Consensus statement on patellofemoral pain
Patellofemoral pain accounts for 11-17% of knee pain presentations to general practice and up to 40% in sports injuries. Although it is highly prevalent, not many guidelines have been published to help clinicans choose an appropriate treatment. The world leading researchers on patellofemoral pain met at the International Patellofemoral Pain Research Retreat in Manchester 2015 and released recommendations based on the current evidence, experiences and expertise.
A literature review had been carried out. At the International Patellofemoral Research Retreat, an expert panel of 35 attendees was formed. All of them were actively researching on patellofemoral pain and were physiotherapists, doctors, podiatrists, biomechanists, epidemiologists and sports therapists.The panel was instructed to integrate the evidence for each intervention with their expert opinions to interpret the appropriateness of each intervention. The panel members were then asked to vote on the appropriateness of each intervention.
The panel experts discussed and voted on 24 statements and agreed on these recommendations:
1. Exercise therapy clearly showed to be effective regardless of the type of exercise (eg, in weight bearing or not; targeting hip or knee). However, instead of only knee exercises, hip and knee exercises should be combined.
2.Combined interventions (combining exercise therapy, targeting knee and hip musculature, patellofemoral taping, mobilisation and foot orthoses) are highly recommended. However, there is a need to individualise treatments to each patient.
3. Foot orthoses are recommended for short-term pain relief. However, they might not be beneficial for all patients. Clinical features that can be used to predict success with foot orthoses are: greater midfoot mobility, less ankle dorsiflexion and immediate improvements in patellofemoral pain when performing a single-leg squat with foot orthoses.
4. Patellar taping and bracing could play a role in patellofemoral pain management
but only in combination with other treatments (ie, as part of a combined intervention as described above).
Other adjunctive treatments, such as joint mobilisations (patella, knee, lumbar), and electrophysical agents were not recommended for use in patellofemoral pain. The 5th International Patellofemoral Pain Research Retreat is scheduled for Brisbane, Australia, July 2017.
> From: Crossley et al., Br J Sports Med (2016) (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the Pubmed summary.