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Background: Patellofemoral pain is a common condition. The Kujala score is a well-established scoring system to assess anterior knee pain and has been translated into many languages including Arabic. The purpose of this cross-sectional study is to culturally adapt the Arabic version of the Kujala score and determine its validity., Methods: The Kujala score is composed of 13 multiple-choice questions. We modified two questions in the score; running and squatting, and were replaced with questions related to walking on different terrain and prostration, each with the same number of answer choices as the original questions so as not to affect the final score. These modifications were written in Arabic by the same group who translated and validated the original score into Arabic. The original and modified Kujala scores was printed and given to patients complaining of patellofemoral pain to be filled during their visit to the orthopedic outpatient clinics. Final scores for the original and modified questionnaires were calculated. Data was analyzed using SPSS statistics version 21.0 measuring Cronbach's alpha, intraclass correlation coefficient, and Pearson correlation., Results: Ninety-four patients were included in the study, 28 (29.8%) men and 66 (70.2%) women. The mean age for the included patients was 43.67 (± 14.46) years. The mean score for the modified initial questionnaire was 63.91 (± 16.32), and the mean score for the modified re-test questionnaire was 66.52 (± 17.50). There was a statistically significant difference between the mean scores (p = 0.041), with a mean difference of 1.97 (95% CI 0.08 to 3.856). We found a significant strong correlation between the score before and after changing the questions with a p value of < 0.001., Conclusions: The culturally modified Arabic Kujala questionnaire is shown to be a valid, well-designed tool and an appropriate method of measuring patellofemoral pain.

Background: The occurrence of Patellofemoral Pain Syndrome (PFPS) is often found in daily medical care. Rehabilitation is usually applied with good results. However, patients often do not respond to standard rehabilitation, suggesting there may be some undetected factors that standard treatments cannot address. It is known that post-traumatic adhesive capsulitis in the knee often shows symptoms similar to those of PFPS, but idiopathic adhesive capsulitis (IAC) has seldom been mentioned as a possible cause of PFPS. Adhesive capsulitis in the shoulder joint causes frozen shoulder (FS), and hydraulic distension (HD) is often applied to FS effectively., Purpose: The purpose of this study was to investigate and report on the clinical application of HD to treat PFPS non-responsive to rehabilitation treatment., Patients and Methods: HD was applied to 72 knees that had resisted regular conservative treatments for PFPS. Follow-up data (e.g. visual analogue scale) was collected immediately after HD, and at periods of 1, 3 and 6 months later., Results: Of the 72 patients, 64 patients obtained pain relief after HD. Pain was relieved for at least 6 months for 33 of the 64 patients. No benefit was received for 8 patients., Conclusions: HD could be an additional conservative option for some PFPS that resisted rehabilitation. Assuming that the mechanisms of action for HD in the knee are the same as those in FS, there is evidence to suggest that IAC might play a role in the development of PFPS for some patients., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Patellofemoral pain syndrome (PFPS) is common and affects approximately 15% of individuals at different ages and activity levels. As a non-surgical intervention, physiotherapy is widely used to treat PFPS. Neuromuscular training exercise is one of the most effective methods for decreasing musculoskeletal pain and improving knee function. However, the effectiveness of neuromuscular training exercise for treating PFPS is not without argument. The purpose of this study is to evaluate the effect of neuromuscular training exercise on patellofemoral pain and whether the neuromuscular training exercise have more advantage effects than taping and health education., Methods: We will operate a prospective, single-blind, randomized controlled trial of 60 patients with patellofemoral pain. Individuals will be indiscriminately assigned to two intervention groups and a health education group. The neuromuscular training exercise which includes the muscle strength training, balance training and knee joint proprioception training, and taping group will use "Y" and "I" type taping on the participants three times a week for three months. The health education group will be given education lectures once each week and which last for three months. The primary outcome measures include the adverse events, visual analog scale for pain, and Anterior Knee Pain Scale Index, which is a knee function self-report questionnaire to evaluate the function of the knee especially for PFPS patients. The secondary outcome measures are the muscle strength and endurance of knee joint flexion and extensor muscles, knee joint proprioception, muscle thickness of the quadriceps femoris, knee function ability, and quality of life. We will manage the intention-to-treat analysis for individuals who will withdraw from this study., Discussion: According to previous studies, neuromuscular training exercise and the taping method are effective treatment for PFPS patients. In this study, we will perform a neuromuscular training exercise for patients with PFPS. We believe that this study may prove the effectiveness of neuromuscular training exercise in treating PFPS., Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800014995 . Registered on 27 February 2018.

Background: Patellofemoral knee pain is a common cause of anterior knee pain. The Kujala anterior knee pain score is a scoring system for the clinical assessment of disease severity. The purpose of this cross-sectional study was to validate an Arabic translation of the original Kujala anterior knee pain score to assess Arabic-speaking patients with patellofemoral pain syndrome., Methods: The Kujala anterior knee pain score was translated into Arabic by a group of native Arabic and native English speakers including orthopedic surgeons, residents, and a medical student. Questionnaires were filled by 127 patients visiting our outpatient department complaining of anterior knee pain diagnosed clinically and after exclusion of other pathologies. Questionnaires were re-filled at least 2 weeks later via phone contact from a member of our team. After exclusions, 97 questionnaires were analyzed for reliability using Cronbach's alpha for the scoring system's internal consistency and intraclass correlation coefficient for test-retest analysis., Results: The mean score of the questionnaire before the follow-up was 62.38 (±17.78) and 64.02 (±18.47) after the follow-up. The scoring system's internal consistency measured via Cronbach's alpha was 0.824. Average ICC for the scoring system was 0.948 (CI: 0.923-0.965) and for single measures, 0.902 (CI: 0.856-0.933). Further, 94.8% of patients were contacted before initiating physiotherapy. Forty-six of the patients (47.4%) showed improvement in their scores when contacted, 44 patients (45.4%) showed a slight worsening of their scores and seven patients' (7.2%) scores were unchanged., Conclusions: The Arabic translation of the Kujala anterior knee pain score is a valid, reliable, useful, and easy-to-interpret scoring system to assess Arabic-speaking patients with patellofemoral pain syndrome., (Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Patellofemoral pain and osteoarthritis are prevalent and associated with substantial pain and functional impairments. Patient-reported outcome measures (PROMs) are recommended for research and clinical use, but no PROMs are specific for patellofemoral osteoarthritis, and existing PROMs for patellofemoral pain have methodological limitations. This study aimed to develop a new subscale of the Knee injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF), and evaluate its measurement properties., Methods: Items were generated using input from 50 patients with patellofemoral pain and/or osteoarthritis and 14 health and medical clinicians. Item reduction was performed using data from patellofemoral cohorts (n=138). We used the COnsesus-based Standards for the selection of health Measurements INstruments guidelines to evaluate reliability, validity, responsiveness and interpretability of the final version of KOOS-PF and other KOOS subscales., Results: From an initial 80 generated items, the final subscale included 11 items. KOOS-PF items loaded predominantly on one factor, pain during activities that load the patellofemoral joint. KOOS-PF had good internal consistency (Cronbach's α 0.86) and adequate test-retest reliability (intraclass correlation coefficient 0.86). Hypothesis testing supported convergent, divergent and known-groups validity. Responsiveness was confirmed, with KOOS-PF demonstrating a moderate correlation with Global Rating of Change scores (r 0.52) and large effect size (Cohen's d 0.89). Minimal detectable change was 2.3 (groups) and 16 (individuals), while minimal important change was 16.4. There were no floor or ceiling effects., Conclusions: The 11-item KOOS-PF, developed in consultation with patients and clinicians, demonstrated adequate measurement properties, and is recommended for clinical and research use in patients with patellofemoral pain and osteoarthritis., Competing Interests: Competing interests: EMR is deputy editor of Osteoarthritis and Cartilage and the developer of Knee injury and Osteoarthritis Outcome Score (KOOS)., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This study investigated whether women with patellofemoral pain (PFP) present kinematic alterations in proximal, local, and distal factors simultaneously, and determined the association between the number of kinematic alterations, pain level, and functional status. A three-dimensional motion analysis system was used to analyze the peak hip adduction, peak knee flexion, and peak rearfoot eversion, addressing the proximal, local, and distal factors, respectively, in fifty women. Functional status and pain level were assessed using the anterior knee pain scale (AKPS) and a visual analogic scale. Receiver operating characteristic curves were calculated to identify participants with and without kinematic alterations and the number of them was obtained for each participant. Associations between the number of kinematic alterations, pain level, and AKPS score were determined by the Pearson correlation. Results showed that 52% of women with PFP presented at least two kinematic alterations of which 24% were local/proximal, 16% local/distal, and 12% proximal/distal. Three kinematic alterations were found in 48% of the women with PFP. A strong positive correlation was found between the number of kinematic alterations and pain (r=0.78; p<0.001). A strong negative correlation was found between the number of altered kinematics and functional status (r=-0.79; p<0.001). Findings revealed that women with PFP presented at least two kinematic alterations and a higher number of kinematic alterations was associated with higher pain levels and lower functional status. Clinicians should carefully assess movement pattern of women with PFP as it could indicate a more severe condition, which is associated with a poor prognosis., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To assess the diagnostic performance of a comprehensive set of tests and measures to discriminate patellofemoral (PF) from tibiofemoral (TF) osteoarthritis (OA)., Methods: The Clinical Assessment of the Knee Study is a study of knee pain in the general population. The presence of PF crepitus and pain with PF compression were assessed. Anterior knee pain was determined using a knee pain map. Pain with climbing/descending stairs and walking on level ground were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index. Radiographs were used to define the compartment(s) of the knee affected by OA (no OA, isolated/predominant PF joint OA, and isolated/predominant TF joint OA). In knees with mixed OA, knees with more severe PF joint OA were included in the isolated/predominant PF group (the same was done for TF joint OA). We determined the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive likelihood ratio (LR+) for each test and measure individually, and the combination of these measures, in distinguishing knees with PF joint OA from knees with TF joint OA or no OA., Results: There were 745 knees included in the study. No measure had high sensitivity and specificity. Pain with climbing/descending stairs had the greatest sensitivity (90%) but poor specificity (15%). The combination of definite crepitus with no pain on walking had the greatest specificity (96%), PPV (53%), and LR+ (1.8), but poor sensitivity (7%)., Conclusion: Typical clinical examination findings and knee pain patterns commonly thought to represent underlying PF joint pathology do not discriminate knees with PF joint OA from knees without OA or TF joint OA., (© 2017, American College of Rheumatology.)

BACKGROUND PFPS is one of the most frequently occurring overuse injuries affecting the lower limbs. A variety of functional and self-reported outcome measures have been used to assess clinical outcomes of patients with PFPS, however, only the Anterior Knee Pain Scale (AKPS) has been designed for PFPS patients. MATERIAL AND METHODS We followed international recommendations to perform a cross-cultural adaptation of the AKPS. The Arabic AKPS and the Arabic RAND 36-item Health Survey were administered to 40 patients who were diagnosed with PFPS. Participants were assessed at baseline and after 2 to 3 days assessed with the Arabic AKPS only. The measurements tested were reliability, validity, and feasibility. RESULTS The Arabic AKPS showed high reliability for both temporal stability, internal consistency (Cronbach's alpha was 0.81 for the first assessment and 0.75 for the second), excellent test-retest reliability (Intraclass Correlation Coefficients ICC=0.96; 95% confidence interval (CI): 0.93, 0.98) and good agreement (standard error of measurement SEM=1.8%). The Arabic AKPS was significantly correlated with physical components of the RAND 36-Item Health Survey (Spearman's rho=0.69: p<0.001). No ceiling or floor effects were observed. CONCLUSIONS The Arabic AKPS is a valid and reliable tool and is comparable to the original English version and other translated versions.

Objective: Patellofemoral pain (PFP) is common among young individuals. Female adolescents with PFP present typically with localized mechanical hyperalgesia around the knee, but the effect of central pain mechanisms are unknown. This study aimed to compare temporal summation of pain, conditioned pain modulation (CPM), and widespread hyperalgesia in young female adults with PFP and age-matched pain-free controls., Design: Cross-sectional study., Setting and Subjects: Twenty young female adults (19-21 years old) with long-standing PFP were compared with 20 pain-free controls from the same population-based cohort., Methods: Cuff algometry was used to assess the pain detection threshold. Temporal summation of pain was assessed by recording the pain intensity on a visual analog scale during repeated cuff pressure stimulations at pain tolerance intensity on the lower leg. CPM was recorded as an increase in the cuff pain detection threshold in response to experimental conditioning pain imposed on the contralateral arm. Handheld pressure algometry was used to assess pressure pain thresholds (PPTs) on the knee, shin, and forearm. The examiner was blinded to the type of subject assessed., Results: Compared with pain-free controls, young females with PFP showed no decrease in cuff pain thresholds (P < 0.40) or facilitated temporal summation (P < 0.15) but had a lower CPM response (P < 0.04) and lower PPTs (P < 0.005)., Conclusions: Young female adults with long-standing PFP demonstrated impaired CPM. This is important because PFP, a peripheral pathology, might have important central components that need to be studied in order to understand its extent and therapeutic implications., (© 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The purpose of this investigation was to estimate and document the reliability and validity of the Anterior Knee Pain Scale (AKPS) and to estimate its relative prediction accuracy of anterior knee pain in young females., Methods: Data from a prospective, epidemiologic study to diagnose patellofemoral knee pain among female athletes (n = 499) using the Anterior Knee Pain Scale (AKPS). Data were treated in 4 phases (descriptive phase, reliability phase, scale refinement phase) and a final validation stage that was focused on an effort to test and document the validation of the AKPS short form and perform head-to-head comparisons of the 6-item short form with the original, 13-item form., Results: The AKPS was reduced from 13 items (αCoeff = 0.77, σSEM = 0.004) to 6 items (αCoeff = 0.78, σSEM = 0.004). Point-biserial correlations with patellofemoral pain diagnosis were comparable: r [498] = 0.70 (R(2) = 0.49, short form) and r [498] = 0.71 (R(2) = 0.51, long form), as was sensitivity: 84% (short form) and 80% (long form), and specificity: 89% (short form) and 90% (long form; AUC = 0.94 both)., Conclusion: The current analyses indicate that a subset of measures from the AKPS is responsive to patellofemoral pain symptoms and may support screening for related diagnoses. A simpler and quicker scale optimized for diagnostic accuracy could reduce the demand on patients, clinicians and research teams focused on the identification and management of patellofemoral pain., Level of Evidence: III.

Introduction: The Lower Extremity Functional Scale is a widely used questionnaire to evaluate the functional impairment in lower extremities. To date, the Lower Extremity Functional Scale has not been translated into Turkish. The aim of this study is to translate and culturally adapt the Lower Extremity Functional Scale into a Turkish version, and evaluate the psychometric properties of this version in patients with knee injuries., Materials and Methods: The translation of the English version of the Lower Extremity Functional Scale into a Turkish version was performed using standard guidelines. Validity and reliability of Turkish version were tested in 134 patients with knee injuries. Association level between other outcomes measures (Kujala Patellofemoral Score, the Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm Knee Scoring Scale and a Visual Analog Scale) and Turkish version of the Lower Extremity Functional Scale was analyzed to assess validation. Participants completed the questionnaire at baseline and after 2 days to test reliability., Results: The Turkish version of the Lower Extremity Functional Scale was showed a high degree of internal consistency (Cronbach α = 0.93). ICCs were 0.96 and no floor or ceiling effects. The Lower Extremity Functional Scale had a high level of association with the Kujala Patellofemoral Score (r = 0.82), Lysholm Knee Scoring Scale (r = 0.80) and the Western Ontario and McMaster Universities Osteoarthritis Index scores (r = 0.69) (all, p < 0.05)., Conclusion: The Turkish version of the Lower Extremity Functional Scale is a valid and reliable questionnaire that can be used to evaluate functional status in Turkish speaking patients with different knee disorders., Level of Evidence: III.

Background: The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system., Method: Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated., Findings: Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements., Interpretation: Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Anterior knee pain (or patellofemoral pain) continues to be a source of frustration and confusion among clinicians. There is wide variation in symptom history, physical exam findings, imaging, and treatment that often confounds the use of any straightforward algorithm or decision tree. This review aims to provide an approach that partners the adolescent athlete with clinician and an experienced physiotherapist. This team approach uses available evidence to develop a treatment program that is specific to the adolescent's symptoms, body movement patterns, and activity demands.

The aim of this investigation was to culturally translate and validate the Functional Index Questionnaire (FIQ) and Modified FIQ (MFIQ) in patients with patellofemoral pain syndrome (PFPS). A sample of 100 patients with PFPS completed the FIQ and MFIQ, and Short-Form 36 (SF-36) Health Survey in the first session. The FIQ and MFIQ were re-administered to a sample of 47 patients to evaluate test-retest reliability. Test-retest reliability and internal consistency were evaluated by the intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient, respectively. Corrected item-total correlations and construct validity were assessed by Spearman's rank correlation. Factor analysis was performed on all items of the Persian FIQ and MFIQ to determine the number of underlying factors and the items which load on each factor. An acceptable level of test-retest reliability (ICC = 0.84, 0.85) and internal consistency (Cronbach's alpha = 0.79, 0.82) was obtained for both the Persian FIQ and MFIQ, respectively. Item-total correlations were greater than 0.40 for all but two questions of the Persian FIQ and all but four questions of the Persian MFIQ. A total of two factors were detected for each questionnaire. There were moderate to low correlations between the Persian FIQ/MFIQ and SF-36. Persian FIQ and MFIQ are two reliable and valid outcome measures of functional limitation and it seems that they are suitable for use in clinical practice of patients with chronic PFPS.

Objective: To determine the relationship between patient-reported single numeric ratings and actual scores obtained from a validated instrument, the Knee Outcome Survey (KOS)., Background: Patient-reported outcome (PRO) measures are an important component of patient management. Information obtained from PRO measures can be used to prioritize goal setting, assist with clinical decision-making, provide evidence for effectiveness of interventions, monitor progress, and assess organizational or clinician performance., Methods: Scores from the KOS activity of daily living (ADL) and Sports subscales completed at the time of initial examination of patients with patellofemoral pain (n = 29) were retrospectively analyzed and compared to a single assessment numerical rating., Results: Bi-variate Pearson product correlation was used to determine association between the KOS-ADL and KOS-Sports with respective single assessment numerical ratings. A high correlation was observed between the KOS-ADL (0.85, p < 0.01) and KOS-Sports (0.88, p < 0.01) with a single assessment numerical rating., Conclusions: Administration and scoring of standardized outcome measures such as the KOS-ADL and KOS-Sports require several minutes to administer but correlate well with a single assessment numerical ratings. The high correlation of single assessment numerical scores to actual KOS-ADL and KOS-Sports scores may provide support for discretionary use of single numerical ratings during interim patient care visits and/or in instances when time is limited. Additional studies are needed with larger patient populations and specific diagnostic subgroups to determine additional clinical relevance.

Objective: To develop a computerized visual analog scale (cVAS) system and determine if it could be used in place of the traditional 100-mm paper-based visual analog scale (pVAS) method for the measurement of pain in patients with patellofemoral pain syndrome (PFPS)., Design: Descriptive laboratory study., Setting: Biomechanics laboratory., Participants: Thirty-six runners diagnosed with PFPS., Interventions: A cVAS system was custom-coded for this study. Participants completed both the cVAS survey and a pVAS survey that measured usual knee pain during running, walking, prolonged sitting, stair ascent, stair descent, and squatting movements. Thus, 216 paired measurements were made in total., Main Outcome Measures: Pearson correlation coefficients and slopes of the line of best fit were calculated to assess the relationship between cVAS and pVAS scores, and Bland-Altman plots were constructed to determine cVAS agreement to pVAS scores., Results: All cVAS measures were highly correlated to pVAS scores (all r values were >0.9), and slopes were always near 1.0. Bland-Altman plots demonstrated that there was good agreement between the 2 methods., Conclusions: The cVAS system that was developed is a valid method for measurement of pain in patients with PFPS. Further use of the cVAS for studies involving PFPS is supported.

Objective: This study validated the Patellofemoral Pain Severity Scale translated into Chinese., Design and Setting: The Chinese Patellofemoral Pain Severity Scale was translated from the original English version following standard forward and backward translation procedures recommended by the International Society for Pharmacoeconomics and Outcomes Research. The survey was then conducted in clinical settings by a questionnaire comprising the Chinese Patellofemoral Pain Severity Scale, Kujala Scale and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index., Subjects: Eighty-four Chinese reading patients with patellofemoral pain were recruited from physical therapy clinics., Main Measures: Internal consistency of the translated instrument was measured by Cronbach alpha. Convergent validity was examined by Spearman rank correlation coefficient (rho) tests by comparing its score with the validated Chinese version of the Kujala Scale and the WOMAC Osteoarthritis Index while the test-retest reliability was evaluated by administering the questionnaires twice., Results: Cronbach alpha values of individual questions and their overall value were above 0.85. Strong association was found between the Chinese Patellofemoral Pain Severity Scale and the Kujala Scale (rho = -0.72, p < 0.001). Moderate correlation was also found between Chinese Patellofemoral Pain Severity Scale with the WOMAC Osteoarthritis Index (rho = 0.63, p < 0.001). Excellent test-retest reliability (Intraclass correlation coefficient = 0.98) was demonstrated., Conclusions: The Chinese translated version of the Patellofemoral Pain Severity Scale is a reliable and valid instrument for patients with patellofemoral pain.

Background: Patellofemoral 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., Methods: A 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., Results: Long symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (beta-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., Conclusions: Patients 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.

Objective: The purpose of this pilot study was to determine the feasibility of (1) using the existing clinic, clinicians, interns, faculty, and staff from our college in conducting all components of a planned randomized controlled clinical trial; (2) successfully recruiting patients with patellofemoral pain syndrome (PFPS); and (3) consistently, effectively, and safely implementing the study protocols and therapy., Methods: Diagnostic, treatment, and blind assessment procedures were carried out while recruitment and administrative techniques for managing long-term storage of data and files were developed. Thirty-one patients were randomized into a local manipulative group (group A) or to a full kinetic chain manipulative therapy group (group B), each combined with exercise and soft tissue treatment. The Anterior Knee Pain Scale, visual analog scale, and Patient Satisfaction Scale were used., Results: All phases of the feasibility study including use of the clinic, staff, recruitment techniques, treatment protocols, data collection, input, and analysis were effectively and safely carried out., Conclusions: A feasibility study investigating the ability to conduct a randomized controlled trial of a manipulative therapy protocol for PFPS using available chiropractic college infrastructure was accomplished. A fully powered PFPS trial is feasible and merited.

Patello-femoral pain syndrome (PFPS) is a common knee joint disability. The integration of hip soft tissue regimens are not always emphasized, although current literature implies that there is a significant relationship between the two and there is a lack of randomized clinical trials to substantiate this relationship in clinical practice. A randomized controlled assessor blinded trial was designed to explore different rehabilitation programs related to PFPS. The study was conducted at RAZIEL institute of physical therapy, Netania, Israel with a total of 30 consecutive patients (mean age 35y), diagnosed with PFPS. All patients were randomly allocated into 3 groups. Group I conventional knee rehabilitation program. Included quadriceps strengthening and Trans Electric Neuromuscular Stimulation (TENS). Group II hip oriented rehabilitation program. included stretching, Hip external rotators strengthening and TENS. Group III a combination of the two above programs. Pain and function were documented on initial of the program and again 3 weeks later, on the completion. Pain was assessed by a numeric visual analogue scale (VAS); function was assessed by Patello-femoral joint evaluation scale (PFJES) (0-100 points). At end of trial, all groups showed significant improvements in VAS and PFJES (p<0.0001); these improvements did not vary significantly between the 3 groups. The conclusions were that the explored different rehabilitation programs showed a similar beneficial effect.

Background: Anterior knee pain, diagnosed as Patellofemoral Pain Syndrome (PFPS), is one of the most common musculoskeletal problems found in adolescents and young adults. There is no consensus in medical literature concerning the aetiology of the PFPS., Aims: To assess by means of Quantitative Sensory Testing (QST) whether patients suffering from long-lasting unilateral PFPS demonstrate somatosensory dysfunction related to afferent fibres from the local pain area., Methods: A descriptive non-experimental study with two independent samples, consisting of 25 men and women between 18 and 44 years of age with unilateral PFPS, and a comparable group of 23 healthy subjects. Somedic Thermotest apparatus was used to assess thresholds of thermal perception, and of heat and cold pain thresholds. Von Frey filaments were used to detect tactile sensitivity. Furthermore, quality and intensity of knee pain, symptoms and signs from a clinical neurological examination were recorded., Results: Decreased sensitivity to tactile stimulation, when tested with von Frey filaments, was demonstrated on both the painful and pain-free knee in subjects with PFPS, compared to the mean between the knees of the control group (p< or =0.001). The mean detection threshold for warmth was increased by 1.9 degrees C (p< or =0.01) in the painful knee, and 1.4 degrees C (p< or =0.01) in the non-painful knee in the PFPS group, compared to the mean of the healthy control group. The mean detection threshold for cold was increased by 1.6 degrees C (p< or =0.01) in the painful knee of the PFPS group, compared to the control group. These findings were supported by clinical sensory tests. No significant differences of mean thermal pain thresholds between the PFPS group and controls were found, and there were no significant differences in mean detection thresholds for warmth, cold or thermal pain thresholds between the painful and the non-painful knees in the PFPS group., Conclusion: This study demonstrated an abnormal sensory function in the painful and non-painful knee in some individuals with long lasting unilateral Patellofemoral Pain Syndrome using Quantitative Sensory Testing supported by clinical neurological examinations. A dysfunction of the peripheral and/or the central nervous system may cause neuropathic pain in some subjects with PFPS.

Background: Patellofemoral pain syndrome is a descriptive term applied to patients with nonspecific anterior knee pain, and is the most common knee problem. The pain in most patellofemoral disorders is generalized to the anterior part of the knee. One important concept in patellofemoral joint function is the quadriceps angle (Q-angle). Theoretically, a higher Q-angle increases the lateral pull of the quadriceps femoris muscle on the patella and potentiates patellofemoral disorders. This study was undertaken to evaluate the relationship between the anterior knee pain and Q-angle., Methods: This prospective study was performed on two groups; the case group consisted of 100 outpatients (44 men, and 56 women) aged between 15 and 35 years, with anterior knee pain. The control group consisted of 100 outpatients (50 men, and 50 women) with the same age distribution, who presented with different problems in the upper extremities and no knee problems. The Q-angle of each knee was measured in all participants, using a universal goniometer., Results: The mean Q-angle for men, women, and all participants in the case group was 15.2, 20.1, and 18.0 degrees, respectively. In the normal control group the angles were 12.1, 16.7, and 14.9 degrees, respectively. All these differences were statistically significant (P < 0.001)., Conclusion: These results substantiate the fact that patients with anterior knee pain have larger Q-angles than healthy individuals.

Background: The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS., Methods: A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements., Results: Thirty patients (age 29 +/- 8; 17 female) with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97); moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79); and poor for femoral anteversion (ICC of .45). Standard error of measurement (SEM) for measures of muscle length ranged from 1.6 degrees to 4.3 degrees. SEM for Q-angle, tibial torsion, and femoral anteversion were 2.4 degrees, 2.9 degrees, and 4.5 degrees respectively. SEM for foot pronation was 1 mm. SEM for measures of muscle strength was 1.8 Kg for abduction and 2.4 Kg for external rotation., Conclusion: Several of the impairments associated with PFPS had sufficient reliability and low measurement error. Further investigation is needed to test if these impairment measurements are related to physical function and whether or not they are useful for decision-making.

The current study is aimed at examining the validity of five clinical patellofemoral tests used in the diagnosis of patellofemoral pain syndrome (PFPS). Forty-five knee patients were divided into either the PFPS or the non-PFPS group, based on the fulfilment of the diagnostic criteria for PFPS. An investigator, blinded to the group assignment, performed the vastus medialis coordination test, patellar apprehension test, Waldron's test, Clarke's test, and the eccentric step test. The positive likelihood ratio was 2.26 for both the vastus medialis coordination test and the patellar apprehension test. For the eccentric step test, the positive likelihood ratio was 2.34. A positive outcome on either the vastus medialis coordination test, the patellar apprehension test, or the eccentric step test increases the probability of PFPS to a small, but sometimes important, degree. For the remaining tests, the positive likelihood ratios were below the threshold value of 2, indicating that given a positive test result, the probability that the patient has PFPS is altered to a small, and rarely important degree. The negative likelihood ratios for all tests exceeded the threshold value of 0.5, suggestive of clinically irrelevant information. These data question the validity of clinical tests for the diagnosis of PFPS.