Management Of Anterior Knee Pain Research Articles

Decision Making and Management of Anterior Knee Pain in Young Patients With Pathological Femoral Anteversion: A Critical Analysis Review.

Pathological femoral anteversion (FAV) or femoral maltorsion is often overlooked as a cause of anterior knee pain (AKP). Therefore, it should be routinely evaluated during physical examination of the patient with AKP. FAV is a problem because it changes the direction of the quadriceps and thereby the force acting on the patellofemoral joint. The Murphy CT method comes closest to showing the anatomical reality when FAV is evaluated. The treatment of choice in a patient with AKP with symptomatic excessive FAV is the femoral derotational osteotomy. Before doing a derotational osteotomy, the hip joint should be evaluated to avoid hip pain. Currently, no scientific evidence supports the cutoff point at which derotational femoral osteotomy should be the treatment of choice in young patients with AKP with symptomatic pathological FAV. Furthermore, no evidence exists regarding the level at which the osteotomy must be done.

Non-operative Management of Anterior Knee Pain: Patient Education

Purpose of ReviewAnterior knee pain is a multifactorial, often chronic condition, which can lead to long-term pain and disability. The purpose of this review is to examine the latest research on patient education for anterior knee pain. We will focus on how we might use patient education to increase the adoption of other efficacious treatment modalities and offer some suggestions for content and form of effective patient education.Recent FindingsNew research suggests that patient education, alone, or in combination with targeted exercise therapy, can be effective in reducing pain and improving function in patients with patellofemoral pain. Addressing non-physical or psychological factors may also be an important component of patient education in many patients with chronic pain. Incorporation of new technologies into patient education, such as those available online, or through phone- or tablet-based apps, is likely to be helpful in the future, as we move more towards connecting with patients virtually.SummaryPatient education has been shown to be effective in decreasing pain and improving activity in patients with patellofemoral pain. Patient education should be individualized to the patient, focus on the latest effective treatments, and emphasize those treatments that can be self-managed by the patient. Emphasis should also be placed on patient understanding of risk factors and patterns of movement that may lead to, or exacerbate, anterior knee pain. Future research should continue to further characterize the elements of patient education that offer the most efficient treatment benefit.

Physical Therapist Management of Anterior Knee Pain.

Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.

Arab Knee: Management and Prevention-A Case Report

Radiographic osteoarthritis of the knee is very common in Saudi patients, especially in the patellofemoral compartment.
 Some studies have considered repetitive daily prayer activities as a factor of causation. However prevention and management recommendations appear to be non-existent in the literature. This report describes the case of chronic bilateral anterior knee pain in a devout adult male, which was dramatically alleviated by simply using a padded cushion under the prayer rug. Simple strategies of temporarily modifying prayer posture, insuring good prayer form, and adequate knee padding, may offer promise as low tech and economical solution for the management of anterior knee pain in this cultural group.

Efficacy of Kinesio Taping and McConnell Taping Techniques in the Management of Anterior Knee Pain

Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. Cross-sectional design. Clinical biomechanics laboratory. Ten participants (age: 20.3 [1.5]y, height: 169.9 [10.4]cm, and mass: 70.17 [13.1]kg) with anterior knee pain and no history of trauma. Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges' g), 95% confidence intervals, and repeated-measures analysis of variance (P < .05) compared baseline and taping conditions during exercises for pain Visual Analog Scale and knee flexion in all exercises, hip abduction during step-down and drop jump, frontal plane projection during step-downs, and knee translation in sagittal plane during squats. Significant reductions in Visual Analog Scale were recorded during squats between tapes (F2.505,12.867 = 3.407, P = .04, Hedges' g = -0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14cm, P = .01) and Kinesio taping (mean difference = 1.54cm, P = .02) compared with baseline during squats. A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.

Anterior knee pain and its intrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng.

BackgroundAnterior knee pain (AKP) is the most common injury among runners, especially in females and young runners. Because of a deficit of rehabilitation services in under-resourced communities, runners train and compete with injuries, resulting in further complications.ObjectivesThis study aimed to determine the prevalence and modifiable intrinsic risk factors for AKP among runners in under-resourced communities in Ekurhuleni, Gauteng Province.MethodThis cross-sectional study included a population of 347 runners from six running clubs. Convenience sampling was used to recruit 183 participants aged between 13 and 55. A standardised questionnaire determined AKP prevalence, and 12 physical tests screened for modifiable intrinsic risk factors. Descriptive and inferential statistical tests were used to analyse the data.ResultsAKP was present in 40% of participants, particularly in males (57.9%) and young runners (57.9%) with 3–5 years of running experience (31.1%). Anterior knee pain was significantly associated with age (chi-square [χ2] = 6.484, p = 0.039) and running experience (χ2 = 8.389, p = 0.036). The modifiable intrinsic risk factors found to have contributed significantly to AKP were: tight hamstrings (odds ratio [OR] = 1.021; p = 0.051); tight iliotibial band (OR = 1.1; p = 0.046); weak quadriceps (OR = 0.15; p = 0.040); weak hip muscles (OR = 1.13; p = 0.004) and patellar tilt abnormalities (OR = 1.33; p = 0.015).ConclusionAnterior knee pain and various modifiable intrinsic risk factors were found among these runners. These findings suggest that management of AKP should take into consideration the effect of these identified modifiable risk factors to improve management outcomes. A community-based rehabilitation approach should be considered, given the lack of resources in low socio-economic communities.Clinical implicationsThe results from this study make explicit the risk factors associated with AKP, particularly in runners from under-resourced communities. These are important considerations in the development of rehabilitation programmes to manage AKP.

Neurodynamic responses to the femoral slump test in patients with anterior knee pain syndrome.

Matched-control, cross-sectional study. The purpose of this study was to compare the responses to the femoral slump test (FST), including the change in hip range of motion and level of discomfort, between subjects with and without anterior knee pain. Anterior knee pain syndrome is a common problem among adults. The FST is the neurodynamic test used to assess the mechanosensitivity of the femoral component of the nervous system. However, as of yet, there is no literature discussing the use of the FST in patients with anterior knee pain. Thirty patients with anterior knee pain and 30 control participants, matched by gender, age, and dominant leg, were recruited. The subjects received the FST, during which the hip extension angle and the location and intensity of pain/discomfort were recorded. Reproduction of symptoms that were alleviated by neck extension was interpreted as a positive test. Differences in hip extension angle and pain intensity between groups were examined using a 2-way, repeated-measures analysis of variance and a Kruskal-Wallis analysis. The level of significance was set at α = .05. Subjects with anterior knee pain had a smaller hip extension angle than that of controls (-3.6° ± 5.3° versus 0.6° ± 6.1°; mean difference, 4.2°; 95% confidence interval [CI]: 1.24°, 7.15°; P = .006). Eight patients with anterior knee pain showed a positive FST, and those with a positive FST had a smaller hip extension angle (-5.7° ± 4.5°) than that of controls (mean difference, 6.3°; 95% CI: 0.8°, 11.8°; P = .007). There was no difference in the hip extension angle between the positive and negative FST groups (mean difference, 2.9°; 95% CI: -8.5°, 2.0°) or between the negative FST and control groups (mean difference, 3.4°; 95% CI: -0.4°, 7.3°). Results of this study suggest that altered mechanosensitivity of the femoral nerve occurred in the patients with anterior knee pain who presented with a positive FST. The role of increased mechanosensitivity in the development and management of anterior knee pain should be investigated in the future.

The Effect of Patellar Taping on Squat Depth and the Perception of Pain in People with Anterior Knee Pain

Patellar taping is a treatment adjunct commonly used in the management of anterior knee pain. The aim of this cross sectional study was to investigate the effects of medial glide patellar taping on sagittal plane lower-limb joint kinematics and knee pain during a unilateral squat in a symptomatic population complaining of anterior knee pain. Ten participants with a history of unilateral or bilateral anterior knee pain were included in the study. Subjects were required to squat on the symptomatic leg under three conditions: placebo tape, patellar tape and no tape. Kinematic data was recorded using the CODA mpx64 motion analysis system and subjects' pain was assessed using the Numerical Rating Scale. Patellar taping resulted in a significantly greater single-legged squat depth compared to placebo tape (p=0.008) and no tape (p=0.001) and a statistically significant reduction in pain during a squat compared to placebo tape (p=0.001) or no tape (p=0.001). Significant differences were not identified for maximum knee flexion in the patella taping compared to the no tape condition. This study may have significant clinical implications as participants reported less pain and alterations in sagittal plane movement following the application of patellar tape.

Efficacy of Nonsurgical Interventions for Anterior Knee Pain

Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0.21; 8-12 weeks: SMD -0.22, 95% CI -0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required.

Contoured prefabricated foot orthoses are superior to flat inserts in the short-term management of anterior knee pain

Contoured prefabricated foot orthoses are superior to flat inserts in the short-term management of anterior knee pain

406 Foot orthoses in the management of anterior knee pain: What is the evidence?

406 Foot orthoses in the management of anterior knee pain: What is the evidence?

Footwear traction and knee joint moments

Patellar complications are a source of poor total knee arthroplasty (TKA) outcomes that can require re-operation or prosthetic revision. Complications can occur with or without patellar resurfacing. The objective of this work is to answer six questions. (1) Have risk factors been identified, and can they help to prevent patellar complications? Patellar complications are associated with valgus, obesity, lateral retinacular release, and a thin patella. Selecting a prosthetic trochlea that will ensure proper patellar tracking is important. Resurfacing is an option if patellar thickness is greater than 12 mm. (2) What is the best management of patellar fracture? The answer depends on two factors: (a) is the extensor apparatus disrupted? and (b) is the patellar implant loose? When either factor is present, revision surgery is needed (extensor apparatus reconstruction, prosthetic implant removal). When neither factor is present, non-operative treatment is the rule. (3) What is the best management of patellar instability? Rotational malalignment should be sought. In the event of femoral and/or tibial rotational malalignment, revision surgery should be considered. If not performed, options consist of medial patello-femoral ligament reconstruction and/or medialization tibial tuberosity osteotomy. (4) What is the best management of patellar clunk syndrome? When physiotherapy fails, arthroscopic resection can be considered. Recurrence can be treated by open resection, despite the higher risk of complications with this method. (5) What is the best management of anterior knee pain? The patient should be evaluated for causes amenable to treatment (fracture, instability, clunk, osteonecrosis, bony impingement on the prosthetic trochlea). If patellar resurfacing was performed, loosening should be considered. Otherwise, secondary resurfacing is appropriate only after convincingly ruling out other causes of pain. A painstaking evaluation is mandatory before repeat surgery for anterior knee pain: surgery is not in order in the 10% to 15% of cases that have no identifiable explanation. (6) What can be done to treat patellar defects? Available options include re-implantation (with bone grafting, cement, a biconvex implant, or a metallic frame), bone grafting without re-implantation, patellar reconstruction, patellectomy (best avoided due to the resulting loss of strength), osteotomy, and extensor apparatus allograft reconstruction.V, expert opinion.

Anterior knee pain: a review.

To establish whether there is consensus in the areas of definition, classification, assessment, diagnostic tests, and management of anterior knee pain. A Medicine search for the years 1988-1995 was performed using the terms patellofemoral joint, knee joint and pain, injury and rehabilitation, and anterior knee pain. In addition, references from selected papers were examined. A total of 77 references specifically related to anterior knee pain were reviewed in the areas of definition, classification, assessment, diagnostic tests, and management. Although a small number of these papers were analytic in their study design, most of the papers reviewed were descriptive. Definitive statements on anterior knee pain in the areas noted herein were extracted and summarized. Similar statements were then grouped as indicative of general consensus. Independent and divergent statements were also summarized for each area of anterior knee pain. Most of the literature related to anterior knee pain is subjective in nature and demonstrates limited consensus among experts. There is no generally accepted definition or classification of anterior knee pain. There was some agreement on the assessment, use of diagnostic tests, and management of anterior knee pain, but there are no definitive or objective management outcome criteria. The scientific literature on anterior knee pain is sparse. This review supports a need for the development of consensus guidelines for anterior knee pain. A consensus approach to anterior knee pain could result in the more efficient use of high-yield diagnostic tests, the use of more effective and standardized protocols for assessment and treatment, increased patient satisfaction, and recommendations on fitness counseling and early prevention.

The McConnell regimen versus isometric quadriceps exercises in the management of anterior knee pain. A randomised prospective controlled trial

Fifty consecutive patients who presented to an Outpatient Physiotherapy Department with anterior knee pain were randomly allocated to management with the McConnell regimen or isometric quadriceps exercises and completed the treatment programme. In patients treated by the McConnell regimen, McConnell's critical test was elicited significantly less frequently at 60° after 7 days, and in all positions, and with pressure at 90° and 120° on completion of treatment. There were no other differences between the two groups.

Arthroscopy in the Treatment of Young Patients with Anterior Knee Pain

Arthroscopy plays an important role in diagnosis in the management of anterior knee pain and may be used for treating the underlying pathology.