PATELLOFEMORAL PAIN SYNDROME

Treatment summary ● Education is an essential part of the treatment of PFPS ● Exercise therapy including quadri- ceps strengthening, soft tissue stretch- ing including hamstrings and ITB, closed and open kinetic chain exercises, eccentric and concentric exercises are the core components to any treatment programme ● A pain monitoring system to prevent too rapid a progression and PFJ over- load could be incorporated in to the program and might be beneficial ● A combination of physiotherapy techniques has been shown to be bene- ficial, but individual modalities such as patellar taping or therapeutic ultra- sound have not been shown to be of proven benefit ● Progressive resistance braces are an exciting prospect for the future

It has been suggested that PFPS may lead to patellofemoral OA, but there is a lack of prospective studies with long-term follow- up and reliable evidence. One study showed that 3% of patients originally diagnosed as having PFPS went on to develop osteoarthritis after seven years. The same study showed that almost 75% of patients treated with intensive quadriceps-muscle exercises had a complete subjective, func- tional and clinical recovery at six months. At the seven-year follow-up 80% of patients reported that their knee was excellent and almost two thirds had a full clinical recovery (19). This suggests that the long-term prognosis for patients with patellofemoral pain syndrome who are managed non-operatively appears to be good. In most patients the condition does not result in chronic disability or radiographic degeneration.

Another study looked at the outcome of 54 adolescent girls with anterior knee pain. The follow up period varied from 2-8 years and was conducted by a non-defined ques- tionnaire. This showed that pain persisted in the majority of patients and in a small proportion the pain constituted a continu- ing handicap in both sporting and day-to- day activities. However the pain did appear to improve with time and was a serious dis- ability in very few. Treatment details were few but none were treated operatively and conservative treatment of physiotherapy was for short periods.

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Milgrom et al. found that in Israeli infantry recruits who developed anterior knee pain during military training, 50% were still symptomatic, but only 8% had severe pain, hindering physical activity when followed up 6 years later (20).

Although overall outcome appears to be good, it is difficult to predict which indi- vidual patients will do well. Kannus et al completed a prospective follow up study of 49 patients with PFPS. The only factor that that was significantly associated with out- come was age. The younger the patient the better the outcome.

Very few patients go on to develop PFJ OA or significant long term disability. The overall outcome is good, particularly after a treatment programme of education, exercise and physiotherapy.

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Dr Alex Bennett is a specialist registrar in rheumatology and rehabilitation at the Defence Services Medical Rehabilitation Centre, Headley Court. He completed the Diploma in Sports Medicine (UK) in 1998. His special interests are seronegative spondyloarthropathy and sports medicine.

Dr Nick Carter is a consultant in rheumatol- ogy and rehabilitation at the Defence Services Medical Rehabilitation Centre, Headley Court. He recently completed a year as a clinical fellow in sports medicine at the Alan McGavin Sports Medicine Centre, University of British Columbia, Canada.