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Author Method Clarke (2000) (15) N=81

Follow-up at 3 and 12 months, 4 groups:

1) Exercise, taping and education 2) Exercise and education 3) Taping and education 4) Education alone

Witrouw (2000) (16) N=60

Follow up 5 weeks and 3 months, 2 groups:

1) 5 week closed kinetic chain exercise programme

2) 5 week open kinetic chain exercise programme

Outcome measures 1) WOMAC*3

2) VAS*2 Results

Physiotherapy based exercise had a beneficial result at 3

3) Patient satisfaction months sufficient to permit 4) Discharge rates from treatment

1) VAS*2 2) Kujala score 3) Functional outcome

discharge from physiotherapy. Taping did not influence outcome

Both open and closed chain exercise programmes showed improved subjective and

assessment including squat, clinical outcomes but there step and jump tests 4) Muscle strength

was no significant difference between the two

measurement on isokinetic groups dynamometer 5) Muscle length measurement using a goniometer

Schneider (2001) (17) N=20

Follow up 8 weeks, 2 groups:

1) 16 physiotherapeutic exercises on a neurophysiological basis, over 8 weeks.

Crossley (2002) (18) N=67 2 groups: 1) VAS*2 3) EMG activity while performing isokenetic muscle

2) Progressive resistance brace for 15 mins tests under concentric and three times a day for 8 weeks

isometric activity 1) VAS*2

2) Functional Index

1) Six one week sessions of physiotherapy questionnaire including VMO retraining, PFJ mobilisations 3) Kujala and patella taping

questionnaire for PFJ disorders

2) Six one week sessions of sham ultrasound 4) Participant perceived and placebo taping

response to treatment. Secondary: 1) SF-36*4 2) Functional measurement of squats and step-ups

Glossary *1 GAGPS = Glycosaminoglycan polysulphate *3 WOMAC = Western Ontario McMasters Knee Scale

Table 5: Randomised studies of non-operative therapy in PFPS

sider surgical treatment until at least 6 months of conservative treatment has been tried and only in the appropriate cases.

The more common surgical procedures are: ● Lateral retinacular release ● Distal realignment procedures ● Articular cartilage procedures Lateral retinacular release maybe indicated in patients with excessive lateral pressure syndrome with tightness of the lateral reti- naculum combined with lateral patella tilt. The procedure is not recommended in the very young or in patients with OA of the

PFJ or normal patella tracking. The results of this procedure are unpredictable with satisfactory results reported between 20 and 92% of patients. While this procedure is aimed at restoring normal tracking of the patella in the femoral trochlear, studies have failed to demonstrate an improve- ment in patellofemoral contact. Distal realignment procedures are generally used for patellar subluxation or dislocation rather than pain. Satisfactory results have been reported but there are concerns over long-term outcomes. Articular cartilage procedures such as patellar shaving, local

excision of defects with drilling of the sub- chondral bone, facetectomy or transplanta- tion of autologous chondrocytes are designed for treating anterior knee pain associate with patellar articular cartilage lesions. Again there is inadequate evidence for these procedures and concerns over long-term outcome.

The outcome of PFPS A review of outcome studies in PFPS has produced mixed results. A contributing fac- tor maybe that outcome measures for PFPS have not been standardised.

SportEX 13 *2 VAS = Visual Analogue Scale of Pain *4 SF-36 = Short Form 36 (Quality of Life Scale) Six, once weekly

physiotherapy treatment sessions including VMO

strengthening, PFJ mobilisa- tion and taping are efficacious for patients with PFPS

Significant improvement in

2) Besette & Hunter score pain and VMO EMG activity for pain

was shown in the patients in the knee brace group