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Targeted Treatment in Anterior Knee Pain Patients According to Subgroups Versus Multimodal Treatment

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Anterior Knee Pain and Patellar Instability

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Abstract

This chapter critically reviews proposed stratification frameworks and subgrouping approaches for patients with patellofemoral pain (PFP) in light of the methodological guidelines which guide stratification research. Potential emergent subgroups are discussed with respect to important clinimetric properties and likely clinical utility. Directions for future research within the three overarching domains of Physical; Psychosocial; Physiological are discussed. Finally a clinical pathway to guide readers to credible and evidence based PFP patient subgroups in light of the current state of knowledge is presented.

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References

  1. Barton CJ, Lack S, Hemmings S, et al. The ‘best practice guide to conservative management of patellofemoral pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med. 2015:1–13.

    Google Scholar 

  2. Smith B, Hendrick P, Bateman M, et al. Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists. BMC Musculoskelet Disord. 2017;18:181.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Crossley KM, Macri EM, Cowan SM, et al. The patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF): development and validation using the COSMIN checklist. Br J Sports Med. 2017;52:1130–6.

    Article  PubMed  Google Scholar 

  4. Whittingham M, Palmer S, Macmillan F. Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial. J Orthop Sports Phys Ther. 2004;34:504–10.

    Article  PubMed  Google Scholar 

  5. Dixit S, DiFiori JP, Burton M, et al. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;15:194–202.

    Google Scholar 

  6. Blond L, Hansen L. Patellofemoral pain syndrome in athletes. Acta Orthop Belg. 1998;64:393–400.

    CAS  PubMed  Google Scholar 

  7. Brennan GP, Fritz JM, Hunter SJ, et al. Identifying subgroups of patients with acute/subacute “nonspecific” low back pain: results of a randomized clinical trial. Spine. 2006;31:623–31.

    Article  PubMed  Google Scholar 

  8. Hill JC, Whitehurst D, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet. 2011;378:1560–2157.

    Article  Google Scholar 

  9. Holmes SW Jr, Clancy WG Jr. Clinical classification of patellofemoral pain and dysfunction. J Orthop Sports Phys Ther. 1998;28:299–306.

    Article  PubMed  Google Scholar 

  10. Selfe J, Janssen J, Drew B, et al. Anterior Knee Pain Subgroups: The First Step Towards a Personalized Treatment. Annals of Joint Special edition on Patellofemoral Pain. Edited by Sanchis-Alfonso V and Dye S. 2018;3:32.

    Google Scholar 

  11. Merchant AC. Classification of patellofemoral disorders. Arthroscopy. 1988;4:235–40.

    Article  CAS  PubMed  Google Scholar 

  12. Wilk KE, Davies GJ, Mangine RE, et al. Patellofemoral disorders: a classification system and clinical guidelines for nonoperative rehabilitation. J Orthop Sports Phys Ther. 1998;28:307–22.

    Article  CAS  PubMed  Google Scholar 

  13. Witvrouw E, Werner S, Mikkelsen C, et al. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc. 2005;13:122–30.

    Article  PubMed  Google Scholar 

  14. Powers CM, Witvrouw E, Davis IS, et al. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International patellofemoral pain research retreat, Manchester, UK: part 3. Br J Sports Med. 2017;51:1713–23.

    Article  PubMed  Google Scholar 

  15. Hingorani AD, van der Windt DA, Riley RD, et al. Prognosis research strategy (PROGRESS) 4: stratified medicine research. BMJ. 2013;346: e5793.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Medical Research Council. The MRC Framework for the Development, Design and Analysis of Stratified Medicine Research. Swindon: Medical Research Council; 2018.

    Google Scholar 

  17. Post WR. Current concepts clinical evaluation of patients with patellofemoral disorders. Arthroscopy. 1999;15:841–51.

    Article  CAS  PubMed  Google Scholar 

  18. Selhorst M, Rice W, Degenhart T, et al. Evaluation of a treatment algorithm for patients with patellofemoral pain syndrome: a pilot study. Int J Sports Phys Ther. 2015;10:178–88.

    PubMed  PubMed Central  Google Scholar 

  19. Keays S, Mason M, Newcombe P. Individualised physiotherapy in the treatment of patellofemoral pain. Physiother Res Int. 2015;20:22–36.

    Article  PubMed  Google Scholar 

  20. Selfe J, Dey P, Callaghan M, et al. Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted Intervention (TIPPs). Br J Sports Med. 2016;50:873–80.

    Article  PubMed  Google Scholar 

  21. Drew B, Conaghan P, Smith T, et al. Development of data-driven diagnostic subgroups for people with patellofemoral pain using modifiable clinical, biomechanical and imaging features. J Orthop Sports Phys Ther. 2019;49:536–47.

    Article  PubMed  Google Scholar 

  22. Willy R, Hoglund L, Barton C, et al. Patellofemoral pain clinical practice guidelines linked to the international classification of functioning, disability and health. From the academy of orthopaedic physical therapy of the american physical therapy association. J Orthop Sports Phys Ther. 2019;49: 623–681.

    Google Scholar 

  23. Dierks T, Manal K, Hamill J, et al. Lower extremity kinematics in runners with patellofemoral pain during a prolonged run. Med Sci Sports Exerc. 2011;43:693–700.

    Article  PubMed  Google Scholar 

  24. Richards J, Selfe J, Kelly S, et al. Are there differences in Knee Stability between patients with patellofemoral pain and healthy subjects during a slow step descent task? PRM+. 2018;1:67–70.

    Google Scholar 

  25. Callaghan M, Richards J, Atkins LT, et al. Medial and lateral knee deviation angular measurements to assess knee instability using smart phone video technology. Can J Biomed Res Tech. 2020;3:3–4.

    Google Scholar 

  26. Dye SF, Vaupel GL. The pathophysiology of patellofemoral pain. Sports Med Arthrosc Rev. 1994;2:203–10.

    Article  Google Scholar 

  27. Dye S, Staubli HU, Biedert RM, et al. The mosaic of pathophysiology causing patellofemoral pain: therapeutic implcations. Oper Techn Sports Med. 1999;7:46–54.

    Article  Google Scholar 

  28. Sanchis-Alfonso V. Pathophysiology of anterior knee pain. In: Zaffagnini S, Dejour D, Arendt EA (eds) Patellofemoral pain, instability, and arthritis. Berlin: Springer; 2010.

    Google Scholar 

  29. Kent P, Keating JL, Leboeuf-Yde C. Research methods for subgrouping low back pain. BMC Med Res Methodol. 2010;10:62.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Selfe J, Callaghan M, Witvrouw E, et al. Study Protocol: Targeted Interventions for Patellofemoral Pain (TIPPs): classification of clinical sub-groups. BMJ Open. 2013;3: e003795. https://doi.org/10.1136/bmjopen-2013-003795.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Davis I, Powers C. Patellofemoral pain syndrome: proximal, distal, and local factors. an international retreat. J Orthop Sports Phys Ther. 2010;40:A1–48.

    Google Scholar 

  32. Maffiuletti NA. Assessment of hip and knee muscle function in orthopaedic practice and research. J Bone Joint Surg Am. 2010;92:220–9.

    Article  PubMed  Google Scholar 

  33. Witvrouw E, Lysens R, Bellemans J, et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population: a two year prospective study. Am J Sports Med. 2000;28:480–9.

    Article  CAS  PubMed  Google Scholar 

  34. Redmond AC, Crane YZ, Menz HB. Normative values for the foot posture index. J Foot Ankle Res. 2008;1:1–9.

    Article  Google Scholar 

  35. Youdas JW, Krause DA, Hollman JH, et al. The influence of gender and age on hamstring muscle length in healthy adults. J Orthop Sports Phys Ther. 2005;35:246–52.

    Article  PubMed  Google Scholar 

  36. Syme G, Rowe P, Martin D, et al. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. Man Ther. 2009;14:252–63.

    Article  CAS  PubMed  Google Scholar 

  37. Brown J. Physiotherapists knowledge of patellofemoral pain syndrome. Br J Ther Rehabil. 2000;7:346–53.

    Article  CAS  Google Scholar 

  38. Janssen J, Selfe J, Callaghan M, et al. Patellofemoral pain subgroups: a critical first step towards personalised clinical intervention. Lower Extremity Review. 2017; https://lermagazine.com/cover_story/patellofemoral-pain-subgroups-a-critical-first-step-toward-personalized-clinical-intervention.

  39. Hébert-Losier K, Hanzlíkováa I, Ghadikolaeia S, et al. An exploration of normative values in New Zealand to inform the targeted interventions for patellofemoral pain approach (TIPPs). Musculoskeletal Science and Practice. 2021;54.

    Google Scholar 

  40. Greuel H, Herrington L, Liu A, et al. How does acute pain influence biomechanics and quadriceps function in individuals with patellofemoral pain? Knee. 2019;26:330–8.

    Article  PubMed  Google Scholar 

  41. Drew BT, Conaghan PG, Smith TO, et al. The effect of targeted treatment on people with patellofemoral pain: a pragmatic, randomised controlled feasibility study. BMC Musculoskelet Disord. 2017;18:338.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Yosmaoglu B, Sonmezer E, Ezgisahin I, et al. Targeted treatment protocol in patellofemoral pain (TIPPs): does treatment designed according to subgroups improve clinical outcomes in patients unresponsive to multimodal treatment? Sports Health. 2019. https://doi.org/10.1177/1941738119883272.

  43. Kısacık P, Tunay V, Bek N, et al. Short foot exercises have additional effects on knee pain, foot biomechanics, and lower extremity muscle strength in patients with patellofemoral pain. J Back Musculoskelet Rehabil. 2021. https://doi.org/10.3233/BMR-200255.

    Article  PubMed  Google Scholar 

  44. Vicenzino B, Rathleff MS, Holden S, et al. Developing clinical and research priorities on pain and psychological features in individuals who have patellofemoral pain: An international consensus process with health care professionals. J Orthop Sports Phys Ther. 2021.

    Google Scholar 

  45. Selfe J, Dey P, Richards J, et al. An exploration of the association between the reporting of musculoskeletal pain in the knee and the propensity for conscious control of movement. Clin Rehabil. 2015;29:95–100.

    Article  PubMed  Google Scholar 

  46. Arnoldi CC. The patellar pain syndrome. Acta Orthop Scand. 1991;62(Suppl244):1–29.

    Article  Google Scholar 

  47. Naslund J, Walden M, Lindberg LG. Decreased pulsatile bloodflow in the patella in patellofemoral pain syndrome. Am J Sports Med. 2007;35:1668–73.

    Article  PubMed  Google Scholar 

  48. Ben-Eliyahu DJ. Infrared thermographic imaging in the detection of sympathetic dysfunction in patients with patellofemoral pain. J Manip Physiol Therapeutics. 1992;15:164–70.

    CAS  Google Scholar 

  49. Sandow MJ, Goodfellow JW. The natural history of anterior knee pain in adolescents. J Bone Jt Surg (Br). 1985;67:36–8.

    Article  CAS  Google Scholar 

  50. Price AJ, Jones J, Allum R. Chronic traumatic anterior knee pain. Injury. 2000;31:373–8.

    Article  CAS  PubMed  Google Scholar 

  51. McConnell J Chapter 2: Patients emotional states and expectations. In: Selfe J, Janssen J, Callaghan M, eds. Patellofemoral Pain: An evidence-based clinical guide. New York: Nova Science; 2017.

    Google Scholar 

  52. Selfe, J Harper L, Pedersen I, et al. Cold legs: A potential indicator of negative outcome in the rehabilitation of patients with patellofemoral pain syndrome? Knee. 2003;10:139–143.

    Google Scholar 

  53. Selfe J, Sutton C, Hardaker N, et al. Anterior knee pain and cold knees: a possible association in women. Knee. 2010;17:319–23.

    Article  PubMed  Google Scholar 

  54. Janssen J, Selfe J, Gichuru P, et al. Hot and cold knees: exploring differences in patella skin temperature in patients with patellofemoral pain. Physiotherapy. 2020;108:55–62.

    Article  PubMed  Google Scholar 

  55. Erande R, Dey M, Richards J, et al. An investigation of the relationship between thermal imaging and digital thermometer testing at the knee. Physiotherapy Pract Res. 2016;37:41–7.

    Article  Google Scholar 

  56. Selfe J. Patellofemoral pain: myths. truths; future directions Physiotherapy Ireland. 2010;31:16–8.

    Google Scholar 

  57. Maclachlan L, Collins N, Matthews M, et al. The psychological features of patellofemoral pain: a systematic review. Br J Sports Med. 2017;51:732–42.

    Article  PubMed  Google Scholar 

  58. Crossley KM, Macri EM, Cowan SM, et al. The patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF): development and validation using the COSMIN checklist. Br J Sports Med. 2018;52:1130–6.

    Article  PubMed  Google Scholar 

  59. Barton CJ, De Oliveira SD, Morton S, et al. REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies. Br J Sports Med. 2021;55:1135–43.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Health and Education, Department of Health Professions, Manchester Metropolitan University, Manchester, UK

    James Selfe

  2. Visiting Academic in Physiotherapy Studies, Satakunta University of Applied Sciences, Pori, Finland

    James Selfe

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  1. James Selfe
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Correspondence to James Selfe .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

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Selfe, J. (2023). Targeted Treatment in Anterior Knee Pain Patients According to Subgroups Versus Multimodal Treatment. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_8

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  • DOI: https://doi.org/10.1007/978-3-031-09767-6_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

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