Kujala Patellofemoral Score Research Articles

Comparison of efficiency of Kinesio® taping and electrical stimulation in patients with patellofemoral pain syndrome

The aim of this study was to compare the efficiency of Kinesio® taping and electrical stimulation in the treatment of patellofemoral pain syndrome. Thirty patients (26 females, 4 females; mean age: 32.9 ± 12.2 years) with patellofemoral pain syndrome were equally divided into two groups; the KT group receiving Kinesio® taping and an exercise program, and the ES group receiving electrical stimulation and the same exercise program. All patients received stretching and strengthening exercises for the lower extremity under the supervision of a physiotherapist in the outpatient unit 3 times a week for 6 weeks (18 sessions). Patients were evaluated for pain (visual analog scale), range of motion (using a goniometer), muscle strength (manual muscle test), functional condition (step test, triple-jump test, knee flexion test and Kujala patellofemoral score), and quality of life (SF-36) before and after treatment. Visual analog scale scores were reduced by 3.33 and 3.93 and Kujala patellofemoral scores increased by 8.93 and 9.66 for the KT and ES groups, respectively. Both these improvements were statistically significant (p<0.05). While improvements were observed in functional tests, range of motion, and muscle strength values in both groups; there were no significant differences between the two groups (p>0.05). There were statistically significant improvements in the SF-36 scores in both groups (p<0.05) and these improvements were of a similar rate (p>0.05). Kinesio® taping and electrical stimulation have similar effects on decreasing pain, improving functional condition, increasing muscle strength and improving quality of life and neither are superior in the treatment of patellofemoral pain syndrome.

Effect of Therapeutic Modalities on Patients With Patellofemoral Pain Syndrome

Context:Patellofemoral pain syndrome (PFPS) is a common orthopaedic condition for which operative and nonoperative treatments have been used. Therapeutic modalities have been recommended for the treatment of patients with PFPS—including cold, ultrasound, phonophoresis, iontophoresis, neuromuscular electrical stimulation, electrical stimulation for pain control, electromyographic biofeedback, and laser.Objective:To determine the effectiveness of therapeutic modalities for the treatment of patients with PFPS.Data Sources:In May and August 2010, Medline was searched using the following databases: PubMed, CINAHL, Web of Science Citation Index, Science Direct, ProQuest Nursing & Allied Health, and Your Journals@OVID.Study Selection:Selected studies were randomized controlled trials that used a therapeutic modality to treat patients with PFPS. The review included articles with all outcome measures relevant for the PFPS patient: knee extension and flexion strength (isokinetic and isometric), patellofemoral pain assessment during activities of daily life, functional tests (eg, squats), Kujala patellofemoral score, and electromyographic recording from knee flexors and extensors and quadriceps femoris cross-sectional areas.Data Extraction:Authors conducted independent quality appraisals of studies using the PEDro Scale and a system designed for analysis of studies on interventions for patellofemoral pain.Results:Twelve studies met criteria: 1 on the effects of cold and ultrasound together, ice alone, iontophoresis, and phonophoresis; 3, neuromuscular electrical stimulation; 4, electromyographic biofeedback; 3, electrical stimulation for control of pain; and 1, laser.Discussion:Most studies were of low to moderate quality. Some reported that therapeutic modalities, when combined with other treatments, may be of some benefit for pain management or other symptoms. There was no consistent evidence of any beneficial effect when a therapeutic modality was used alone. Studies did not consistently provide added benefit to conventional physical therapy in the treatment of PFPS.Conclusions:None of the therapeutic modalities reviewed has sound scientific justification for the treatment of PFPS when used alone.

Surgical treatment of recurrent habitual patellar dislocation associated with severe trochlear hypoplasia and generalized ligament laxity

Abstract Introduction Recurrent habitual patellar dislocation can be treated by soft tissue reconstruction or osteotomy or combination of both. However, no single surgical procedure can address the complex issue. We have successfully treated three patients (four knees) with trochlea hypoplasia and generalized ligament laxity with different surgical techniques. Patients and Methods From January 2001 to November 2008, four knees of three female patients were presented with recurrent habitual dislocation of the patella and generalized ligament laxity. Different surgical procedures were performed, including Insall proximal realignment in two knees, Roux-Goldthwait procedure in one knee, and combined trochleoplasty and tibial tubercle transfer in one knee. This article reports the functional and radiographic assessments at a mean follow-up of 3.4 years. Results The modified Cincinnati score increased from 74 ± 9 preoperatively to 88 ± 6 at latest follow-up; and the Kujala patellofemoral disorder score increased from 75 ± 10 to 86 ± 11. No recurrent dislocation occurred on all knees. Radiographic parameters improved, including congruence angle and axial linear patellar displacement. The sulcus angle improved in patient who underwent combined trochleoplasty and tibial tubercle transfer. Conclusions Surgical treatment for recurrent habitual dislocation of the patella varied according to the severity of the anatomical abnormality and the patellar stability assessed intraoperatively. In severe cases, combined trochleoplasty and tibia tubercle transfer is indicated to correct the recurrent dislocation of the patella. Proper patient selection and good surgical technique are the keys to success.

Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study

BackgroundPatellofemoral pain syndrome (PFP) is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected individuals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in individuals with PFP.MethodsA prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS), functional index questionnaire (FIQ), step down repetitions) were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ). Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome.ResultsLong symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (β-0.07, 95% confidence interval -0.1 to -0.03, p < 0.000; and -0.02, -0.03 to -0.01, p < 0.000, respectively). Worse KPS at baseline was predictive of outcome at six, 12 and 52 weeks. Gender, body mass index and arch height were generally not associated with outcome (univariate analysis), while age, worst pain, FIQ and step downs were excluded during multivariate analyses.ConclusionsPatients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis.

Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome

Patellofemoral pain syndrome is one of the most common knee problems, with major effects on quality of life and function. The Kujala patellofemoral score is a functional evaluation instrument to evaluate knee problems related to the patellofemoral system. The aim of this study was to evaluate the validity of the Turkish version of the Kujala patellofemoral score in patients with patellofemoral pain syndrome. After obtaining permission from Kujala et al., the Kujala patellofemoral score was translated into Turkish. The translated version was administered to 40 patients (32 women, 8 men; mean age 33+/-12 years; range 17 to 54 years) twice at a two-week interval to test internal consistency and test-retest reliability of the scale. All the patients had patellofemoral pain syndrome and did not receive any treatment before administration of the scale. Cronbach's alpha coefficient was used to assess internal consistency and Spearman's correlation analysis was used to assess test-retest reliability. Cronbach's alpha calculated for internal consistency of the Kujala patellofemoral score was 0.84. Correlation coefficients of the items to estimate test-retest reliability ranged from 0.613 (p=0.004) to 1.000 (p=0.000), with the mean correlation coefficient of 0.944 (p=0.000). There has been no functional assessment scale validated for Turkish patients with patellofemoral pain syndrome. Internal consistency of the Turkish version of the Kujala patellofemoral score showed good reliability and test-retest results showed high reliability, suggesting that it is an appropriate functional instrument for Turkish patients with patellofemoral pain syndrome.

Exercise Therapy Versus "Usual Care" For Patellofemoral Pain Syndrome - The Pex Study

Exercise therapy versus "usual care" for patellofemoral pain syndrome - the PEX study, a randomized clinical trial. OBJECTIVE: To assess the effectiveness of exercise therapy compared to 'usual care' (wait and see approach) at 3 and 12 months follow-up with respect to recovery, pain, and function in patients with patellofemoral pain syndrome. PARTICIPANTS: Patients with a new episode of PFPS (n=131) recruited by their physician. INTERVENTIONS: The intervention group received a standardized exercise program tailored to individual performance supervised by a physical therapist. Both the intervention group (exercise therapy; n=61) and the control group ("usual care"; n=66) received similar written information about the syndrome and similar instructions for home exercises, as well as the advice to avoid pain-provoking activities. MAIN OUTCOME MEASURES: The primary outcomes were recovery (using a 7 points Likert scale), pain at rest and pain on activity (using a numerical rating scale) and function (using Kujala's patellofemoral score) at 3 and 12 months follow-up RESULTS: A total of 131 participants were included in the study. After 3 months the intervention group showed significantly less pain and better function scores. Adjusted differences for pain at rest -1.07 (-1.92 to -0.22), pain on activity -1.00 (-1.91 to -0.08) and function score 4.92 (0.14 to 9.72).At 12 months pain scores were significantly lower in the intervention group; pain at rest -1.29 (-2.16 to -0.42) and pain on activity -1.19 (-2.22 to -0.16). There was no significant difference for recovery at 3 and 12 months between groups. Recovery ranged from 41.9% at 3 months to 62.1% at 12 months in the exercise group and from 35% (3 months)to 50.8% (12 months) in the control group. Predefined subgroup analyses revealed that patients recruited by the sports physician (n=30 patients) showed no beneficial effect of exercise therapy, whereas being recruited by the general practitioner (n=101 patients) resulted in significant and clinically relevant differences for outcomes 'pain' and 'function' in favor of the exercise group. CONCLUSION: 3 months of supervised exercise therapy for patellofemoral pain syndrome results in less pain and better function at short term and long term follow up compared to 'usual care' for patients in general practice.

Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial

Objective To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome.Design Open label randomised controlled...

The effects of vacuumic bracing system on the patellofemoral articulation in patients with patellofemoral pain syndrome

Patellar bracing is a component of treatment of patellofemoral joint (PFJ) problems. A new vacuumic brace was designed by the researchers that act based on an external vacuuming suction. Ten patients were undertaken for the CT scan study at both 0 degrees and 30 degrees knee flexion immediately pre- and post-bracing. Also they examined clinically pre, post and 1 week after using the brace. Measurements of patellofemoral joint space width (PFJSW) and patellofemoral joint area (PFJA) showed that the application of the vacuumic brace is able to create a significant patellofemoral joint distraction at both knee angles. A significant reduction in visual analog scale (VAS) and increase in kujala patellofemoral score (KPS) was found in subjects after using the brace for 1 week. In conclusion, the results conveyed that application of the vacuumic brace is able to create a joint distraction and useful changes in VAS and KPS parameters.

Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts

Existing clinical studies have not proven which graft is to be preferred in anterior cruciate ligament (ACL) reconstruction. In recent years, bone-patellar tendon-bone and hamstring tendons have been the most frequently used graft types. Muscle strength deficit is one of the consequences after ACL reconstruction. The aim of this study was to evaluate possible differences in hamstring and quadriceps muscle strength and knee function 5 years after ACL reconstruction between the BPTB and the STG groups. The study group consisted of 288 patients (132 women, 156 men) with a unilateral ACL rupture who had received a BPTB (175 patients) or STG (113 patients) ACL reconstruction. Lower extremity concentric isokinetic peak extension and flexion torques were assessed at the angular velocities of 60 degrees /s and 180 degrees /s. The International Knee Documentation Committee (IKDC), the Tegner activity level, the Lysholm knee and the Kujala patellofemoral scores were also collected. Isokinetic quadriceps peak torque (percentage of the contralateral side) was 3.9% higher in the STG group than in the BPTB group at the velocity of 60 degrees /s and 3.2% higher at the velocity of 180 degrees /s and the isokinetic hamstring peak torque 2% higher in the BPTB group than in the STG group at the velocity of 60 degrees /s and 2.5% higher at the velocity of 180 degrees /s. In both groups the subjects had weaker quadriceps and hamstring muscle strength in the injured extremity compared with the uninjured one. In the single-leg hop test (according to the IKDC recommendations) there was a statistically significant difference (P = 0.040) between the groups. In the STG group, 68% of the patients had the single-leg hop ratio (injured vs. uninjured extremity) > or =90%, 31% of the patients 75-89% and 1% of the patients <75%, while in the BPTB group the corresponding percentages were 72, 21 and 7%. However, no statistically significant differences in clinical outcome were found between the groups as determined by the IKDC, Tegner activity level, Lysholm knee and Kujala patellofemoral scores.

Training Program and Additional Electric Muscle Stimulation for Patellofemoral Pain Syndrome: A Pilot Study

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study. Objectives To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles. Design A randomized clinical trial. Setting Supervised physiotherapy (PT) training and home-based EMS. Participants Patients (N=38; 14 men, 24 women) with bilateral PFPS. Interventions One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA. Main Outcome Measures Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year. Results Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group. Conclusions A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.

Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results

Patellar tendon graft has been the most frequently used material in anterior cruciate ligament (ACL) reconstruction, but the hamstring tendons have been increasingly used as well; however, which graft is to be preferred is not adequately supported by existing clinical studies. In this prospective randomized clinical trial, the study hypothesis was that the hamstring tendons are equally good graft material as the patellar tendon in ACL reconstruction. Ninety-nine patients with laxity due to a torn ACL underwent arthroscopically assisted reconstruction with graft randomization according to their birth year to either patellar tendon with metal interference screw fixation or double looped semitendinosus and gracilis tendons with fixation similar to the Endobutton technique using a titanium metal plate suspension proximally and screw-washer postdistally. Excluding preoperative Lysholm knee score, there were no significant differences between the two groups in the preoperative and operative data. A standard rehabilitation regimen was used for all the patients, including immediate postoperative mobilization without a knee brace, protected weight bearing for 2 weeks, and return to full activity at 6-12 months postoperatively. Forty patients in the patellar tendon group and 39 patients in the hamstring tendon group were available for clinical evaluation at median 5 years after surgery (ranges 3 years 11 months-6 years 7 months). The results revealed no statistically significant differences with respect to clinical and instrumented laxity testing, isokinetic muscle torque measurements, International Knee Documentation Committee ratings, Lysholm (knee score), Tegner (activity level) and Kujala patellofemoral knee scores. There was an enlargement of the drill tunnels, statistically more in the hamstring tendon group, but no increase from 2 to 5 years in either group. Narrowing of the joint spaces (IKDC measurement method) from 2 to 5 years postoperatively was seen in both the groups, however, without difference between the two groups.

Electric muscle stimulation of the quadriceps in the treatment of patellofemoral pain

Callaghan MJ, Oldham JA. Electric muscle stimulation of the quadriceps in the treatment of patellofemoral pain. Arch Phys Med Rehabil 2004;85:956–62. Objective To compare a commercially available electric muscle stimulation regimen with a novel form of stimulation for the rehabilitation of the quadriceps muscle, in patients with patellofemoral pain syndrome. Design Double-blinded randomized trial with a parallel control group and stratified randomization. Setting Home-based rehabilitation program assessed in research center. Participants Eighty patients (47 women, 33 men) with patellofemoral pain syndrome. Interventions One group (EMPI) received 1 uniform constant frequency component of 35Hz. The other (EXPER) group received an experimental form of stimulation that contained 5 simultaneously delivered frequency components of 125, 83, 50, 2.5, and 2Hz. Stimulation was applied to the quadriceps muscles of the affected leg for 1 hour daily for 6 weeks, a total of 42 treatments. Main outcome measures Lower-limb isometric and isokinetic torque, quadriceps fatigue, knee flexion, patellar pain, a step test, quadriceps cross-sectional area, and Kujala patellofemoral score for pain before and after treatment. Results Seventy-four patients (43 women, 31 men) completed the trial. Patients in both groups showed significant improvements in all outcomes ( P<.05). No significant differences existed between the 2 stimulators in any outcome ( P>.05) except for quadriceps cross-sectional area ( P=.023). Conclusions One form of stimulation was just as efficacious as the other in improving subjective and objective measures.

Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment.

We performed a prospective analysis of 29 Fulkerson anteromedial tibial tubercle transfers in patients with chronic anterior knee pain. The average followup was 32 months (range, 25 to 44). Fourteen patients (Group 1) had subluxation-type malalignment (congruence angle > 20 degrees, tilt angle > 8 degrees) and were treated with an isolated anteromedial tibial tubercle transfer. Fifteen patients (Group 2) had combined subluxation and tilt malalignment (congruence angle > 20 degrees, tilt angle < 8 degrees) and underwent anteromedial tibial tubercle transfer combined with a lateral release. Pre- and postoperative evaluations included clinical and radiographic examinations, Lysholm and Kujala patellofemoral scores, and standing-alignment computed tomography scans in 15 degrees of flexion taken transversely at the midpatellar. In all but one patient a dramatic improvement in Lysholm and Kujala scores was noted. The congruence angle improved in all patients except one, with an average improvement of 16 degrees in Group 1 and of 14 degrees in Group 2. The tilt angle remained relatively unchanged (change, -0.5 degree) in Group 1, but it improved by 11 degrees in Group 2. We conclude that an isolated anteromedial tibial tubercle transfer can consistently improve patellar subluxation and, when combined with a lateral release, can improve patellar subluxation and tilt, resulting in improved functional scores for patients with chronic anterior knee pain.

Psychophysiological significance of temporal order in brain chaos

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study.To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.A randomized clinical trial.Supervised physiotherapy (PT) training and home-based EMS.Patients (N=38; 14 men, 24 women) with bilateral PFPS.One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.