Infrapatellar Straps Decrease Patellar Tendon Strain at the Site of the Jumper's Knee Lesion: A Computational Analysis Based on Radiographic Measurements

Rehabilitation of patellar tendinopathy

Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals' decision making in the management of this disorder.

A biomechanical analysis of 3D stress and strain patterns in patellar tendon during knee flexion

Patellar tendinopathy is among the most widespread patellar tendon diseases in athletes that participate in activities involving running and jumping. Although their symptoms can be detected, especially at the inferior pole of the patella, their biomechanical cause remains unknown. In this study, a three-dimensional finite element model of knee complex was developed to investigate principal stress and strain distributions in the patellar tendon during 0° to 90° knee flexion and slow and fast level-ground walking. Results indicate that the patellar tendon is subjected to tensile stress and strains during all three activities. During flexion, its central proximal posterior region exhibited highest peak stress and strain, followed by central distal posterior, central distal anterior and central proximal anterior region. Similar trends and magnitudes were reported during slow and fast walking. The region with highest principal stresses and strains, central proximal anterior region, also corresponds to the most commonly reported patellar tendinopathy lesion site, suggesting that principal stress and strain are good indicators of lesion site location. Additional factors such as regional variations in material properties and frequency and duration of cyclic loading also need to be considered when determining the biomechanical aetiology of patellar tendinopathy.

The effect of Kinesio-tape® on pain and vertical jump performance in active individuals with patellar tendinopathy

BACKGROUND

Patellar tendinopathy is a common inflammatory condition in athletes who undergo large volumes of running and jumping. Kinesio-tape® (KT) is proposed to provide pain relief; however, its effect has not been examined on patellar tendinopathy.

OBJECTIVE

To examine the effects of KT on pain modulation for active individuals with patellar tendinopathy during functional activities.

METHODS

Thirteen symptomatic knees from seven college-aged females (6 bilateral; 1 unilateral) were included. Participants underwent three data collection sessions with KT, sham, and no tape (NT) in a randomized order. During the session, participants performed a maximum vertical jump, single-leg squats and isometric knee extension. The KT intervention was applied according to the KT manual and the sham utilized the same pattern without tension. Pain level was evaluated using the numeric pain scale before, during and after each activity. Function was assessed as maximum vertical jump height and maximum isometric strength. A separate repeated measures ANOVA was used to compare each dependent variable (pain level, vertical jump height, and isometric strength) among the conditions.

RESULTS

Reported pain scores were significantly lower (p = 0.05) during the maximal vertical jump test for KT (3.38 ± 1.26) compared to NT (4.54 ± 2.22). Significantly lower jump heights were found under KT (17.73 ± 3.06in) during the maximum vertical jump test compared to sham (18.65 ± 2.17in, p = 0.000) and NT (18.18 ± 2.93in, p = 0.008).

CONCLUSIONS

The use of the KT tape with a tendon corrective strip and muscle facilitative strip was effective for decreasing pain associated with patellar tendinopathy during jump landing but led to decreased maximum jump height.

CLINICAL TRIAL IDENTIFIER

NCT04153877.

Patella-patellar tendon angle decreases in patients with infrapatellar fat pad syndrome and medial patellar plica syndrome

PURPOSE

Infrapatellar fat pad (IPFP) syndrome and medial patellar plica (MPP) syndrome are two recognized causes of anterior knee pain. However, diagnosing these syndromes is challenging without arthroscopic examination. The aim of this study was to evaluate sagittal patellar tilt in patients with IPFP syndrome or MPP syndrome by measuring the patella-patellar tendon angle (PPTA) in affected patients.

METHODS

Eighty-three patients with anterior knee pain who underwent diagnostic arthroscopy that confirmed isolated IPFP or MPP syndrome from 2011 to 2016 were included in this retrospective study. Patients were divided into Group A (IPFP syndrome, n = 44) and Group B (MPP syndrome, n = 39). The control group included 78 patients without knee pathology who underwent magnetic resonance imaging (MRI) of the knee during the study period. Radiographic measurements, including PPTA, IPFP area, patellar height, axial patellar alignment, patellar tilt, sulcus angle, and lateral trochlear inclination, were made on MRI images by two experienced sports medicine orthopedists.

RESULTS

The mean PPTA in each knee-pathology group was significantly smaller than that in the control group (Group A: 137.3° ± 4.9°; Group B: 138.1° ± 3.2°; control group, 141.4° ± 2.9°). There was no significant difference between groups for any other radiographic parameter evaluated.

CONCLUSION

The PPTA was significantly smaller in patients with IPFP syndrome or MPP syndrome than in healthy controls. Therefore, sagittal patellar tilt should be included in the routine evaluation of patients with anterior knee pain. Evaluation of PPTA may help to diagnose IPFP syndrome or MPP syndrome.

LEVEL OF EVIDENCE

Level IV.

Models of tendon development and injury

Tendons link muscle to bone and transfer forces necessary for normal movement. Tendon injuries can be debilitating and their intrinsic healing potential is limited. These challenges have motivated the development of model systems to study the factors that regulate tendon formation and tendon injury. Recent advances in understanding of embryonic and postnatal tendon formation have inspired approaches that aimed to mimic key aspects of tendon development. Model systems have also been developed to explore factors that regulate tendon injury and healing. We highlight current model systems that explore developmentally inspired cellular, mechanical, and biochemical factors in tendon formation and tenogenic stem cell differentiation. Next, we discuss in vivo, in vitro, ex vivo, and computational models of tendon injury that examine how mechanical loading and biochemical factors contribute to tendon pathologies and healing. These tendon development and injury models show promise for identifying the factors guiding tendon formation and tendon pathologies, and will ultimately improve regenerative tissue engineering strategies and clinical outcomes.

Evidence based treatment options for common knee injuries in runners

The purpose of this paper is to review the current literature regarding conservative treatment options for the three most common knee injuries in runners including patellofemoral pain syndrome (PFPS), iliotibial band friction syndrome (ITBFS), and patellar tendinopathy (PT). Each diagnosis is discussed using current research to describe the pathophysiology, evaluation process, and evidence based effective treatment strategies including therapeutic exercise, manual therapy, neuromuscular re-education, and modalities. The result is a comprehensive overview of each diagnosis and a research-based approach to effectively evaluate and treat each condition for best outcomes.

Immediate effect of infrapatellar strap on pain and jump height in patellar tendinopathy among young athletes

BACKGROUND:

Infrapatellar strapping is a treatment technique used in various knee pathologies; however, its effect on pain and functional performance among young athletes has not been studied.

OBJECTIVES:

To evaluate the effect of infrapatellar strap on pain and jumping performance among young athletes diagnosed with patellar tendinopathy.

STUDY DESIGN:

Pre-/post-test (within-subject research design).

METHODS:

A total of 16 young male basketball and volleyball athletes (age range, 12-18 years) diagnosed with patellar tendinopathy were included in the study. Infrapatellar strap was applied beneath the patella, over the patellar tendon. The athletes performed four jumping tests: squat jump, drop jump, single-leg jump, and jumps 30 s test, with and without the strap. Pain severity in the symptomatic knee during jumping was assessed using a visual analog scale and jumping performance parameters were assessed using an Optojump Next optical measurement system.

RESULTS:

Pain severity reported by the participants decreased in drop test, single-leg jump test, and jumps 30 s test while using the infrapatellar strap compared with no strap condition ( p < 0.05). No significant difference in jumping performance was found between jumping with and without the strap.

CONCLUSION:

The infrapatellar strap was effective in reducing local pain among young male athletes without altered jumping performance.

CLINICAL RELEVANCE

The infrapatellar strap can be recommended to use during physical activity as part of the physical therapy treatments for patellar tendinopathy. Given the low cost, ease to use, and being a non-invasive method without adverse effects, it is an appropriate intervention for young athletes.

Patellar tendinopathy with intratendinous alteration on MRI may be related to patellofemoral dysplasia

Patellar tendinopathy (PT) is a frequent overuse injury of the extensor knee apparatus, whereas as up to 30% of the athletes might suffer from persisting symptoms during their entire career. In the present case-control study, 47 patients (30.8 ± 11.4 years) with PT with intratendinous alteration (PTita) of a minimum of ≥25% of the axial surface on MRI and minimum Blazina score of II (pain during without limiting sports activity) were included; MR images were analyzed for trochlear geometry, patellar height/tilt, and tibial tubercle-trochlear groove distance (TT-TG). The control group (CG) comprised 87 age- and gender-matched patients without history of anterior knee pain or lateral patellar instability. It was hypothesized that patients with PT might be related to patellofemoral dysplasia. It was found that the patella was significantly higher in patients with PT compared to the CG (patellotrochlear index [PT-I]: 0.33 vs 0.37, P = .014; Insall-Salvati index [InSa]: 1.18 vs 1.07, P = .004). PT-I was above the cut-off value in 10.6% of PT knees (CG 5.7%, P = .27), and InSa in 42.6% (CG 21.8%, P = .012). TT-TG was significantly higher in patients with PT compared to CG (12.0 mm vs 9.9 mm, P = .002); however, TT-TG was only pathologic (>20 mm) in one patient. The trochlear facet ratio was above the cut-off value in 55.3% of PT patients and 23% of CG (P < .001), and was significantly greater in patients with PT (0.39 ± 0.09) than CG (0.48 ± 0.1, P < .001). Knees with PT have significantly more morphological characteristics of patellofemoral instability, which needs to be considered especially in recurrent or treatment-refractive cases.

Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella

PURPOSE

The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis.

METHODS

Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis.

RESULTS

The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models.

CONCLUSION

This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities.

LEVEL OF EVIDENCE

IV.

Single-limb landing biomechanics are altered and patellar tendinopathy related pain is reduced with acute infrapatellar strap application

BACKGROUND

Patellar tendinopathy, a common condition of the knee, is often treated with patellar tendon straps to control pain during dynamic activity. Little is known regarding their effect on pain, landing kinematics and kinetics with their application. The purpose of this study was to determine if patellar tendon straps influenced pain, kinematics at landing and ground reaction forces in individuals with patellar tendinopathy versus healthy controls.

METHODS

Thirty participants with patellar tendinopathy and 30 controls participated. They completed single-limb landings with and without patellar tendon straps while pain, three-dimensional kinematics and vertical ground reaction forces were measured. A multivariate analysis of variance was completed to determine the differences in strapping condition and group for the dependent variables.

RESULTS

Individuals with patellar tendinopathy demonstrated a significant decrease in pain (no strap=37.1±22.1mm (mean±SD), strap=28.0±18.5mm (mean±SD)). With the strap at landing all participants displayed less hip rotation (F=7.16, p=.01), knee adduction (F=10.20, p=.002), ankle inversion (F=4.60, p=.04), and peak vertical ground reaction force (F=7.30, p=.009).

CONCLUSIONS

Patellar tendon straps reduced pain in those with patellar tendinopathy. Additionally, with the strap, individuals landed in a more neutral alignment and decreased landing forces which could provide a benefit to those with patellar tendinopathy.

Effect of a patellar strap on the joint position sense of the symptomatic knee in athletes with patellar tendinopathy

OBJECTIVES

The primary aim of this study was to investigate the effect of a patellar strap on the proprioception of the symptomatic leg in PT. Secondary aims were to investigate a possible difference in effectiveness between athletes with high and low proprioceptive acuity, and whether predictors of effectiveness could be found.

DESIGN

Randomised cross-over pilot study.

METHODS

24 athletes with PT (age 27.3±9.0, VISA-P 50.6±11.2) performed a joint position sense test with and without a patellar strap. The difference between both conditions was analysed using linear mixed-model analysis.

RESULTS

No improvement in the joint position sense using the strap for the whole group was found, while those classified as having low proprioceptive acuity did improve using the strap (p=0.015, 17.2%). A larger knee girth, longer duration of symptoms and more tendon abnormalities were negatively associated with the strap's effectiveness.

CONCLUSIONS

The use of a patellar strap improves the knee joint proprioception - measured with joint position sense - of the symptomatic leg in athletes with poor proprioceptive acuity. Especially athletes with relatively small knee girth, short duration of symptoms and small tendon abnormalities might benefit from the strap. As proprioception plays an important role in motor control, and deficits in proprioception may put an athlete at risk for (re-)injury, these findings may be relevant for prevention as well as rehabilitation purposes in those PT athletes with low proprioceptive acuity.

Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy

OBJECTIVE

To determine if patellar tendon straps altered quadriceps' muscle activity during a drop-jump landing in males with and without patellar tendinopathy.

DESIGN

Case-control.

SETTINGS

Biomechanics Research Laboratory.

PARTICIPANTS

Twenty recreationally-active males participated: ten (age = 21.3 ± 2.4 years, height = 182.8 ± 5.3 cm, mass = 81.7 ± 8.6 kg) with patellar tendinopathy; ten (age = 22.0 ± 1.6 years, height = 185.7 ± 4.5 cm, mass = 82.2 ± 9.8 kg) were healthy with no history of tendinopathy.

MAIN OUTCOME MEASURES

Electromyography (EMG) data for the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) muscles were collected. Five 2-legged 40 cm drop-jumps were performed wearing a patellar tendon strap and 5 with no-strap in a counterbalanced order. Root-mean square EMG (REMG) values of the VM, RF, and VL were averaged for a pre-landing and post-landing interval. Multiple mixed-model two-way ANOVAs were performed to determine the effect of tendinopathy and strapping condition on REMG values for each muscle.

RESULTS

For the pre-landing interval, all participants displayed lesser VL EMG activation (0.44 ± 0.19%, 0.53 ± 0.27%, respectively; p = 0.007, d = 0.39) in the no-strap compared with the strap condition.

CONCLUSIONS

When wearing a strap, all participants demonstrated lower VL activation prior to landing which may be helpful in reducing tensile stress at the tendon. These effects may be clinically important in modulating pain in those with patellar tendinopathy.

Impact of Patellar Tendinopathy on Knee Proprioception: A Cross-Sectional Study

OBJECTIVE

To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity.

DESIGN

Cross-sectional study.

SETTING

University research laboratory (institutional).

PARTICIPANTS

Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study.

ASSESSMENTS

Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained.

MAIN OUTCOME MEASURES

Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS).

RESULTS

No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight.

CONCLUSIONS

Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.

The immediate effect of patellar tendon strap on weight-bearing asymmetry during squatting in patients with unilateral knee osteoarthritis: A pilot study

BACKGROUND

Knee osteoarthritis has commonly been associated with a symptom of pain resulting in an inter-limb weight-bearing asymmetry during functional tasks. Patellar tendon strap is one of the non-pharmacologic interventions to alleviate knee pain.

OBJECTIVES

To investigate the immediate effect of a patellar tendon strap on weight-bearing asymmetry during squatting in people with unilateral knee osteoarthritis.

STUDY DESIGN

Cross-sectional study.

METHODS

Ten patients with unilateral knee osteoarthritis and 10 healthy subjects were included in the study. Weight-bearing asymmetry of patients was assessed using a weight-bearing squat test during squatting at 30° and 60° both with and without patellar tendon strap. Pain intensity was assessed during squatting in unstrapped and strapped conditions with Visual Analog Scale.

RESULTS

The decrease in weight-bearing asymmetry values immediately after wearing patellar tendon strap during 30° (p = 0.006) and 60° (p = 0.011) of squatting tests was significantly higher in knee osteoarthritis patients than in healthy subjects. Reported pain intensity was similar in unstrapped and strapped conditions (p = 0.066).

CONCLUSION

The results of this study showed improved inter-limb weight-bearing symmetry during squatting. Further research with larger sample sizes investigating the effect of patellar tendon strap on weight-bearing asymmetry during functional activities in people with knee osteoarthritis is warranted.

CLINICAL RELEVANCE

Patellar tendon straps (easily fit and cheap unlike knee braces) had more improvements in inter-limb weight-bearing symmetry during squatting in people with knee osteoarthritis compared to healthy subjects. This study is a new insight for future studies to investigate clinical benefits of wearing patellar tendon straps in this population.

Patellar Tendinopathy

Context:

Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment.

Evidence Acquisition:

PubMed spanning 1962-2014.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities.

Conclusion:

Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients.

Tendon Contraction After Cyclic Elongation Is an Age-Dependent Phenomenon: In Vitro and In Vivo Comparisons

BACKGROUND

Tendons are viscoelastic tissues that deform (elongate) in response to cyclic loading. However, the ability of a tendon to recover this elongation is unknown.

HYPOTHESIS

Tendon length significantly increases after in vivo or in vitro cyclic loading, and the ability to return to its original length through a cell-mediated contraction mechanism is an age-dependent phenomenon.

STUDY DESIGN

Controlled laboratory study.

METHODS

In vitro, rat tail tendon fascicles (RTTfs) from Sprague-Dawley rats of 3 age groups (1, 3, and 12 months) underwent 2% cyclic strain at 0.17 Hz for 2 hours, and the percentages of elongation were determined. After loading, the RTTfs were suspended for 3 days under tissue culture conditions and photographed daily to determine the amount of length contraction. In vivo, healthy male participants (n = 29; age, 19-49 years) had lateral, single-legged weightbearing radiographs taken of the knee at 60° of flexion immediately before, immediately after, and 24 hours after completing eccentric quadriceps loading exercises on the dominant leg to fatigue. Measurements of patellar tendon length were taken from the radiographs, and the percentages of tendon elongation and subsequent contraction were calculated.

RESULTS

In vitro, cyclic loading increased the length of all RTTfs, with specimens from younger (1 and 3 months) rats demonstrating significantly greater elongation than those from older (12 months) rats (P = .009). The RTTfs contracted to their original length significantly faster (P < .001) and in an age-dependent fashion, with younger animals contracting faster. In vivo, repetitive eccentric loading exercises significantly increased patellar tendon length (P < .001). Patellar tendon length decreased 24 hours after exercises (P < .001) but did not recover completely (P < .001). There was a weak but significant (R (2) = 0.203, P = .014) linear correlation between the amount of tendon contraction and age, with younger participants (<30 years) demonstrating significantly more contraction (P = .014) at 24 hours than older participants (>30 years).

CONCLUSION

Cyclic tendon loading results in a significant increase in tendon elongation under both in vitro and in vivo conditions. Tendons in both conditions demonstrated an incomplete return to their original length after 24 hours, and the extent of this return was age dependent.

CLINICAL RELEVANCE

The age- and time-dependent contraction of tendons, elongated after repetitive loading, could result in transient alterations in the mechanobiological environment of tendon cells. This, in turn, could induce the onset of catabolic changes associated with the pathogenesis of tendinopathy. These results suggest the importance of allowing time for contraction between bouts of repetitive exercise and may explain why age is a predisposing factor in tendinopathy.

Influence of infrapatellar and suprapatellar straps on quadriceps muscle activity and onset timing during the body-weight squat

The use of knee braces for the treatment of patellofemoral pain syndrome (PFPS) is widely documented, yet the mechanism by which such braces alleviate knee pain remains unclear. This study attempted to clarify this issue by simplifying the brace to the level of only straps. The effectiveness of an infrapatellar strap for PFPS remains controversial, and the use of a suprapatellar strap has not yet been studied. Quadriceps muscle activity and onset timing parameters were measured with surface electromyography (EMG) during a body-weight squat in 19 healthy subjects during 4 different knee-strapping conditions (infra, supra, both, and none). No differences in normalized mean or peak EMG activity in any part of the quadriceps were found. The onset timing of the vastus lateralis (VL) was significantly delayed when using an infrapatellar strap (p < 0.05) or both straps (p < 0.05) and marginally delayed when using a suprapatellar strap (p < 0.10) in comparison with the no-strap (control) condition. No differences in the vastus medialis oblique (VMO) onset timing or VMO-VL onset timing difference were found among the strapping conditions, although an improvement in timing was noted with the suprapatellar condition. The results provide novel evidence that the application of an infrapatellar strap, suprapatellar strap, or both straps improves quadriceps muscle timing imbalances by delaying VL onset. Because the largest delay in VL onset occurred when wearing both straps, the combined application of an infrapatellar and suprapatellar strap may be the most beneficial in managing patellofemoral pain. Knee straps, unlike braces, are cost effective, nonrestrictive, and can be universally fitted to any knee and based on the results deserve further study in the patellofemoral pain population.