Common Cause Of Knee Pain Research Articles

PATELLOFEMORAL INSTABILITY MANAGEMENT IN A PROSPECTIVE PAEDIATRIC COHORT IN EDINBURGH

Patellofemoral instability (PFI) is a common cause of knee pain and disability in the paediatric population. Patella alta, lateralised tibial tubercle, medial patellofemoral ligament (MPFL) deficiency, genu valgum and trochlear dysplasia are well known risk factors.A prospective database was created including patients referred through our physiotherapy pathway following first-time patella dislocation. Patella alta and lateralisation of the tibial tuberosity was treated with a Fulkerson-type tibial tubercle osteotomy(TTO). Medial patellofemoral ligament was reconstructed using quads tendon autograft pull-down technique. A modified Sheffield protocol was used postoperatively allowing weightbearing in a hinged knee brace.Forty patients were identified with 8 patients having bilateral presentations. Male to female ratio was 12:28 with an age range of 4–17 years. Eight patients had congenital PFI, five patients acquired PFI through traumatic patella dislocation and twenty-seven patients developed PFI from recurrent dislocations. Structural abnormalities were found in 38(95%) of patients. Patella alta (Caton-Deschamps index >1.2) was identified in 19(47%) patients, genu valgum in 12(30%) patients, increased tibial tubercle-trochlear groove distance(TT-TG>20mm) was present in 9(22.5%) patients and persistent femoral anteversion(> 20 deg) in 7(17%) patients.Eight patients were treated with TTO and MPFL reconstruction, three patients with MPFL reconstruction alone and five patients had guided growth for genu valgum correction. Ten patients are awaiting surgery. No postoperative patients had recurrence of PFI at their latest follow up.PFI is a common problem in the adolescent paediatric population with identifiable structural abnormalities. Correcting structural pathology with surgery leads to predictable and safe outcomes.

In-Office Needle Arthroscopy with Meniscal Repair for Meniscal Lesions of the Knee

Meniscal injuries are a common cause of knee pain and are often an indication for knee arthroscopy, the most common orthopedic surgical procedure in the United States. In-office needle arthroscopy (IONA) is a described technique with the ability to diagnose and treat meniscal injuries in the office. IONA allows for diagnosis and treatment at a significantly deceased cost, with both quicker patient recovery, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office needle arthroscopy for meniscal injuries of the knee, including the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

Proximal to distal posture correction protocol for IT band friction syndrome in female amateur runners

Iliotibial band friction syndrome is an overuse knee injury that is more common in runners. In IT band syndrome, pain, and tenderness are present over the lateral aspect of the knee. It is more common in females because of physiological and anatomical factors. The objective of this research was to determine and compare the effect of proximal to distal postural correction protocol with conventional physiotherapy program for IT band friction syndrome in female amateur runners. This study included 150 female amateur runners with IT band friction syndrome based on inclusion and exclusion criteria. Then the subjects were randomly allocated into group A and group B by simple random sampling method. Group A was given proximal to distal postural correction protocol and for group B conventional physiotherapy exercise program was given. Outcome measures used were a visual analog scale, postural assessment, tenderness assessment by palpation and Ober’s test. Pre and post-assessment of the above measures was taken to conform the results. The results showed a statistically significant effect of the proximal to distal postural correction protocol as compared to a conventional exercise program for IT band friction syndrome in female amateur runners. There was a significant reduction in pain (<0.0001) in individuals in group A than the group B. Postural abnormalities in IT band friction syndrome were also significantly (<0.0001) resolved and the Ober’s test came as 76% negative out of 100%positive patients. Based on results, it was concluded that the proximal to distal postural correction protocol is effective in female amateur runners.

Prevalence of Patellofemoral Pain and Knee Pain in the General Population of Saudi Arabia.

Background Patellofemoral pain (PFP) is a common cause of knee pain. This condition can restrict daily activities by trying to avoid activities that aggravate their pain. This study aimed to determine the prevalence of PFP and knee pain and its associated factors among Saudi young adults. Methods A descriptive cross-sectional study was conducted in Saudi Arabia. A validated translated Arabic questionnaire was used. Data was collected through an online self-administered questionnaire. Saudi young adults of both genders aged between (18 to 40 years) were included. The mean ±SD was described for continuous variables, whereas categorical variables were reported using frequencies and percentages. The chi-square test was used for descriptive analysis. Results A total of 1558 subjects were enrolled in the current study. About 663 (42.6%) were males and 895 (57.4%) were females. Of the total participants, 718 (46%) were within the age group of 18 to 25.The overall prevalence of PFP among the current study participant was found to be 30.3%. The prevalence of PFP among males was found to be 31.4% and the prevalence of PFP among females was found to be 29.5%. The overall prevalence of knee pain among study participants was found to be 13.2% as 205 of the participants reported knee pain. The prevalence of knee pain among males was found to be 14% and the prevalence of knee pain among females was found to be 12.3%. The multivariate analysis included the following variables: age, gender, and marital status. The following factors predicted higher rate of PFP: being 18 to 25 years old (p-value < 0.001, odds ratio = 1), being 26 to 35 years old (p-value = 0.001, odds ratio = 1.689). Conclusion The prevalence of PFP and knee pains was found to be relatively high in Saudi Arabia. Age less than 40 years old was found to be associated with a higher prevalence of PFP and knee pain when compared to other age groups.

Structural And Morphologic Maladaptation Underlies Patellar Tendinopathy Following ACL Injury

Anterior cruciate ligament (ACL) rupture is a prevalent sports injury associated with prolonged muscle weakness and atrophy. Patellofemoral pain is also common following ACL injury, but the direct impact of ACL injury on knee tendons has not been defined. Tendons are crucial for force transmission from muscle to bone, and the highly structured collagen network within tendon supports optimal load bearing and force transduction. With development of tendinopathy—a common cause of knee pain and restricted sports participation—normal tendon morphology shifts to a pathologic phenotype with altered collagen content and organization, which may contribute to impaired sports performance. PURPOSE: Determine if altered morphology representative of tendinopathy exists in patellar tendon after ACL injury. METHODS: Surgical ACL transection (ACL-T) was performed unilaterally on healthy adult mice (n=7). The patellar tendon was collected from injured and uninjured knees 7d after ACL-T and processed for morphological analysis. Immunohistochemical and histological techniques were used to assess collagen structure and abundance and tendon morphology. RESULTS: Collagen 1 content in the patellar tendon of the injured knee was significantly elevated by 78% at 7d after ACL-T (30.7 ± 3.3 pixels/μm2 vs. 17.2 ± 5.7 pixels/μm2; p=0.03). The collagen 3 to collagen 1 ratio was similarly higher in patellar tendon from the injured knee (0.09 ± 0.05 vs. 0.05 ± 0.04) but did not reach statistical significance. Densely packed collagen was 18% lower in the patellar tendon of the ACL-T injured knee (1.5 ± 0.3 pixels/μm2 vs. 1.8 ± 0.2 pixels/μm2; p=0.08). CONCLUSIONS: Collagen 1 content is starkly elevated in patellar tendon 7d after ACL-T in mice, consistent with tendinopathy. ACL injury was associated with reduced abundance of densely organized collagen, despite the elevated abundance of collagen 1. These findings are consistent with tendon pathology and may impair tendon loading capacity and force transduction. These data are the first to identify patellar tendon structural and morphologic maladaptation following ACL injury. Support: R01 AR072061

Tibial Tubercle Osteotomy With Anteriorization and Distalization for Treatment of Patellar Instability With Patella Alta

Patellofemoral instability is a common cause of knee pain that can lead to long-standing pain, chondral injury, recurrent dislocations, and degenerative changes if not treated appropriately. Tibial tubercle osteotomy is indicated when there is anatomy predisposing to patellar maltracking and instability, namely abnormal patellar height or tibial tubercle location. In this Technical Note, we describe a technique for tibial tubercle anteriorization and distalization as part of the overall treatment algorithm for patellar instability with associated patella alta. This method of tibial tubercle osteotomy reliably produces anterior and distal translation of the patella to correct patellar height and decrease contact pressure across the patellofemoral joint.

Osgood-Schlatter disease: a review of current diagnosis and management

Osgood-Schlatter disease is a common cause of knee pain in children and adolescents, particularly in those who participate in sports. Repetitive force during athletic activities, along with changes that happen during a growth spurt, result in the development of traction apophysitis. Because of its typical presentation, the diagnosis is usually made clinically. The disorder generally resolves with skeletal maturity, and most patients respond to conservative therapy. Surgery can be considered in recalcitrant cases. Several approaches of surgical intervention have been proposed; each approach has its advantages and disadvantages.

Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors

BackgroundOsgood-Schlatter Disease is the most common cause of knee pain in youth. Scientific research in youth elite football is limited. ObjectivesTo assess clinical and ultrasonographic factors associated with Osgood-Schlatter Disease and calculate point prevalence of clinical diagnosis and time-loss in youth elite male football. Study designNested case-control study and cross-sectional prevalence study; Level of evidence: 3. MethodsWe obtained data during the pre-season periodic health evaluation. Osgood-Schlatter Disease diagnosis was defined as (1) athlete-reported anterior knee pain and (2) clinical confirmation by pain provocation at the tibial tuberosity. Time-loss was defined as inability to participate in team training and/or competition.For the nested-case control study, we examined clinical and ultrasonographic factors in the U13 to U16 teams. We matched on calendar-age. The clinical factors were: self-reported history of Sever's disease, growth measures, leg muscles flexibility and strength and ultrasonographic bone maturity stages according to Ehrenborg, For the cross-sectional study, we included players of the U13 to U19 teams to calculate the point prevalence. ResultsThe case-control study consisted 30 players and the cross-sectional study 127 players. Previous Sever's disease was strongly associated with Osgood-Schlatter Disease (OR = 16.8; p = 0.02; 95% CI = 1.6–174.5). None of the other clinical or ultrasonographic factors were associated. The point prevalence was 17% and 80% had no time-loss despite presence of clinical symptoms. ConclusionConsidering the 16.8OR, previous Sever's disease indicates a strong association with Osgood-Schlatter Disease. Although generally suggested, growth velocity and bone maturity are not associated in an age-matched comparison.

A Case of Chronic Deep Infrapatellar Bursitis Complicated by Patellar Tendinopathy and its Evaluation With Musculoskeletal Ultrasound

Knee pain is a very common complaint in routine physiatry and orthopedic practice. While bursitis is a well-known and common cause of knee pain, deep infrapatellar bursa (DIPB) involvement is relatively less common. Inflammation of DIPB occurs commonly due to either direct trauma or overuse, but other rare causes have also been reported in the literature including infection, juvenile idiopathic arthritis, gout, and juvenile ankylosing spondylitis. We report a case of chronic inflammation of DIPB caused by direct trauma and associated with patellar tendinopathy. Additionally, we describe the characteristic findings on musculoskeletal ultrasonography (MSK-USG). For ultrasound evaluation, the patient should lie supine with the knee slightly flexed. Deep infrapatellar bursitis can be seen as an anechoic fluid-filled structure immediately posterior to the distal patellar tendon and anterior to the tibial tuberosity. While MRI can confirm the diagnosis of bursitis, MSK-USG can be quick, highly sensitive, and is able to confirm the diagnosis as well as to detect dynamic changes in the patellar tendon and adjacent structures. USG can also help in the treatment by guiding corticosteroid injection into the bursa. Activity modification and eccentric exercises play an important role in the rehabilitation program in these cases.

Bracing for the Patellofemoral Joint.

Patellofemoral disorders are common causes of knee pain that result in frequent visitations to musculoskeletal care clinics. Patellar tendinopathy, patellar instability and patellar maltracking, and pain are some of the most common pathologies resulting in patellofemoral dysfunction. For each of these diagnoses, there are unique orthoses and braces available, some of which are uniquely designed to address the pathology involved. While the spectrum of patellofemoral disorders is wide ranging and can often be challenging to treat, bracing frequently plays a large role in the overall treatment algorithm. In this article, we summarized the current literature and treatment recommendations related to the most common types of patellar braces. We performed a thorough review of randomized controlled trials and up to date literature to reach well-informed conclusions on current best practice regarding the uses of patellar braces for patellofemoral disorders.

The correlation between clinical and radiological severity of osteoarthritis of the knee.

Introduction: Primary osteoarthritis (OA) is a common cause of knee pain. Appropriate management of knee OA is based on clinical and radiological findings. Pain, deformity, and functional impairments are major clinical factors considered along with radiological findings when making management decisions. Differences in management strategies might exist due to clinical and radiological factors. This study aims at finding possible associations between clinical and radiological observations. Methods: A prospective cross-sectional study of 52 patients with primary osteoarthritis of the knee managed conservatively at a tertiary hospital arthroplasty clinic was conducted for three months. English speaking patients with primary OA were identified and included in this study. Pain and functional impairment were assessed using Wong-Baker Faces pain scale, The Knee Society Score (KSS), and Western Ontario and McMaster Osteoarthritis Index (WOMAC). The Body Mass Index (BMI) of all participants was measured. Standard two views plain radiographs were used for radiographic grading of the OA. Anonymized radiographs were presented to two senior consultant orthopaedic surgeons who graded the OA using Kellgren and Lawrence (KL) and Ahlbäck classification systems. The severity of the functional impairment and pain score was then compared to the radiological grading. Results: The average age of our participants was 63 ± 9 years. Their average BMI was 34.9 ± 8.4 kg/m2, median self-reported pain, total WOMAC, and pain WOMAC scores were 8, 60, and 13, respectively. We observed no significant correlation between BMI and pain scores. Inter-rater reliability for KL and Ahlbäck grading was strong. There was no significant correlation between WOMAC scores and the radiological grades. Conclusion: There was no correlation between pain and functional scores, patient factors and radiological severity of OA of the knee.

Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients.

PurposePatellofemoral instability is a common cause of knee pain and dysfunction in paediatric and adolescent patients. The purpose of the study was to evaluate the frequency of patellar dislocations seen in emergency departments (EDs) and the rates of surgical procedures for patellar instability at paediatric hospitals in the United States between 2004 and 2014.MethodsThe Pediatric Health Information System database was queried for all paediatric patients who underwent surgery for patellar instability or were seen in the ED for acute patellar dislocation between 2004 and 2014. This was compared with the annual numbers of overall orthopaedic surgical procedures.ResultsBetween 2004 and 2014, there were 3481 patellar instability procedures and 447 285 overall orthopaedic surgical procedures performed at the included institutions, suggesting a rate of 7.8 per 1000 orthopaedic surgeries. An additional 5244 patellar dislocations treated in EDs were identified. Between 2004 and 2014, the number of patellar instability procedures increased 2.1-fold (95% confidence interval (CI) 1.4 to 3.0), while orthopaedic surgical procedures increased 1.7-fold (95% CI 1.3 to 2.0), suggesting a 1.2-fold relative increase in patellar instability procedures, compared with total paediatric orthopaedic surgeries.ConclusionThis study shows a significant rise in the rate of acute patellar instability treatment events in paediatric and adolescent patients across the country. Surgery for patellar instability also increased over the study period, though only slightly more than the rate of all paediatric orthopaedic surgical procedures. This may suggest that increasing youth sports participation may be leading to a spectrum of increasing injuries and associated surgeries in children.Level of EvidenceIV

INFLUENCE OF GENDER ON PAIN, QUALITY OF LIFE, AND PHYSICAL ACTIVITY IN PATIENTS WITH KNEE OSTEOARTHRITIS

Osteoarthritis is the most common cause of knee pain which contributes to adults’ disability. Females have an increased risk of knee osteoarthritis. However, little is known about the gender influence in pain perception, quality of life (QOL), and physical activity. Hence, this study aimed to investigate the influence of gender on pain perception, QOL, and physical activity in patients with knee osteoarthritis. A cross-sectional study design with a total of 186 patients(mean age of 56.64 ± 6.49) with knee osteoarthritis were recruited. Pain intensity, level of physical activity, and QOL of patients were assessed using a visual analog scale (VAS), global physical activity questionnaire (GPAQ), and Short Form-36 (SF-36) questionnaire. Among the studied patients, 52% of patients with knee osteoarthritis had a relatively low level of physical activity with females representing the majority of them. Lower mean was observed in QOL and physical activity whereas pain intensity was higher in females compared to males (p &lt; 0.05). Pearson correlation demonstrated a strong negative correlation between physical activity and pain (r = -0.77, n = 186, p &lt;0.01), and a weak correlation exist between physical activity and all domains of QOL except for the functional capacity and body pain. Majority of female participants with knee osteoarthritis exhibit poor QOL, physical activity, and increased pain intensity as compared to males. Clinicians need to be aware of the influence of gender in treating patients with knee osteoarthritis.

IMMEDIATE AND SHORT TERM EFFECTS OF MULLIGAN MOBILIZATION WITH MOVEMENT, ON PAIN, DISABILITY AND RATIO OF VASTUS MEDIALIS AND VASTUS LATERALIS ACTIVITY IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS IN THE AGE GROUP 50-70 YEARS.

Knee osteoarthritis is a common cause of knee pain and functional impairment. In this study immediate and short term effect of Mulligan mobilization with movement (MWM) technique on Pain,disability,and ratio of vastus medialis and vastus lateralis activity were assessed on 40 individuals with knee osteoarthritis in the age group of 50-70 years. Method- Duration of study for each participant was 2 weeks which included 4 sessions- on day 1,3,5 and 12.Immediate effect was assessed immediately after each treatment session and short term effect was assessed one week after the nal treatment session i.e on day 12.Outcome measures were Numerical Pain Rating Scale,Knee outcome Survey and EMG activity of vastus medialis and vastus lateralis. Result-Signicant immediate effect of MWM on pain was obtained in every session.(p&lt;0.0001).There was signicant short term effect of Mulligan on pain. (p&lt;0.0001).Signicant effect of MWM on disability reduction was also seen (p&lt;0.0001). There was no immediate or short term effect of MWM on ratio of EMG activity of vastus medialis and vastus lateralis muscles.(p=0.5) Conclusion- Mulligan MWM has immediate and short term effect on pain and disability but not on ratio of vastus medialis and vastus lateralis activity in individuals with knee osteoarthritis in the age group of 50-70 years.

Ultrasound-Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study.

Distal iliotibial band friction syndrome (ITBFS) is a common cause of knee pain in endurance athletes. Nonsurgical treatment is usually successful, but surgery is occasionally required for recalcitrant cases. No published studies to date have evaluated the feasibility of an ultrasound-guided (USG) partial iliotibial band (ITB) release. To determine the feasibility of an USG partial ITB release using a cutting wire. A secondary aim was to assess whether adjacent structures were damaged. We hypothesized that the posterior distal ITB could be partially transected with a cutting wire under USG with no injury to adjacent structures. Cadaveric study. Quaternary-care academic institute. Ten cadaveric knees ranging from 76-89 years old with a mean body mass index of 21.9 kg/m2 . One physician sonographer performed USG releases of the posterior ITBs at the level of the lateral femoral epicondyle with a cutting wire. Dissection was carried out by an independent second physician to assess for primary and secondary outcomes. (1) Release of the posterior border of the ITB; (2) width of the release; (3) evaluation for any injury to adjacent structures; (4) technical difficulty of the procedure (0 = no difficulty, 10 = most difficult procedure possible); (5) duration of time it took to complete the procedure. All 10 knees had the posterior border of the ITB transected. Mean release length was 16 mm (range 15-17), which was within 1 mm of the target release length of 15 mm. No adjacent structures were damaged. A USG release of the posterior ITB utilizing a cutting wire is feasible and safe in a cadaveric model. Translational research is warranted to determine how these results apply to the clinical setting.

HAPPi Kneecaps! Protocol for a participant- and assessor-blinded, randomised, parallel group feasibility trial of foot orthoses for adolescents with patellofemoral pain

BackgroundPatellofemoral pain (PFP) is a common cause of knee pain in adolescents, but there are limited evidence-based treatment options for this population. Foot orthoses can improve pain and function in adults with PFP, and may be effective for adolescents. The primary aim of this study is to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating the effects of contoured foot orthoses on knee pain severity and patient-perceived global change, compared to flat shoe insoles, in adolescents with PFP. The secondary aim is to provide an estimate of treatment effects for foot orthoses, compared to flat insoles, in adolescents with PFP.MethodsThis randomised, controlled, participant- and assessor-blinded, feasibility trial has two parallel groups. Forty adolescents (aged 12–18 years) with clinical symptoms of PFP will be recruited from Queensland, Australia. Participants will be randomised to receive either prefabricated contoured foot orthoses or flat shoe insoles. Both interventions will be fit by a physiotherapist, and worn for 3 months. Feasibility will be evaluated through assessing willingness of volunteers to enrol, number of eligible participants, recruitment rate, adherence with the study protocol, adverse effects, success of blinding, and drop-out rate. Secondary outcomes will evaluate knee-related pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions, at 6 weeks and 3 months. Primary outcomes will be reported descriptively, while estimates of standard deviation and between-group differences (with 95% confidence intervals) will be reported for secondary outcomes.DiscussionFindings of this study will inform the feasibility of a full-scale RCT investigating the efficacy of contoured foot orthoses in adolescents with PFP. This full-scale study is necessary to improve the evidence base for management of adolescent PFP, and enhance outcomes for this population.Trial registrationACTRN12619000957190.

Impact of ultrasonography-detected pes anserine bursitis on pain and function in patients with primary knee osteoarthritis

Background: Pes anserine bursitis (PAB) is one of the most common causes of knee pain. Hence, this study aimed to compare the pain and function among all primary knee osteoarthritis (KOA) patients with or without ultrasonic-detected PAB and the associated clinical and radiological findings.Methods: A single-center cross-sectional study was conducted on 245 patients with primary KOA. The more symptomatic knee examined with musculoskeletal ultrasound (MSUS), were then categorized into two groups according to the presence of PAB; PAB was graded from 0 to 2 on a semi-quantitative scale. Radiological grades of Kellgren–Lawrence were recorded. Pain and functional status was assessed by visual analog scale (VAS), Health Assessment Questionnaire-II (HAQ-II), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results: A total of 110 (44.9%) patients were diagnosed with PAB where 91 (82.7%) of them had Grade 1 and only 19 (17.3%) had Grade 2. The presence of PAB was statistically significant related (P < 0.05*) with age, VAS, HAQ-II, WOMAC subscales, synovitis, and radiographic Grades 3 and 4. However, there was no statistically significant difference (P ≥ 0.05) between KOA patients without PAB and KOA patients with PAB, regarding sex, body mass index, Baker cyst, and effusion.Conclusion: The presence of PAB on MUS is associated with increased pain and disability in KOA. MSUS should be more widely used to establish the association between PAB and symptom severity and disability among KOA patients.

Knee pain in children

Abstract Knee pain is common in children, particular during adolescence. A detailed history and clinical examination often will identify the likely cause. Health care professionals looking after children and young people should be aware of the common causes of knee pain and red flags which are a feature of more sinister causes. Common causes of knee pain include patellofemoral problems, apophysitis such as Osgood Schlatter's disease and Sinding-Larsen-Johansson Syndrome, osteochondritis dissecans, trauma, rheumatological causes such as juvenile idiopathic arthritis, and infective causes as such septic arthritis and osteomyelitis. Malignancy must be excluded when there are red flag signs. Non-accidental injury and referred pain from the hip if not considered, can be easily missed. This review offers practical advice regarding the assessment of knee pain.

KNEE PAIN PRESENTING AS LUMBAR RADICULOPATHY: A CASE REPORT

Background: Knee pain in general and if to be specific is the pain located anteriorly, and it is widespread among teenage, adults, and the old age population. Among the anterior knee pain etiologies, patellofemoral pain is one of the most common causes of knee pain. One of the significant issues with the patellofemoral pain is that most of the time it is misdiagnosed, or it is underrated for patients' problems, which in the long run lead to severe functional limitations and muscular atrophy. Right clinical diagnosis at an early phase in musculoskeletal conditions is vital.Case summary: The patient presented with chief complaints of diffused pain over right leg tracking it over to the lower back. She presented with a painful limping gait. No tenderness was noted over the lower back; the neural tension test was nonsignificant. Patellar compression test, Clark's test, eccentric step was positive. Severe disuse quadriceps muscular atrophy was noted over-involved limb. Tenderness over the retropatellar surface was significant. The patient was managed with cryotherapy at home, therapeutic ultrasound over the tender area along with Kinesio tapping, proprioception exercises, stretching, and strengthening exercises.Outcome measure: Pain, ROM, girth measurement, gait pattern. Significant improvement was noted in pain on NPS, ROM, and gait pattern in two weeks management.Conclusion: The Physiotherapy management in cases of anterior knee pain, specifically patellofemoral pain, mainly consisting of kinesiotaping, therapeutic ultrasound, cryotherapy, therapeutic exercises are very effective provided right clinical diagnosis, is made. The treatment outcome may be more fruitful if the correct clinical diagnosis is made at an early stage.

Knee pain, with or without osteoarthritis, is associated with significant co-morbidity in a primary care population

Purpose: Knee pain is a common symptom experienced by patients of all ages and sexes. Though the underlying pathologies are numerous, one of the most common causes of knee pain, especially in the aging population, is osteoarthritis (OA). OA is associated with significant disability, morbidity and mortality. In contrast, the burden of knee pain and its association with chronic disease is not well understood, though joint pain has been previously suggested to adversely impact outcomes in patients with multiple co-morbidities. This study therefore seeks to understand the relationship of knee pain, with and without associated OA, and the prevalence of common chronic conditions in primary care populations within Southwestern Ontario. Methods: In Southwestern Ontario, the Deliver Primary Health Care Information (DELPHI) database has been developed to share primary health information with researchers. The data presented in this study is a retrospective analysis of International Classification of Primary Care (ICPC-2R) coded encounters in the DELPHI database. This database contains data from 1790 patients under the care of 23 physicians encompassing 15,149 randomly selected encounters between 2006-2010. According to the ICPC-2R coding, L15 represents knee symptom/knee complaint and L90 is the diagnostic code for OA. Results: Between 2006 and 2010, 209/1790 (11.7%) patients presented with knee symptoms/knee complaint (L15) in a total of 342 visits. Of these 209 patients, 99 (60 females, 39 males) had a diagnosis of osteoarthritis (L90) while 110 (60 females, 50 males) did not. Of the 99 patients with OA, 64 of these were new diagnoses made within the study period and 57 of them were diagnosed at their first L15 visit. Using chi-square analysis and pairwise comparison of proportions, we found statistically significant increases in the prevalence of diabetes (13.6% versus 20.9% with L15, p=.004), hypertension (28.1% versus 45.5% with L15, p<.001) and heart failure (3.5% versus 8.2% with L15, p=.013) in patients with knee symptoms/complaints without OA compared to the prevalence within the study population. Additionally, we saw modest (but not significant) increases in the prevalence of depression and anxiety (19.6% versus 28.2% with L15), hyperlipidemia (15.7% versus 22.7% with L15), obesity (7.5% versus 8.2% with L15) and osteoporosis (5.2% versus 6.4% L15) in patients with knee symptoms/complaints without OA compared to the prevalence within the study population. Interestingly, in patients with OA experiencing persistent knee symptoms/complaints we see a higher prevalence of diabetes (23.2%), hypertension (54.5%), hyperlipidemia (24.2%), obesity (14.1%), osteoporosis (10.1%) compared to those with knee symptoms alone. In patients with OA and persistent knee symptoms/complaints we see depression and anxiety (23.2%) and heart failure (5.1%) with reduced prevalence compared to what was seen in patients with knee symptoms/complaints alone. Conclusions: Our data show that knee pain is a common presenting complaint in the primary care population and OA is identified to be the cause of that symptom in approximately 48.8% of these cases. Our data support previous findings that suggest knee OA is a common contributor to multi-morbidity and an increasingly prevalent challenge to healthcare. Interestingly however, our data also show that knee pain alone, without OA, is also associated with significant increases in the prevalence of these same conditions when compared to the general study population. Furthermore, increases in the prevalence of depression, anxiety and heart failure are also seen in patients with isolated knee pain without OA. These findings can help primary care physicians better understand the population of patients presenting with knee pain and improve our understanding of the burden of the symptom, with or without OA as the underlying cause. Furthermore, understanding the relationship between chronic disease, mental health and pain can help guide multimodal management strategies to comprehensively manage symptoms, despite limited disease modifying strategies available for OA.