database Syst Rev (2):CD002267

    Not in our library10.1002/14651858.cd002267

23. 23.

    Domenech J, Sanchis-Alfonso V, López L, Espejo B. Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1562-1568.

    Not in our library10.1007/s00167-012-2238-5

24. 24.

    Draper CE, Besier TF, Santos JM, Jennings F, Fredericson M, Gold GE, Beaupre GS, Delp SL. Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res. 2009;27(5):571-577.

    Not in our library10.1002/jor.20790

25. 25.

    Draper CE, Fredericson M, Gold GE, Besier TF, Delp SL, Beaupre GS, Quon A. Patients with patellofemoral pain exhibit elevated bone metabolic activity at the patellofemoral joint. J Orthop Res. 2012;30(2):209-213.

    Not in our library10.1002/jor.21523

26. 26.

    Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436:100-110.

    Not in our library10.1097/01.blo.0000172303.74414.7d

27. 27.

    Ford KR, Myer GD, Hewett TE. Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc. 2003;35:1745-1750.

    Not in our library10.1249/01.mss.0000089346.85744.d9

28. 28.

    Ford KR, Myer GD, Toms HE, Hewett TE. Gender differences in the kinematics of unanticipated cutting in young athletes. Med Sci Sports. 2005;37:124-129.

    Not in our library

29. 29.

    Fulkerson JP, Arendt EA. Anterior knee pain in females. Clin Orthop Relat Res. 2000;431:69-73.

    Not in our library10.1097/00003086-200003000-00009

30. 30.

    Gilleard W, McConnell J, Parsons D. The effect of patellar taping on the onset of vastus medialis obliquus and vastus lateralis muscle activity in persons with patellofemoral pain. Phys Ther. 1998;78(1):25-32.

    Not in our library10.1093/ptj/78.1.25

31. 31.

    Gross MT, Foxworth JL. The role of foot orthoses as an intervention for patellofemoral pain. J Orthop Sports Phys Ther. 2003;33(11):661-670.

    Not in our library10.2519/jospt.2003.33.11.661

32. 32.

    Harvie D, O’Leary T, Kumar S. A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works? J Multidiscip Healthc. 2011;4:383-392.

    Not in our library10.2147/jmdh.s24595

33. 33.

    Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003;4:CD00347.

    Not in our library10.1002/14651858.cd003472

34. 34.

    Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2004;3:CD003470.

    Not in our library10.1002/14651858.cd003470.pub2

35. 35.

    Hewett TE, Myer GD, Ford KR. Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg Am. 2004;86-A:1601-1608.

    Not in our library10.2106/00004623-200408000-00001

36. 36.

    Jensen R, Hystad T, Baerheim A. Knee function and pain related to psychological variables in patients with long-term patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2005;35(9):594-600.

    Not in our library10.2519/jospt.2005.35.9.594

37. 37.

    Jensen R, Hystad T, Kvale A, Baerheim A. Quantitative sensory testing of patients with long lasting patellofemoral pain syndrome. Eur J Pain. 2007;11(6):665-676.

    Not in our library10.1016/j.ejpain.2006.10.007

38. 38.

    Johnston LB, Gross MT. Effects of foot orthoses on quality of life for individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2004;34(8):440-448.

    Not in our library10.2519/jospt.2004.34.8.440

39. 39.

    Kaya D, Doral MN. Is there any relationship between Q-angle and lower extremity malalignment? Acta Orthop Traumatol Turc. 2012;46(6):416-419.

    Not in our library10.3944/aott.2012.2883

40. 40.

    Kettunen JA, Harilainen A, Sandelin J, Schlenzka D, Hietaniemi K, Seitsalo S, Malmivaara A, Kujala UM. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial. BMC Med. 2007;13(5):38-45.

    Not in our library10.1186/1741-7015-5-38

41. 41.

    Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):193-206.

    Not in our library10.1136/bjsports-2011-090369

42. 42.

    Levinger P, Gilleard W. Tibia and rearfoot motion and ground reaction forces in subjects with patellofemoral pain syndrome during walking. Gait Posture. 2007;25(1):2-8.

    Not in our library10.1016/j.gaitpost.2005.12.015

43. 43.

    MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR. Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am. 2006;88(12):2596-2605.

    Not in our library10.2106/jbjs.e.00674

44. 44.

    Mølgaard M. Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc. 2011;101(3):215-222.

    Not in our library10.7547/1010215

45. 45.

    Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, Rauh MJ, Divine JG, Hewett TE. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon). 2010;25(7):700-707.

    Not in our library10.1016/j.clinbiomech.2010.04.001

46. 46.

    Padua DA, Marshall SW, Beutler AI, Demaio M, Boden BP, Yu B, Garrett WE. Predictors of knee valgus angle during a jump-landing task. Med Sci Sports Exerc. 2005;37:398-404.

    Not in our library

47. 47.

    Patil S, White L, Jones A, Hui AC. Idiopathic anterior knee pain in the young. A prospective controlled trial. Acta Orthop Belg. 2010;76(3):356-359.

    Not in our library

48. 48.

    Patil S, Dixon J, White LC, Jones AP, Hui AC. An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain. Knee. 2011;18(5):329-332.

    Not in our library10.1016/j.knee.2010.07.007

49. 49.

    Pattyn E, Verdonk P, Steyaert A, Vanden Bossche L, Van den Broecke W, Thijs Y, Witvrouw E. Vastus medialis obliquus atrophy: does it exist in patellofemoral pain syndrome? Am J Sports Med. 2011;39(7):1450-1456.

    Not in our library10.1177/0363546511401183

50. 50.

    Pal S, Draper CE, Fredericson M, Gold GE, Delp SL, Beaupre GS, Besier TF. Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients. Am J Sports Med. 2011;39(3):590-598.

    Not in our library10.1177/0363546510384233

51. 51.

    Park SK, Stefanyshyn DJ. Greater Q angle may not be a risk factor of patellofemoral pain syndrome. Clin Biomech (Bristol, Avon). 2011;26(4):392-396.

    Not in our library10.1016/j.clinbiomech.2010.11.015

52. 52.

    Petersen W, Ellermann A, Liebau C, Brüggemann GP, Best R, Gösele-Koppenburg A, Semsch H, Albasini A, Rembitzki I. Das patellofemorale schmerzsyndrom. Orthopädische Praxis. 2010;46(8):34-42.

    Not in our library

53. 53.

    Pfeiffer RP, DeBeliso M, Shea KG, Kelley L, Irmischer B, Harris C. Kinematic MRI assessment of McConnell taping before and after exercise. Am J Sports Med. 2004;32(3):621-628.

    Not in our library10.1177/0363546503261693

54. 54.

    Piva SR, Fitzgerald GK, Wisniewski S, Delitto A. Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome. J Rehabil Med. 2009;41(8):604-612.

    Not in our library10.2340/16501977-0372

55. 55.

    Piva SR, Fitzgerald GK, Irrgang JJ, Fritz JM, Wisniewski S, McGinty GT, Childs JD, Domenech MA, Jones S, Delitto A. Associates of physical function and pain in patients with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2009;90(2):285-295.

    Not in our library10.1016/j.apmr.2008.08.214

56. 56.

    Powers CM, Ward SR, Chen YJ, Chan LD, Terk MR. Effect of bracing on patellofemoral joint stress while ascending and descending stairs. Clin J Sport Med. 2004;14(4):206-214.

    Not in our library10.1097/00042752-200407000-00003

57. 57.

    Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9-15.

    Not in our library10.1016/s0004-9514(09)70055-8

58. 58.

    Rathleff MS, Roos EM, Olesen JL, Rasmussen S, Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013;18:234-239.

    Not in our library10.2519/jospt.2013.4383

59. 59.

    Rauh MJ, Koepsell TD, Rivara FP, Rice SG, Margherita AJ. Quadriceps angle and risk of injury among high school cross-country runners. J Orthop Sports Phys Ther. 2007;37:725-733.

    Not in our library10.2519/jospt.2007.2453

60. 60.

    Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2007;37:232-238.

    Not in our library10.2519/jospt.2007.2439

61. 61.

    Sanchis-Alfonso V, Roselló-Sastre E. Immunohistochemical analysis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A neuroanatomic basis for anterior knee pain in the active young patient. Am J Sports Med. 2000;28(5):725-731.

    Not in our library10.1177/03635465000280051801

62. 62.

    Sanchis-Alfonso V (2008) Patellofemoral pain. Orthopade 37(9):835-6, 838–840

    Not in our library10.1007/s00132-008-1289-2

63. 63.

    Souza RB, Draper CE, Fredericson M, Powers CM. Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther. 2010;40(5):2772-2785.

    Not in our library10.2519/jospt.2010.3215

64. 64.
    Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review · 2010

    No notice
65. 65.

    Thomeé P, Thomeé R, Karlsson J. Patellofemoral pain syndrome: pain, coping strategies and degree of well-being. Scand J Med Sci Sports. 2002;12(5):276-281.

    Not in our library10.1034/j.1600-0838.2002.10226.x

66. 66.

    Tsuji T, Matsuyama Y, Goto M, Yimin Y, Sato K, Hasegawa Y, Ishiguro N. Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain. J Orthop Sci. 2002;7(5):519-523.

    Not in our library10.1007/s007760200092

67. 67.

    Utting MR, Davies G, Newman JH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee. 2005;12:362-365.

    Not in our library10.1016/j.knee.2004.12.006

68. 68.

    Vicenzo B, Collins N, Crossley K, Beller E, Darnell R, McPoil T. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC Musculoskelet Disord. 2008;9:27-34.

    Not in our library10.1186/1471-2474-9-27

69. 69.

    Vicenzo B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med. 2010;44(12):862-866.

    Not in our library10.1136/bjsm.2008.052613

70. 70.

    Warden SJ, Hinman RS, Watson MA, Avin KG, Bialocerkowski AE, Crossley KM. Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthr Rheum. 2008;59(1):73-83.

    Not in our library10.1002/art.23242

71. 71.

    White LC, Dolphin P, Dixon J. Hamstring length in patellofemoral pain syndrome. Physiotherapy. 2009;95(1):24-28.

    Not in our library10.1016/j.physio.2008.05.009

72. 72.

    Wilson NA, Press JM, Koh JL, Hendrix RW, Zhang LQ. In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 2009;91(3):558-566.

    Not in our library10.2106/jbjs.g.00572

73. 73.

    Wiener-Ogilvie S, Jones RB. A randomised trial of exercise therapy and foot orthoses as treatment for knee pain in primary care. Br J Podiatry. 2004;7(2):43-49.

    Not in our library

74. 74.

    Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med. 2000;28:480-489.

    Not in our library10.1177/03635465000280040701

75. 75.

    Wojtys EM, Beaman DN, Glover RA, Janda D. Innervation of the human knee joint by substance-P fibers. Arthroscopy. 1990;6(4):254-263.

    Not in our library10.1016/0749-8063(90)90054-h

76. 76.

    Wu CC, Shih CH. The influence of iliotibial tract on patellar tracking. Orthopedics. 2004;27(2):199-203.

    Not in our library10.3928/0147-7447-20040201-12

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