Prevalence Of Anterior Knee Pain Research Articles

Prevalence of anterior knee pain among patients following total knee arthroplasty with nonreplaced patella: A retrospective study of 1778 knees

Background and objective: Anterior knee pain (AKP) may compromise the results of total knee arthroplasty in more than quarter of cases. The aim of the current work was to determine the prevalence of AKP and the severity of patellofemoral symptoms among patients who received a total knee arthroplasty with non-replaced patella in East-Tallinn Central Hospital from January 1, 2000 to December 31, 2009. Materials and methodsWe carried out a retrospective study involving 1778 consecutive total knee arthroplasties with non-replaced patella. Mean follow-up time was 68 months. We collected data by two patient-reported measures: the knee pain questionnaire and the Kujala score. ResultsWe diagnosed AKP among 20.2% of patients, 33.6% had pain in the knee from a source other than patellofemoral joint and 46.2% were pain free. In 87.3% of AKP cases the pain emerged within the first five years of knee replacement. AKP was more prevalent among patients with osteoarthritis compared to rheumatoid arthritis and among patients below 60 years. There was no difference in the prevalence of AKP in terms of gender or mobile and fixed bearing implants. The severity of patellofemoral symptoms in case of AKP was moderate. ConclusionsAKP is a frequent complication of total knee arthroplasty with non-replaced patella and patients undergoing this procedure should be apprised of the high probability of experiencing pain in the anterior part of the replaced knee.

The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing

Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing. A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n=131) or without decompression (control group, n=140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change. There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p=0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p=0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p=0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees. As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.

Expected Prevalence From the Differential Diagnosis of Anterior Knee Pain in Adolescent Female Athletes During Preparticipation Screening

Anterior knee pain is a common disorder in female athletes with an undefined cause. The relative prevalence of specific patellofemoral disorders associated with anterior knee pain in adolescent females remains undetermined. To determine the prevalence of specific patellofemoral disorders obtained using the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening. Descriptive epidemiology study. Preparticipation screening evaluations at a county public school district in Kentucky. A total of 419 unique middle and high school-aged female athletes. Participants were evaluated by physicians for anterior knee pain over 3 consecutive basketball seasons. Given the longitudinal nature of this study, some participants were tested longitudinally over multiple years. Over the course of 3 basketball seasons, 688 patient evaluations were performed. Of these, 183 (26.6%) were positive for anterior knee pain. A statistically significant difference was noted in the prevalence of anterior knee pain by school level, with 34.4% (n = 67) in high school-aged athletes versus 23.5% (n = 116) in middle school-aged athletes (P < .05). In the 1376 knees evaluated, patellofemoral dysfunction was the most common diagnosis, with an overall prevalence of 7.3% (n = 100). The only diagnosis shown to be statistically different between age levels was Sinding-LarsenJohansson disease or patellar tendinopathy, with 38 cases (9.7%) in high school-aged and 31 (3.1%) in middle school-aged athletes (P < .05). Anterior knee pain was present in 26.6% of the adolescent female athletes screened over 3 years. Symptoms of anterior knee pain likely persist after middle school-aged onset and reach peak prevalence during the high school years.

Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction

The purpose of this study was to evaluate the prevalence of anterior knee pain in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and to identify critical factors affecting postoperative anterior knee pain development. Subjects comprised 171 patients (171 knees) who underwent anatomic double-bundle ACL reconstruction with a follow-up period of ≥2years. The procedure used bone-patellar tendon-bone plus gracilis tendon (BTB-G) in 56 knees, semitendinosus tendon (ST) in 71 knees, and ST-G in 44 knees. Clinical results and prevalence and severity of anterior knee pain were assessed at 3months and 2years postoperatively. Clinical variables influencing anterior knee pain development at each postoperative period were subjected to univariate analysis, followed by logistic regression analysis to identify risk factors for anterior knee pain. Overall prevalences of anterior knee pain at 3months and 2years postoperatively were 42.0 and 11.1%, respectively. Use of BTB-G graft represented the highest prevalence of anterior knee pain between the 3 different grafts (P=0.001); however, this statistical significance disappeared at 2years postoperatively. Prevalence of postoperative extension deficit was significantly higher in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 3months postoperatively. Level of quadriceps strength was significantly lower, and Lysholm score was significantly worse in anterior knee pain-positive cohort than in anterior knee pain-negative cohort at 2years postoperatively. According to logistic regression analysis, knee extension deficit was a predisposing factor for the development of anterior knee pain at 3months postoperatively (odds ratio, 2.76; P=0.004); however, there was no significant predisposing factor for anterior knee pain at 2years postoperatively. Knee extension deficit was an important predisposing factor for postoperative anterior knee pain in the early postoperative period, and anterior knee pain was associated with impaired quadriceps function and inferior subjective results over 2years postoperatively. Early recovery of full extension may prevent postoperative development of anterior knee pain and achieve successful outcomes for ACL reconstruction. Retrospective comparative study, Level III.

To Resurface the Patella or Not? Better Assessments Needed to Address the Benefits for Total Knee Replacement

Low-friction metal-on-polyethylene primary total knee arthroplasty has been utilized for forty years, and anterior knee pain has been an issue for all of that time. The first implants either ignored the patellofemoral joint or even compromised it by means of a transverse metal bar that joined the medial and lateral condylar femoral components. Anterior knee pain was common, developing in 40% to 58% of patients1. As a result, attempts were made to address the patellofemoral joint in the design of future total knee arthroplasties. The first initiative was to add an anterior flange to the femoral component, and this was followed shortly by the addition of a polyethylene resurfacing button to the articular surface of the patella that articulated with the anterior flange of the femoral component2. The prevalence of anterior knee pain was greatly reduced by these changes, but it was not completely eliminated. Since that time, continued patellofemoral-related changes have been made, such as a move to specific right and left femoral components, closer replication of normal patellar tracking, and deepening of the patellar groove in the femoral component3. Despite these improvements, consensus was not reached with regard to how to deal with the patellofemoral joint during total knee arthroplasty. Complications …

Total knee replacement with natural rollback

A novel class of total knee replacement (AEQUOS G1) is introduced which features a unique design of the articular surfaces. Based on the anatomy of the human knee and differing from all other prostheses, the lateral tibial "plateau" is convexly curved and the lateral femoral condyle is posteriorly shifted in relation to the medial femoral condyle. Under compressive forces the configuration of the articular surfaces of human knees constrains the relative motion of femur and tibia in flexion/extension. This constrained motion is equivalent to that of a four-bar linkage, the virtual 4 pivots of which are given by the centres of curvature of the articulating surfaces. The dimensions of the four-bar linkage were optimized to the effect that constrained motion of the total knee replacement (TKR) follows the flexional motion of the human knee in close approximation, particularly during gait. In pilot studies lateral X-ray pictures have demonstrated that AEQUOS G1 can feature the natural rollback in vivo. Rollback relieves the load of the patello-femoral joint and minimizes retropatellar pressure. This mechanism should reduce the prevalence of anterior knee pain. The articulating surfaces roll predominantly in the stance phase. Consequently sliding friction is replaced by the lesser rolling friction under load. Producing rollback should minimize material wear due to friction and maximize the lifetime of the prosthesis. To definitely confirm these theses one has to wait for the long term results.

Prevalence of Anterior Knee Pain and Pes Planus in Israel Defense Force Recruits

This study examined the prevalence of anterior knee pain (AKP) and pes planus (PP) in Israeli defense force recruits and assessed the relationship between these conditions. We examined the medical records of 97,279 recruits--18,338 females and 78,941 males. The prevalence of AKP was 4.15%. It was lower in females (2.39%) than in males (4.56%). The prevalence of flexible and rigid PP were 15.30% and 0.83%, respectively. The prevalence of both conditions was lower in females (11.31% and 0.34%) than in males (16.23% and 0.94%). AKP was more prevalent in individuals with flexible PP (4.50%) than with normal feet (4.06%) and more prevalent in individuals with rigid PP (6.93%) than in individuals with flexible PP. Despite current opinion, AKP is more common in males than in females. The role of orthotics in individuals with AKP and PP should be more thoroughly investigated.

Prevalence of Anterior Knee Pain and Pes Planus in Israel Defense Force Recruits

Prevalence of Anterior Knee Pain and Pes Planus in Israel Defense Force Recruits

A Dutch Survey on Circumpatellar Electrocautery in Total Knee Arthroplasty

Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown.Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery.Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella.Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty.

The Correlation between Pes Planus and Anterior Knee or Intermittent Low Back Pain

Anterior knee pain and intermittent low back pain are among the most common orthopedic complaints of adolescents. However, little is known about pes planus and its relative risk for these symptoms. The goal of the study was to track the prevalence of pes planus in adolescents, and examine its associated risk to anterior knee pain and intermittent low back pain, respectively. A retrospective study of 97,279 military recruits presenting to recruitment centers was conducted. Pes planus was graded by an orthopedist as mild, moderate or severe according to the flattening of the plantar arch and its rigidity to standing on one's toes. Anterior knee pain was diagnosed when symptoms were attributed to the patellofemoral joint. Intermittent low back pain was diagnosed when there was pain but neither abnormal clinical nor radiographic findings. Pes planus was present in 15,698 (16%) individuals. 11,549 (74%), 3,341 (21%) and 808 (5%) were diagnosed as having mild, moderate and severe pes planus, respectively. The prevalence of intermittent low back pain was 5% in both the control and mild pes planus groups, while it was 10% in the moderate and severe pes planus groups (p < 0.0001). The prevalence of anterior knee pain was 4% in both the control and mild pes planus groups, while it was 7% in the moderate and severe pes planus groups (p < 0.0001). Moderate and severe pes planus was associated with nearly double the rate of anterior knee pain and intermittent low back pain, while mild pes planus was associated with no higher rate for these problems. Prophylactic measures may be helpful only in those adolescents with moderate and severe pes planus.

Effect of a preventive intervention programme on the prevalence of anterior knee pain in volleyball players

Chronic knee disorders, such as patellofemoral pain syndrome and patellar tendinosis, are common injuries in volleyball players. Using a randomized clinical trial, the aim of the present study was to determine the effect of a 4-month in-season intervention programme on the prevalence of anterior knee pain in volleyball players. No significant differences were observed between the intervention and control group for the prevalence of anterior knee pain after the intervention programme (odds ratio =1.58 [95% confidence interval: 0.60–4.20]). Also, no significant differences were observed for individuals with previously sustained anterior knee pain (OR =0.81 [95% CI: 0.33–2.20]). It was revealed that the risk for recurrent anterior knee pain is significantly higher than the risk for newly sustained anterior knee pain (OR =5.79 [95% CI: 1.59–21.00]). In conclusion, we were unable to confirm any preventive effect of the intervention programme on the prevalence of anterior knee pain. However, a previous study using the same intervention and measuring the effect on the intrinsic risk factors of anterior knee pain showed a positive effect.

The Severity and Prediction of Anterior Knee Pain Post Tibial Nail Insertion

To compare the prevalence of anterior knee pain and functional impairment post-tibial nailing to the contralateral knee and a background population. Patients were assessed by postal questionnaire, case note, and radiographic review. An age demographically matched control group answered the same questions. The Orthopaedic Department at our institution. Patients who had a tibial nail inserted between September 1999 and November 2004 in our hospital (85 patients). Twelve were excluded, and 52 replies from 73 cases (71%) were received. The mean age was 39.4 years (range 22-69), and 38 of the patients were men. Patients treated with AO tibial nail. Both knees were assessed using an analogue pain score (0-10) and a functional anterior knee pain score (0-50). Of the patients, 83% had anterior knee pain following tibial nailing. The mean analogue pain score was 4.3, and the functional score was 33.3. The prevalence of anterior knee pain in the uninjured knee was 40%; in the control group it was 42%. Mean visual analogue scores were 1.3 and 1.2, respectively (both P<0.001 compared to the nailed side). Functional knee pain scores were 43.3 and 46.8 (both P<0.001 compared to the nailed side). Pain scores between both the knee on the injured and the contralateral sides correlated significantly (P<0.01). Last, the pain scores of the patients' knees of the uninjured side in the operative group and the scores from the control group appeared similar but not with statistical significance (P<0.57 analogue pain score and P<0.77 functional knee pain score). There is a significant preinjury prevalence of anterior knee pain. Postnailing knee pain severity correlates with that in the uninjured limb. Relative risk of anterior knee pain postnailing is twice that of a comparative population.

Normative Three-Dimensional Patellofemoral and Tibiofemoral Kinematics: A Dynamic,in VivoStudy

In order to advance biomechanical modeling, knee joint implant design and clinical treatment of knee joint pathology, accurate in vivo kinematic data of the combined patellofemoral and tibiofemoral joint during volitional activity are critical. For example, one cause of the increased prevalence of anterior knee pain in the female population is hypothesized to be altered tibiofemoral kinematics, resulting in pathological patellofemoral kinematics. Thus, the objectives of this paper were to test the hypothesis that knee joint kinematics vary based on gender and to explore the correlation between the 3-D kinematics of the patellofemoral and tibiofemoral joints. In order to accomplish these goals, a large (n = 34) normative database of combined six degree of freedom patellofemoral and tibiofemoral kinematics, acquired noninvasively during volitional knee extension-flexion using fast-PC (dynamic) magnetic resonance imaging, was established. In this normative database, few correlations between tibiofemoral and patellofemoral kinematics were found. Specifically, tibial external rotation did not predict lateral patellar tilt, as has been stated in previous studies. In general, significant differences could not be found based on gender. Further investigation into these relationships in the presence of pathology is warranted.

Infrapatellar Plica as a cause of Anterior Knee Pain

1066 Despite the prevalence of anterior knee pain in sports medicine, the etiology of many cases remains unclear with resultant long-term pain and limited function. While the medial plica is a well document source of knee pain, the infrapatellar plica has yet to be implicated as a source of knee pain. When inflamed, fibrotic, or torn, the infrapatellar plica has the potential to cause anterior knee pain. PURPOSE: To determine if isolated resection of the infrapatellar plica in a select group of individuals improves anterior knee pain. METHODS: A restrospective case series analysis involving twelve cases of isolated infrapatellar plica resection in patients with anterior knee pain was performed. Charts were reviewed to assess mechanism of injury, clinical symptoms, and physical exam findings. Telephone interview was used to evaluate each patient. A standardized and validated outcome meansure, The Knee injury and Osteoarthritis Outcome Score (KOOS), was used to assess post-surgical outcome. RESULTS: Ninty-one percent (11 of 12) of patients reported excellent or good results using a subjective knee scale at follow-up. The KOOS outcome scoring of knee function demonstrated average scores of 97, 96, 99, 99, and 87 for pain, symptoms, activities of daily living, sports activity and quality of life, respectively. CONCLUSIONS: Review of these cases demonstrates the potential role of the infrapatellar plica, when abnormal, in causing symptoms consistent with anterior knee pain. Future randomized, prospective studies addressing the role of the infrapatellar plica in causing knee pain are thus warrented.

Patellar Resurfacing in Total Knee Arthroplasty

Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty. Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only. Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side. Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible. Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Prevalence of anterior knee pain among young South African basketball players

The aim of the article is to provide an indication of anterior knee pain prevalence among young South African basketball players. A retrospective questionnaire survey was conducted to capture information on injuries sustained over one season. The sample comprised 458 young basketball players in Cape Town and comprised 122 club players and 337 school basketball players. A total of 180 knee injuries were reported indicating a rate of 1 knee injury in 2.5 players. Anterior knee pain was the most commonly reported area ofpain by the 458 basketball players (49.1%, n=141). The most common combination of pain area was anteromedially (18.2%, n=141). The results of our survey are in agreement with other studies indicating that patellofemoral pain is probably the most common knee presentation among young active individuals and arguably the most common condition seen at sports injury clinics.