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Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Smith TO, Logan P. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One 2018; 13:e0190892. [PMID: 29324820 PMCID: PMC5764329 DOI: 10.1371/journal.pone.0190892] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patellofemoral pain is considered one of the most common forms of knee pain, affecting adults, adolescents, and physically active populations. Inconsistencies in reported incidence and prevalence exist and in relation to the allocation of healthcare and research funding, there is a clear need to accurately understand the epidemiology of patellofemoral pain. METHODS An electronic database search was conducted, as well as grey literature databases, from inception to June 2017. Two authors independently selected studies, extracted data and appraised methodological quality. If heterogeneous, data were analysed descriptively. Where studies were homogeneous, data were pooled through a meta-analysis. RESULTS 23 studies were included. Annual prevalence for patellofemoral pain in the general population was reported as 22.7%, and adolescents as 28.9%. Incidence rates in military recruits ranged from 9.7-571.4/1,000 person-years, amateur runners in the general population at 1080.5/1,000 person-years and adolescents amateur athletes 5.1%-14.9% over 1 season. One study reported point prevalence within military populations as 13.5%. The pooled estimate for point prevalence in adolescents was 7.2% (95% Confidence Interval: 6.3%-8.3%), and in female only adolescent athletes was 22.7% (95% Confidence Interval 17.4%-28.0%). CONCLUSION This review demonstrates high incidence and prevalence levels for patellofemoral pain. Within the context of this, and poor long term prognosis and high disability levels, PFP should be an urgent research priority. PROSPERO REGISTRATION CRD42016038870.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, United Kingdom
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Damian Thacker
- PhysioWorks (Sheffield), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, United Kingdom
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, United Kingdom
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, United Kingdom
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Validity of Combining History Elements and Physical Examination Tests to Diagnose Patellofemoral Pain. Arch Phys Med Rehabil 2017; 99:607-614.e1. [PMID: 29128344 DOI: 10.1016/j.apmr.2017.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/14/2017] [Accepted: 10/17/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP). DESIGN Prospective diagnostic study. SETTINGS Orthopedic outpatient clinics, family medicine clinics, and community-dwelling. PARTICIPANTS Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated. RESULTS Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2-14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06-.27). CONCLUSIONS Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee disorders were developed. External validation is required before clinical use.
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Halabchi F, Abolhasani M, Mirshahi M, Alizadeh Z. Patellofemoral pain in athletes: clinical perspectives. Open Access J Sports Med 2017; 8:189-203. [PMID: 29070955 PMCID: PMC5640415 DOI: 10.2147/oajsm.s127359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Patellofemoral pain (PFP) is a very common problem in athletes who participate in jumping, cutting and pivoting sports. Several risk factors may play a part in the pathogenesis of PFP. Overuse, trauma and intrinsic risk factors are particularly important among athletes. Physical examination has a key role in PFP diagnosis. Furthermore, common risk factors should be investigated, such as hip muscle dysfunction, poor core muscle endurance, muscular tightness, excessive foot pronation and patellar malalignment. Imaging is seldom needed in special cases. Many possible interventions are recommended for PFP management. Due to the multifactorial nature of PFP, the clinical approach should be individualized, and the contribution of different factors should be considered and managed accordingly. In most cases, activity modification and rehabilitation should be tried before any surgical interventions.
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Affiliation(s)
- Farzin Halabchi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirshahi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Michaleff ZA, Campbell P, Protheroe J, Rajani A, Dunn KM. Consultation patterns of children and adolescents with knee pain in UK general practice: analysis of medical records. BMC Musculoskelet Disord 2017; 18:239. [PMID: 28576118 PMCID: PMC5457541 DOI: 10.1186/s12891-017-1586-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/17/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Knee problems are common in children and adolescents. Despite this, little is known about the epidemiology of knee problems in children and adolescents who consult in general practice. The aim of this study was to describe consultations by children and adolescents about knee problems in general practice, and examine patterns of patient presentations and consultations by age group, sex and area of socio-economic deprivation. METHODS Consultations records specific to the knee region were extracted from a general practice consultation database (CiPCA) over a one year period. Knee consultation codes were organised into 'symptom' or 'diagnosis' (sub-categorised: 'trauma', 'non-trauma') categories. Descriptive statistics were used to describe patient presentations and number of consultations overall, and stratified analysis carried out on age group, sex, and area of socio-economic deprivation. RESULTS Out of all musculoskeletal consultations, knee problems were the fourth most common patient presentation, responsible for the second highest number of consultations. Patient presentations and consultations increased up to age 12-15 years and then stabilised. Symptoms codes e.g. 'knee pain' were used more commonly than diagnosis codes e.g. 'knee sprain' overall. However, symptom code use declined as age increased, more symptom codes were used in girls compared to boys, and more diagnosis codes were used in patients from areas of high socio-economic deprivation. CONCLUSIONS This study provides insight into the epidemiology of knee problems in children and adolescents in general practice. Future research is needed to improve our understanding of the knee problems encountered by GPs, and the influence socio-economic deprivation has on consultations.
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Affiliation(s)
- Zoe A Michaleff
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Paul Campbell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Amit Rajani
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Alshehri A, Lohman E, Daher NS, Bahijri K, Alghamdi A, Altorairi N, Arnons A, Matar A. Cross-Cultural Adaptation and Psychometric Properties Testing of the Arabic Anterior Knee Pain Scale. Med Sci Monit 2017; 23:1559-1582. [PMID: 28364114 PMCID: PMC5386430 DOI: 10.12659/msm.901264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
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/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.
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Affiliation(s)
- Abdullah Alshehri
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Everett Lohman
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Noha S Daher
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Khalid Bahijri
- Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Abdulmohsen Alghamdi
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Nezar Altorairi
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Arin Arnons
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Matar
- Department of Physical Therapy, Prince Faisal Bin Fahad Hospital for Sports Medicine, Riyadh, Saudi Arabia
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Santos GM, Say KG, Pulzatto F, Libardoni TDC, Sinhorim LMB, Martins TB, Pedro VM. VASTUS LATERALIS OBLIQUE ACTIVITY DURING GAIT OF SUBJECTS WITH PATELLOFEMORAL PAIN. REV BRAS MED ESPORTE 2017. [DOI: 10.1590/1517-869220172302146524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: So far, little is known about the behavior of electromyographic activity of vastus lateralis oblique muscle during treadmill gait in subjects with and without patellofemoral pain syndrome. Objective: The purpose of this study was to investigate the electromyographic activity of the patellar stabilizers muscles and the angle of the knee joint flexion in subjects with and without patellofemoral pain syndrome. Method: Fifteen subjects without (21 ± 3 years) and 12 with patellofemoral pain syndrome (20 ± 2 years) were evaluated. The electromyographic activity and flexion angle of the knee joint were obtained during gait on the treadmill with a 5 degree inclination. Results: The knee flexion angle was significantly lower in the subjects with patellofemoral pain syndrome when compared with the healthy controls. The electromyographic activity of vastus lateralis longus was significantly greater during gait on the treadmill with inclination in subjects with patellofemoral pain syndrome. The results also showed that the electromyographic activity of vastus lateralis oblique and vastus medialis oblique were similar in both groups, regardless of the condition (with/without inclination). Conclusion: We have shown that knee kinematics during gait differs among patients with and without patellofemoral pain syndrome and healthy controls and that a different motor strategy persists even when the pain is no longer present. In addition, the findings suggested that the vastus lateralis oblique has a minor role in patellar stability during gait.
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Leibbrandt DC, Louw Q. The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:353. [PMID: 30135903 PMCID: PMC6093140 DOI: 10.4102/sajp.v73i1.353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background Anterior knee pain (AKP) or patellofemoral pain syndrome is common and may limit an individual’s ability to perform common activities of daily living such as stair climbing and prolonged sitting. The diagnosis is difficult as there are multiple definitions for this disorder and there are no accepted criteria for diagnosis. It is therefore most commonly a diagnosis that is made once other pathologies have been excluded. Objectives The aim of this study was to create an evidence-based checklist for researchers and clinicians to use for the diagnosis of AKP. Methods A systematic review was conducted in July 2016, and an evidence-based checklist was created based on the subjective and objective findings most commonly used to diagnose AKP. For the subjective factors, two or more of the systematic reviews needed to identify the factor as being important in the diagnosis of AKP. Results Two systematic reviews, consisting of nine different diagnostic studies, were identified by our search methods. Diagnosis of AKP is based on the area of pain, age, duration of symptoms, common aggravating factors, manual palpation and exclusion of other pathologies. Of the functional tests, squatting demonstrated the highest sensitivity. Other useful tests include pain during stair climbing and prolonged sitting. The cluster of two out of three positive tests for squatting, isometric quadriceps contraction and palpation of the patella borders and the patella tilt test were also recommended as useful tests to include in the clinical assessment. Conclusion A diagnostic checklist is useful as it provides a structured method for diagnosing AKP in a clinical setting. Research is needed to establish the causes of AKP as it is difficult to diagnose a condition with unknown aetiology.
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Affiliation(s)
- Dominique C Leibbrandt
- Department of Physiotherapy/FNB-3D Movement Analysis Laboratory, Faculty of Medicine and Health Sciences, University of Stellenbosch, South Africa
| | - Quinette Louw
- Department of Physiotherapy/FNB-3D Movement Analysis Laboratory, Faculty of Medicine and Health Sciences, University of Stellenbosch, South Africa
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Maclachlan LR, Collins NJ, Matthews ML, Hodges PW, Vicenzino B. The psychological features of patellofemoral pain: a systematic review. Br J Sports Med 2017; 51:732-742. [DOI: 10.1136/bjsports-2016-096705] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
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Leibbrandt D, Louw Q. Kinematic factors associated with anterior knee pain during common aggravating activities: a systematic review. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1283832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dominique Leibbrandt
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Physiotherapy Division/FNB-3D Movement Analysis Laboratory , Tygerberg, South Africa
| | - Quinette Louw
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Physiotherapy Division/FNB-3D Movement Analysis Laboratory , Tygerberg, South Africa
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Décary S, Ouellet P, Vendittoli PA, Roy JS, Desmeules F. Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis. Phys Ther Sport 2016; 23:143-155. [PMID: 27693100 DOI: 10.1016/j.ptsp.2016.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests. OBJECTIVE To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders. METHODS A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR. RESULTS Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions. CONCLUSION When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests.
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Affiliation(s)
- Simon Décary
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
| | - Philippe Ouellet
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
| | - Pascal-André Vendittoli
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada; Department of Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Centers for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada.
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
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Kurt EE, Büyükturan Ö, Erdem HR, Tuncay F, Sezgin H. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome. J Phys Ther Sci 2016; 28:2034-40. [PMID: 27512259 PMCID: PMC4968501 DOI: 10.1589/jpts.28.2034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/07/2016] [Indexed: 12/21/2022] Open
Abstract
[Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both groups. Pain was measured with a Visual Analog Scale, kinesiophobia with the Tampa kinesiophobia scale, and symptoms and functional limitations with the Kujala pain scale. Measurements were repeated 2 days after kinesio tape application. [Results] No differences were found between baseline isokinetic muscle measurements and those taken 2 days after application. However, significant improvements were observed in the kinesio tape group, with regard to joint position sense, pain, kinesiophobia, symptoms, and functional limitations after treatment. Examination of the differences between pre- and post-treatment values in both groups revealed that the kinesio tape group demonstrated greater improvements compared to the placebo kinesio tape group. [Conclusion] Although short-term kinesio tape application did not increase hamstring muscle strength, it may have improved joint position sense, pain, kinesiophobia, symptoms, and daily limitations.
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Affiliation(s)
- Emine Eda Kurt
- Department of Physical Medicine and Rehabilitation, Ahi Evran University Medical Faculty, Turkey
| | - Öznur Büyükturan
- Ahi Evran University School of Physical Therapy and Rehabilitation, Turkey
| | - Hatice Rana Erdem
- Department of Physical Medicine and Rehabilitation, Ahi Evran University Medical Faculty, Turkey
| | - Figen Tuncay
- Department of Physical Medicine and Rehabilitation, Ahi Evran University Medical Faculty, Turkey
| | - Hicabi Sezgin
- Department of Orthopedics and Traumatology, Ahi Evran University Medical Faculty, Turkey
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Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med 2016; 50:839-43. [PMID: 27343241 PMCID: PMC4975817 DOI: 10.1136/bjsports-2016-096384] [Citation(s) in RCA: 335] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - James Selfe
- Faculty of Health, Psychology and Social Care, Department of Health Professions. Manchester Metropolitan University, Manchester, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Centre, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jenny McConnell
- McConnell Physiotherapy Group, Mosman, New South Wales, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Jean-Francois Esculier
- Faculty of Medicine, Centre for Interdisciplinary Research in Rehabilitation and Social Integration Universite Laval, Quebec, Quebec, Canada
| | - Dylan Morrissey
- Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK Physiotherapy Department, Bart's Health NHS Trust, London, UK
| | - Michael J Callaghan
- Faculty of Health, Psychology and Social Care, School of Health Professions. Manchester Metropolitan University, Manchester, UK Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
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Esculier JF, Bouyer LJ, Dubois B, Frémont P, Moore L, Roy JS. Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms. BMC Musculoskelet Disord 2016; 17:5. [PMID: 26738470 PMCID: PMC4702381 DOI: 10.1186/s12891-015-0859-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Patellofemoral pain (PFP) is highly prevalent in runners, and often leads to functional limitations and cessation of running. Training errors as well as decreased lower limb strength and control during running have all been associated with PFP. While strengthening and gait retraining are commonly used by clinicians, no randomised clinical trial has compared these modalities in runners with PFP. The primary objective of this randomised clinical trial will be to compare the effects of three rehabilitation programs targeting different key factors on symptoms and functional limitations of runners with PFP. The secondary objective will be to explore the factors leading to clinical improvement. Methods/design We will conduct a single-blind randomised clinical trial to compare three different 8 week rehabilitation programs: Group 1 will receive education on symptoms management based on training modifications; Group 2 will receive an exercise program targeting lower limb strengthening and control in addition to the education component of Group 1; Group 3 will receive running gait retraining advice as well as the education component of Group 1. Sixty-nine runners with PFP will be recruited and will be seen by independent physiotherapists on five visits through 8 weeks. The primary outcome measure will be symptoms and functional limitations measured by the Knee Outcome Survey – Activities of Daily Living Scale questionnaire at baseline, and at the four, eight and 20 weeks follow-up. Secondary outcomes will include pain level measured using visual analog scales, and running mileage. Lower limb kinematics and kinetics during running, and isometric strength will also be evaluated at baseline and 8 weeks follow-up. The effects of rehabilitation programs on measures of symptoms and functional limitations will be assessed using a 2-way ANOVA (Groups x Time). Regression analyses will be used to identify if changes in running mechanics or strength are determinants of clinical success. Discussion Studies with a high level of evidence are needed to determine the best rehabilitation interventions for runners with PFP. This randomised clinical trial will be the first to compare programs targeting different key factors linked with PFP. Results may guide clinicians and improve their clinical outcomes when treating runners with PFP. Trial Registration ClinicalTrials.gov: NCT02352909. Registered on December 3, 2014.
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Affiliation(s)
- Jean-Francois Esculier
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada. .,The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3B 2J8, Canada.
| | - Laurent J Bouyer
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada.
| | - Blaise Dubois
- The Running Clinic, C.P. 1075, Lac-Beauport, QC, G3B 2J8, Canada.
| | - Pierre Frémont
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
| | - Lynne Moore
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
| | - Jean-Sébastien Roy
- Faculty of Medicine, Laval University, 1050 Avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada.
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Ingram TGJ, Roddick JM, Byrne JM. Is gamma loop dysfunction related to bilateral inhibition in anterior knee pain? Muscle Nerve 2015; 53:280-6. [DOI: 10.1002/mus.24705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/27/2015] [Accepted: 05/12/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Tony G. J. Ingram
- School of Human Kinetics and Recreation; Memorial University of Newfoundland, St. John's; Newfoundland A1C 5S7 Canada
| | - Jenna M. Roddick
- School of Human Kinetics and Recreation; Memorial University of Newfoundland, St. John's; Newfoundland A1C 5S7 Canada
| | - Jeannette M. Byrne
- School of Human Kinetics and Recreation; Memorial University of Newfoundland, St. John's; Newfoundland A1C 5S7 Canada
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Miao P, Xu Y, Pan C, Liu H, Wang C. Vastus medialis oblique and vastus lateralis activity during a double-leg semisquat with or without hip adduction in patients with patellofemoral pain syndrome. BMC Musculoskelet Disord 2015; 16:289. [PMID: 26459411 PMCID: PMC4604088 DOI: 10.1186/s12891-015-0736-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/24/2015] [Indexed: 01/10/2023] Open
Abstract
Background The purpose was to investigate the effect of double-leg semisquat with hip adduction on the activation of vastus medialis oblique (VMO) and vastus lateralis (VL) in patients with patellofemoral pain syndrome (PFPS). Methods Thirty patients with PFPS were designated to the study group, while 30 healthy matched subjects were enrolled in the control group. The activation of VL and VMO was recorded with surface electromyography (EMG) during double-leg semisquat (DS) and double-leg semisquat with hip adduction (DS-HA). The time domain and frequency domain indexes of the electromyography data were collected for analysis. Results In the study group, the time domain indexes (RMS, IEMG) and frequency domain index (MPF) of VL were significant higher than VMO in the test of DS (P < 0.05); and the time domain of VMO was significantly higher in the test of DS-HA when compared to DS (P < 0.05) while there was no difference in the activation of VL. Conclusions In the study group, an increase in activity of the VMO was observed through the surface EMG signal in the double-leg semisquat exercise with hip adduction compared to the exercise without hip adduction. This finding indicates that VMO activation can be more selectively obtained through the exercise with hip adduction which can help balance the VL and VMO.
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Affiliation(s)
- Ping Miao
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Yi Xu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Cuihuan Pan
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Hao Liu
- Department of Physical Therapy, University of North Texas, Health Science Center, Fort Worth, Texas, USA.
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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67
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Leibbrandt DC, Louw QA. The use of McConnell taping to correct abnormal biomechanics and muscle activation patterns in subjects with anterior knee pain: a systematic review. J Phys Ther Sci 2015; 27:2395-404. [PMID: 26311990 PMCID: PMC4540889 DOI: 10.1589/jpts.27.2395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/18/2015] [Indexed: 12/31/2022] Open
Abstract
[Purpose] The aim of this review was to present the available evidence for the effect of
McConnell taping on knee biomechanics in individuals with anterior knee pain. [Methods]
The PubMed, Medline, Cinahl, SPORTDiscus, PEDro and ScienceDirect electronic databases
were searched from inception until September 2014. Experimental research on knee
biomechanical or EMG outcomes of McConnell taping compared with no tape or placebo tape
were included. Two reviewers completed the searches, selected the full text articles, and
assessed the risk of bias of eligible studies. Authors were contacted for missing data.
[Results] Eight heterogeneous studies with a total sample of 220 were included in this
review. All of the studies had a moderate to low risk of bias. Pooling of data was
possible for three outcomes: average knee extensor moment, average VMO/VL ratio and
average VMO-VL onset timing. None of these outcomes revealed significant differences.
[Conclusion] The evidence is currently insufficient to justify routine use of the
McConnell taping technique in the treatment of anterior knee pain. There is a need for
more evidence on the aetiological pathways of anterior knee pain, level one evidence, and
studies investigating other potential mechanisms of McConnell taping.
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Affiliation(s)
| | - Quinette A Louw
- Faculty of Medicine and Health Sciences, University of Stellenbosch, South Africa
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Briani RV, Silva DDO, Pazzinatto MF, Albuquerque CED, Ferrari D, Aragão FA, Azevedo FMD. Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2015; 30:302-7. [PMID: 25583618 DOI: 10.1016/j.clinbiomech.2014.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. METHODS Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. FINDINGS The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of individuals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. INTERPRETATION The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose individuals with patellofemoral pain.
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Affiliation(s)
- Ronaldo Valdir Briani
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil; Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Danilo de Oliveira Silva
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Marcella Ferraz Pazzinatto
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Carlos Eduardo de Albuquerque
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil
| | - Deisi Ferrari
- University of São Paulo, Post-graduation Program Interunits Bioengineering, EESC/FMRP/IQSC-USP, São Carlos, Brazil
| | - Fernando Amâncio Aragão
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil
| | - Fábio Mícolis de Azevedo
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil.
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Silva DDO, Briani RV, Pazzinatto MF, Ferrari D, Aragão FA, Albuquerque CED, Alves N, Azevedo FMD. Reliability and differentiation capability of dynamic and static kinematic measurements of rearfoot eversion in patellofemoral pain. Clin Biomech (Bristol, Avon) 2015; 30:144-8. [PMID: 25550186 DOI: 10.1016/j.clinbiomech.2014.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/17/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain development, due to the kinesiological relationship with ascendant adaptations. Individuals with patellofemoral pain are often diagnosed through static clinical tests, in scientific studies and clinical practice. However, the adaptations seem to appear in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Thus, the aim of this study was to determine the reliability and differentiation capability of three rearfoot eversion measures: rearfoot range of motion, static clinical test and static measurement using a three-dimensional system. METHOD A total of 29 individuals with patellofemoral pain and 25 control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional motion analysis during stair climbing and static clinical tests. Intraclass correlation coefficient and standard error measurements were performed to verify the reliability of the variables and receiver operating characteristic curves to show the diagnostic accuracy of each variable. In addition, analyses of variance were performed to identify differences between groups. FINDINGS Rearfoot range of motion demonstrated higher diagnostic accuracy (an area under the curve score of 0.72) than static measures and was able to differentiate the groups. Only the static clinical test presented poor and moderate reliability. Other variables presented high to very high values. INTERPRETATION Rearfoot range of motion was the variable that presented the best results in terms of reliability and differentiation capability. Static variables do not seem to be related to patellofemoral pain and have low accuracy values.
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Affiliation(s)
- Danilo de Oliveira Silva
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
| | - Ronaldo Valdir Briani
- State University of West Parana, Physical Therapy Department, Cascavel, Parana, Brazil
| | - Marcella Ferraz Pazzinatto
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
| | - Deisi Ferrari
- University of São Paulo, Post-Graduation Program Interunits Bioengineering EESC/FMRP/IQSC-USP, São Carlos, Brazil
| | | | | | - Neri Alves
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; University of São Paulo, Post-Graduation Program Interunits Bioengineering EESC/FMRP/IQSC-USP, São Carlos, Brazil
| | - Fábio Mícolis de Azevedo
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
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Ferrari D, Kuriki HU, Silva CR, Alves N, Mícolis de Azevedo F. Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome. Arch Phys Med Rehabil 2014; 95:1521-6. [PMID: 24742937 DOI: 10.1016/j.apmr.2014.03.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). DESIGN Sensitivity and specificity analysis. SETTING Physical rehabilitation center and laboratory of biomechanics and motor control. PARTICIPANTS Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The diagnostic accuracy was calculated for sEMG parameters' reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. RESULTS The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80-.90), precise (SEM=2.71-3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). CONCLUSIONS The results provide evidence to support the use of EMG signals (B2-frequency band of 45-96 Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.
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Affiliation(s)
- Deisi Ferrari
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil; Bioengineering Postgraduate Program, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil
| | - Heloyse Uliam Kuriki
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil; Bioengineering Postgraduate Program, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil
| | - Cristiano Rocha Silva
- Neuroscience Program and Biomedical Engineering Laboratory, University of São Paulo, SP, Brazil
| | - Neri Alves
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil; Bioengineering Postgraduate Program, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil
| | - Fábio Mícolis de Azevedo
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil.
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The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing. Arch Orthop Trauma Surg 2013; 133:561-7. [PMID: 23435648 DOI: 10.1007/s00402-013-1702-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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