Rethinking patellofemoral pain: Prevention, management and long-term consequences

• Published in: Best practice & research. Clinical rheumatology 2019-02, Vol.33 (1), p.48-65
• Main Authors: Crossley, Kay M., van Middelkoop, Marienke, Barton, Christian J., Culvenor, Adam G.
• Format: Article
• Language: English
• Subjects: Adult; Female; Humans; Impairments; Male; Patellofemoral pain; Patellofemoral Pain Syndrome; Prevention; Prospective Studies; Risk Factors; Treatment
• ISSN: 1521-6942; 1532-1770
• DOI: 10.1016/j.berh.2019.02.004

Patellofemoral pain is one of the most common knee complaints, particularly among physically active young individuals. Although once thought to be self-limiting, prospective studies have demonstrated the propensity towards the chronicity of patellofemoral pain (PFP). The pathogenesis of PFP is complex, with multiple interactive pathways suggested to contribute to its onset and persistence. Quadriceps weakness is one of the few risk factors of PFP, with at least moderate evidence from prospective studies, although limited clinical trials of lower limb strengthening have generally not been successful in preventing PFP. The challenge of managing PFP is reflected by a lack of evidence-based clinical guidelines. International consensus and current evidence recommends exercise therapy, focussed on hip and knee strengthening, as a cornerstone of management to reduce PFP. Rethinking management approaches beyond exercise therapy to incorporate movement retraining, education and psychosocial aspects provides potential avenues to enhance outcomes for patients with PFP.