Patellofemoral pain CPG

Question 1

In AKP, what two regions are typically painful?

Answer 1

Retro- and peripatellar regions

Question 2

What two age groups are AKP typically associated with?

Answer 2

12-19 y.o.

50-59 y.o (PFOA)

Question 3

What is the most accurate clinical diagnostic test for a diagnosis of AKP/PFP? (High sensitivity)

Answer 3

Squatting - high -LR 0.1-0.2

Question 4

What are three other highly sensitive tests for exclusion of PFP?

Answer 4

Stair climbing
Kneeling
Sitting with knees flexed

Question 5

What are two highly specific tests for inclusion of PFP?

Answer 5

Patellar tilt

Eccentric step down test

Question 6

What two ways are quadriceps affected in those with AKP/PFP?

Answer 6

1) Atrophy (visible only on MRI)

2) arthrogenic inhibition

Question 7

True/false: hip weakness is a direct cause of PFP

Answer 7

False - may be a result, not a direct cause

Question 8

True/false: those with PFP have an increased FPPA with single leg squat, hop landing, SLS (frontal plane projection angle)

Answer 8

True - tend to have more knee valgus

Question 9

Six factors for PFP: (6)

Answer 9

1) female gender
2) single sport athletes
3) isometric knee extensor weakness **predictor
4) weakness in hip ext/abd/ERs
5) dec flexibility of quad/HS/gastroc
6) hip/foot mechanics ** inconclusive

Question 10

What are factors as it pertains to a negative outcome with PFP? (3)

Answer 10

1) longer duration sxs
2) higher baseline pain
3) poorer function/ strength

Question 11

What are the 4 subcategories of PFP?

Answer 11

1) overuse/overload
2) muscle performance deficits
3) movement coordination deficits
4) mobility impairments

Question 12

What are the Ottawa / Pittsburgh knee rules: 5 factors/ 3 factors

Answer 12

1) age > 55
2) isolated tenderness patella
3) tenderness of fibular head
4) unable to flex > 90 deg
5) unable to take 4 WB steps, limping counts

1) age <12, >50
2) MOI - blunt trauma, fall
3) unable to take 4 WB steps, limping counts

Question 13

What two outcome measures are most applicable to PFP/AKP?

Answer 13

Knee injury and OA outcome scale - PFJ (KOOS -PJF)

Anterior knee pain scale (AKPS)

Question 14

Which intervention has more beneficial outcomes for AKP: targeted knee strengthening or combined hip and knee strengthening ?

Answer 14

Combined hip and knee targeted exercise program reduces pain, improves outcome measure with function in all phases

Question 15

True/false: taping has good long term outcomes for PFP

Answer 15

False - only beneficial in short term, with immediate pain relief

Question 16

For PFP, what other intervention should taping and/or foot orthoses be combined with?

Answer 16

Exercise - critical component to success with any approach

Question 17

Do foot orthoses have short- or long-term pain reduction in AKP/PFP?

Answer 17

Short-term; aid with pain reduction and only with combination of exercise

Question 18

What 3 treatment approaches were recommended against use in the PFP CPG?

Answer 18

1) needling
2) biofeedback
3) biophysical agents

Question 19

Is manual therapy beneficial for PFP?

Answer 19

Yes but only as adjunct to exercise