Patellofemoral Score Research Articles

Does the appearance of the patellofemoral joint at surgery influence the clinical result in medial unicompartmental knee arthroplasty?

The purpose of this study is to investigate the likelihood of unicompartmental knee arthroplasty (UKA) in patients with chondrosis in the patellofemoral joint. We evaluated the pain and functional changes in the patellofemoral joint of 62 patients who underwent medial UKA for medial compartmental osteoarthritis with symptoms in the patellofemoral joint. They were analyzed by the patellofemoral score of Lonner at postoperative 3months, 6months, 1year, and 2years prospectively. Preoperatively, the grade by total score was poor in all 62 cases, but it was improved to 36 excellent (58%), 16 good (26%), and 10 fair (16%), and there were no poor cases at 2years. The last follow-up showed satisfactory results in pain score, function score, and total score (p<0.05). Regarding this result, we believe chondrosis in the patellofemoral joint is not a contraindication to UKA, even in patients with patellofemoral joint symptoms.

Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome

Recurrent patella subluxation may be secondary to excessive external tibial torsion. The purpose of this study is to evaluate the clinical and radiographic outcome of patients undergoing tibial derotation osteotomy and tibial tuberosity transfer for recurrent patella subluxation in association with excessive external tibial torsion. A combined tibial derotation osteotomy and tibial tuberosity transfer was performed in 15 knees (12 patients) with recurrent patella subluxation secondary to excessive external tibial torsion. Clinical evaluation was carried out using preoperative and post-operative Knee Society Score (KSS), Kujala Patellofemoral score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the short form-12 (SF-12) and a visual analogue score (VAS) pain scale. The median follow-up period was 84 months (range 15-156) and median patient age was 34 years (range 19-57 years). The median preoperative external tibial torsion was 62° (range 55°-70°), with a median rotational correction of 36° (range 30°-45°) after surgery. Significant improvement (p < 0.05) was found in the KSS part I (37 ± 14 to 89 ± 11 points), KSS part II (25 ± 26 to 85 ± 14 points), Kujala score, the SF-12 outcome, WOMAC score and VAS score (8.8 ± 1.9 to 2.4 ± 1.5). Two patients had a nonunion of the tibial osteotomy site; one patient required bone grafting, while another patient required revision to total knee arthroplasty. Patients presenting with recurrent patella subluxation secondary to excessive external tibial torsion >45° who underwent tibial derotation osteotomy and tibial tuberosity transfer achieved a satisfactory outcome in terms of pain relief and improved function. A significant complication was seen in 2/15 patients. Case series, Level IV.

A Novel Patellofemoral Scoring System for Patellofemoral Joint Status

We were not aware of a well-validated patellofemoral joint-specific scoring system. We performed this study to develop and validate a scoring system (Samsung Medical Center [SMC] patellofemoral scoring system) suitable for the evaluation of patellofemoral joint status. We recruited 179 individuals consisting of a study group of 123 patients with anterior knee pain but without pain in another part of the knee, twenty-eight patients with knee pain other than anterior knee pain (group A), and twenty-eight healthy volunteers without knee pain (group B). Items in the development of the scoring system that showed a significant difference between the study group and group A and between the study group and the group B were selected. Test-retest reliability was measured by intraclass correlation coefficient, internal consistency was measured by the Cronbach alpha, content validity was assessed by ceiling and floor effects, and construct validity was determined by the association of the Feller scores and the SMC patellofemoral scores. After the item verification process, seventeen items (eight items for patellofemoral pain and nine items for patellofemoral function) were selected. Test-retest reliability for overall SMC patellofemoral scores showed excellent reliability (intraclass correlation coefficient, 0.85), and internal consistency was excellent (Cronbach alpha, 0.97). Floor and ceiling effects were acceptable (&lt;30%) for all the items of the SMC patellofemoral scoring system, except one: sitting down on a chair, in the patellofemoral function score. The SMC patellofemoral scores showed moderate correlation with the Feller scores (ρ = -0.45). The SMC patellofemoral score is a novel scoring system that distinguishes patients with anterior knee pain or patellofemoral dysfunction from patients with knee pain or dysfunction arising from other knee problems, and from those without knee pain. The reliability and validity of the SMC patellofemoral scoring system were verified in the present study.

The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture

The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. There were 14 (42.4%) patients in Group A, 12 (36.4%) patients in Group B and 7 (21.2%) patients in Group C. The mean patella score in Group C (74±7.02) was significantly lower when compared with Group B (87.6±9.9) and group A (90.6±6.1) (p<0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

Is there a relationship between tracking ability, joint position sense, and functional level in patellofemoral pain syndrome?

This prospective cohort study investigated proprioception and motor control changes in patients with patellofemoral pain syndrome (PFPS), and how these changes related to knee function, pain, muscle strength and muscle endurance. The study included 43 women diagnosed with unilateral patellofemoral pain syndrome. Thirty-one healthy women were recruited as control group. Peak quadriceps femoris and hamstring muscle isokinetic torques were recorded at 60 and 180°/s. Joint position sense was tested by active reproduction of joint position during horizontal squat performance. Muscle coordination and motor control ability were tested by a multi-joint lower limb tracking-trajectory test. Muscle endurance was tested using a computerized functional squat system. Severity of pain in during stair ascent/descent, squatting, and prolonged sitting with knees 90° flexed were measured using a 10 category modified visual analogue scale. Functional levels of patients were determined using Kujala patellofemoral scores. Active reproduction of joint position did not differ between PFPS and control groups. However, tracking-trajectory error was significantly higher in PFPS group than control subjects. Hamstring and quadriceps peak isokinetic torque and muscle endurance scores were significantly lower in the PFPS group. Kujala patellofemoral score displayed significant relationships with peak isokinetic quadriceps torque, knee pain, and joint position sense scores. Pain during stair descent, sitting, and quadriceps torque at 180°/s explained 57.7 % of the variation in Kujala patellofemoral score. Although lower extremity joint position sense did not differ between groups, the PFPS group displayed a target-trajectory muscular coordination deficit, decreased muscular endurance, and decreased muscular strength compared to control group subjects. Pain level directly related to motor control performance while joint position sense scores did not. Knee pain and impaired strength related more to functional performance impairment than joint position sense scores in patients with PFPS.

Triple positioning of tibial tubercle osteotomy for patellofemoral disorders

Background and purposePatellofemoral disorders are often associated with patellofemoral malalignment. Tibial tubercle transfer is an effective method to correct the patellofemoral malalignment. This study evaluated the long-term results of triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders with 10-year follow-up. Patients and MethodsFifty-six patients with 62 knees underwent triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders. All patients received standard rehabilitation protocol postoperatively. The average length of follow-up was 128.5±9.8months (range 116 to 149). The evaluations included pain score, Kujala patellofemoral score, Lysholm score and radiograph of the knee. ResultsThe overall clinical results were excellent in 41.9%, good in 37%, fair in 12.9% and poor in 5% at 1year; and 29% excellent, 41% good, 18.3% fair and 9.3% poor at 10years. Satisfactory results were 78.9% and 70.9%, and unsatisfactory results 21.1% and 29.1% at 1year and 10years respectively. There was no correlation of clinical outcomes with age, sex, body weight and height and preoperative pain score. However, there was a positive correlation of clinical outcomes with the improvement of the congruence angle on postoperative X-rays of the knee, and a negative correlation of clinical outcome with the severity of articular cartilage damage assessed in arthroscopy. The complications included 1 non-union and 1 infection with non-union. ConclusionTriple positioning of tibial tubercle osteotomy is effective and long lasting in patients with patellofemoral disorders with 70.9% satisfactory results at 10-year follow-up. Level of evidenceIV (refer to instructions for detailed description on the level of evidence).

Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns

The objective of present study was to propose a new classification for acute MPFL injury, which can help choose optimal treatment method for certain injury type. Eighty-five patients with acute patellar dislocation treated non-surgically were retrospectively reviewed. They were assigned into two groups according to the newly introduced classification scheme, which classified MPFL injury into three types: injury in overlap region, injury in non-overlap region and combined injury of both regions. For study purpose, patients with combined injury were not included. Of 85 patients, 33 were in the overlap-region group (Group 1) and 52 in the non-overlap-region group (Group 2). Clinical patellar instability rate and patellofemoral score were measured and recorded at 2-year follow-up. The patellar instability rate was 15.2% in Group 1 and 38.5% in Group 2, with statistically significant difference between the two groups (P=0.022). The mean visual analogue scale for Group 1 and Group 2 was 15.6 points and 28.3 points, respectively (P=0.026). The mean Kujala score was 91.1 points and 82.6 points (P=0.009), with a good or excellent subjective result recorded for 27 of 33 patients (81.8%) in Group 1 compared with 30 of 52 patients (57.7%) in Group 2 (P=0.021). Non-surgical treatment achieves better clinical outcomes with respect to a lower patellar instability rate and better subjective function for the overlap-region injury of MPFL than for the non-overlap-region injury, and can be considered as treatment of choice for overlap-region injury of MPFL. The optimal choice for the non-overlap-region injury still requires further researches. Therapeutic, Level IV.

Bone-patellar tendon-bone graft via a single minimally-invasive approach versus a classical approach in anterior cruciate ligament reconstruction: A prospective study

Harvesting the patellar ligament for anterior cruciate ligament reconstructions can be a source of anterior knee pain and hypoesthesia of the lateral side of the knee. We analyzed the feasibility of a minimally-invasive technique via a single patellar approach and postulate that it reduces anterior pain and limits the hypoesthesia area. A prospective, comparative, non-randomized, single-center study was conducted on two groups: one undergoing surgery with the classical anteromedial approach, the other with the minimally-invasive approach. Each group included 20 patients. Both series were reviewed between the 6th and 8th month after surgery. The revision was clinical, radiological, and ultrasonographic. The grafts harvested via the classical approach in all 20 cases presented good characteristics, versus eight out of 18 for the grafts harvested via the minimally-invasive approach. A prominent anterior tibial tuberosity improved the quality of the tibial bone block. A hypoesthesia zone was found in 16 cases out of 18 in the classical approach group, it measured a mean 10.3 ± 5.6 cm(2). A surface area of 3 cm(2) was noted in one case from the minimally-invasive group. No significant difference was found for the subjective and objective IKDC and Lille patellofemoral scores between the two groups. Anterior pain was present in four patients in the classical group and six in the minimally-invasive group. The minimally-invasive technique reduces the risk of cutaneous hypoesthesia. It does not prevent anterior pain related to harvesting the patellar tendon and a good-quality transplant can be obtained if the anterior tibial tuberosity is prominent. Level III: case-control study.

The Effects of Quadriceps Strengthening on Pain, Function, and Patellofemoral Joint Contact Area in Persons with Patellofemoral Pain

Patellar malalignment is a major cause of patellofemoral pain syndrome (PFPS), but the relationship between clinical symptoms and changes in patellar position and knee muscle strength has not been confirmed. This study examined the effect of weight training on hip and knee muscle strength, patellofemoral joint contact area, and patellar tilt on subjects with and without PFPS, hoping to develop an optimal rehabilitation protocol for subjects with PFPS. The study uses a prospective independent group comparison. Fifteen subjects with and without PFPS were assessed for knee strength, patellofemoral joint contact area, and patellar tilt angle using magnetic resonance imaging. The subjects with PFPS were also examined and given a numeric pain rating score and a Kujala patellofemoral score. The subjects performed lower-limb weight training 3 times/wk for 8 wks, and the outcomes were assessed both before and after training. Subjects with PFPS have increased their patellofemoral joint contact area after weight training (P < 0.001). No statistical significant change was found on the patellar tilt angle. The isometric and isokinetic knee strength in subjects with and without PFPS have increased after weight training (P value increased from 0.007 to 0.05). Both numeric pain rating and Kujala patellofemoral score in the PFPS group improved after training (P < 0.001). Weight-training exercise increased knee muscle strength and the patellofemoral joint contact area, which could reduce mechanical stress in the joint, improving pain and function in subjects with PFPS.

Open Lateral Patellar Retinacular Lengthening Versus Open Retinacular Release in Lateral Patellar Hypercompression Syndrome: A Prospective Double-Blinded Comparative Study on Complications and Outcome

To compare complication rates and outcome of open lateral retinacular (LR) lengthening and open LR release in the treatment of lateral patellar hypercompression syndrome (LPHS). In a prospective double-blinded study, 28 patients (mean age, 48 years; 21 women and 7 men) received either LR release (14 patients) or LR lengthening (14 patients) in alternating fashion over the same lateral parapatellar skin incision for LPHS (blinding of patients to surgical procedure [i.e., single blinding]). Strict inclusion criteria (retinacular pain, tight retinaculum, decreased patellar mobility) were used to exclude other reasons for anterior knee pain (patellar instability, leg malalignment or maltorsion, trochlear dysplasia, patella alta). The surgeon and postsurgical rehabilitation were the same. Preoperatively and at 3, 6, 12, and 24 months postoperatively, complications, muscle atrophy, and Kujala patellofemoral outcome score were documented by examiners blinded to the surgical procedure (double blinding). All patients completed 2 years of follow-up. The results of 2 years of follow-up showed that recurrence of LPHS, as indicated by the patellar tilt test and decreased medial patellar glide test, developed in 2 cases after LR release and 1 case after LR lengthening (P > .999). Medial patellar subluxation, as indicated by the gravitation-subluxation test and increased medial patellar glide test, developed in 5 cases after LR release and no case after LR lengthening (P = .041). Quadriceps atrophy, as indicated by the mean circumference difference compared with the healthy contralateral side, was significantly higher (P = .001) in the LR release group (1.8 cm) than in the LR lengthening group (0.2 cm). The mean Kujala score was significantly lower (P = .035) in the LR release group (77.2 points) than in the LR lengthening group (88.4 points). In this prospective double-blinded study, retinacular lengthening showed less medial instability, less quadriceps atrophy, and a better clinical outcome at 2 years compared with retinacular release. We believe that this may be explained by the controlled preservation of the lateral patellar muscle-capsuloligamentous continuity after retinacular lengthening. Level II, prospective double-blinded comparative study.

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.

Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty

This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings. A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months. With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection. No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction.

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.

Quality of Life and Clinical Outcome After Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Graft or Quadrupled Semitendinosus Graft

Background: Randomized controlled trials after anterior cruciate ligament reconstructions with long-term follow-up including assessment of health-related quality of life are rare. Purpose: To compare clinical outcome and health-related quality of life 8 years after anterior cruciate ligament reconstruction using 2 types of graft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Long-term follow-up of 164 patients with anterior cruciate ligament injury randomized to arthroscopic reconstruction with a quadrupled semitendinosus graft or a bone–patellar tendon–bone graft was undertaken. After a mean 8 years, 153 patients were available for follow-up, including instrumented laxity, 1-legged hop test, a knee-walking test, and assessment with International Knee Documentation Committee, Lysholm, Tegner, and patellofemoral pain score. Health-related quality of life was assessed with Knee Osteoarthritis Outcome Score and Short Form–36. Results: Patients in both graft groups retained the same stability, knee function, and health-related quality of life. The patellofemoral pain score was similar for both groups; the bone–patellar tendon–bone group had more donor site morbidity from kneeling and knee walking. In the bone–patellar tendon–bone group, 19 patients had no kneeling problems, 23 slight problems, 31 moderate problems, and 5 unable to kneel. Corresponding figures for the semitendinosus group were 25, 32, 16, and 2 (P < .001). Patients with early reconstructions (<5 months) had a lower risk for meniscal injuries (37%) than did later reconstructed (62%, P = .008). Health-related quality of life regarding physical functioning in Short Form–36 was better for the early-reconstructed patients than for the later reconstructed (92 vs 85; P = .014). Patients without medial meniscal surgery had higher Knee Osteoarthritis Outcome Scores for all subscales than did patients with medial meniscal surgery, with most significant difference for sport and recreation (63 vs 75, P = .008). Conclusion: In the long term, the semitendinosus graft provided similar stability, knee function, and health-related quality of life but with less kneeling morbidity than did the bone–patellar tendon–bone graft.

Role of suture anchors in management of fractures of inferior pole of patella

Background:The traditional recommendation for displaced comminuted inferior pole fractures is excision of the comminuted pole followed by reattachment of the patellar tendon with transosseous suture. To the best of our knowledge there has been no previous published study mentioning the use of suture anchors for fracture inferior pole of patella. We present a retrospective analysis of five cases of patients doing well at final follow-up of two years.Materials and Methods:Five patients treated at our institute using suture anchors for repair of comminuted inferior pole fractures of patella between January 2007 to March 2007. (range 28 years-55 years). There were three males and two females.Results:The average follow-up was 25 months (range 24 months-26 months). The patients were evaluated for range of motion, strength, patellofemoral scores and any alteration of patellar height. The outcome of the procedure was assessed with use of the patellofemoral scoring system of Noyes et al,5 as adapted by Saltzman et al.6 The final patellofemoral score (maximum 100 points) was 94.6 (range 93-96).Conclusion:We believe it is a novel extended indication of the use of suture anchors and should be in the armament of every trauma surgeon.

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.

Double-incision mini-invasive technique for BTB Harvesting: Its superiority in reducing anterior knee pain following ACL reconstruction

Arthroscopically-assisted ACL-reconstructions are currently reliable, reproducible and thoroughly used methods. Residual anterior knee symptoms however, especially after patellar-BTB graft use, are not uncommon occurrences following ACL-reconstructions, and can downgrade patient's satisfaction. Anterior knee pain contributing factors are numerous and include injury to the saphenous nerve infrapatellar branches (SNIB) and/or histologic changes at the harvest site. We thus preferably suggest a double-incision minimal approach for the patellar transplant harvesting stage in order to prevent injury to the SNIB. This technical variation decreases the risk of injury to the saphenous nerve infrapatellar branches while preserving the peritenon. Prospective controlled trial. Two groups were alternatively constituted in 2004: ligament reconstructions were either performed via a two-incisions approach during the first 2004 semester or via a single-incision approach during the second 2004 semester. Pain, even at a mild level, was evaluated. Patients were assessed using objective pain provocative tests and sensory assessment, a Lille University femoropattelar score, the IKDC Knee evaluation, the SF36 quality of life score in combination with radiographic and ultrasonographic investigations. Forty patients were reviewed at a mean 33 months follow-up delay: 21 of these had a double-incision approach and 19 had a single-incision approach. Four patients from the double-incision sub-group and 11 from the single-incision sub-group reported anterior knee pain (p<0.01). The knee-walking test came out normal in 11 patients from the double-incision sub-group and in three from the single-incision sub-group (p<0.02). The Lille University patello-femoral score was 91/100, demonstrating no significant difference. At follow-up, sensory disorders were observed in 17 patients from the single-incision sub-group and in nine from the double-incision sub-group (p<0.002). However, no statistical correlation could be established between anterior knee pains and sensorial disturbances. SF36 and IKDC objective and subjective scores were similar in both groups. Ultrasonographic findings revealed a lesser degree of patellar tendon thickening in the double-incision sub-group. However, no statistically significant differences definitely emerged between the two groups (p=0.50). The results of this study strongly support our main hypothesis: The double-incision approach significantly reduces the mid-term incidence of anterior knee pains after ACL-reconstructions. Additionally, this technical variation markedly decreased the occurrence of sensory disorders and the extent of hypoesthesia. We thus advocate the use of a double-incision graft harvesting technique in ACL-reconstructions using a patellar-bone-tendon-bone transplant.