LITERATURE REVIEW


TREATING ADOLESCENT PATELLOFEMORAL PAIN


BY MICHAEL SKOVDAL RATHLEFF MHSC PHD


INTRODUCTION Knee pain among adolescents Pain is not an uncommon experience among adolescents (1). At any given time more than 25% of adolescents will report some musculoskeletal complaint (2). For most pain conditions, females have a 2–3-fold higher prevalence compared to males. One of the most common musculoskeletal complaints among adolescents is knee pain (Fig. 1) (3).


Thirty percent of adolescents


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Knee pain and especially patellofemoral pain (PFP) is common among adolescents, but most of the previous scientific research has focused on adults even though adolescents with PFP are frequently seen in the clinic. During the last five years a research group from Denmark has systematically investigated PFP among adolescents. The research group has explored how common this knee condition is, what characterises the adolescents with PFP and how adolescents with PFP should be treated. Adolescent PFP is hard to treat and this article highlights key aspects that need to be considered when treating adolescents with PFP.


report knee pain with approximately two thirds of these reporting an insidious onset of knee pain with no apparent trauma preceding their knee pain (4,5). Fifty percent of the adolescents with knee pain will at some point seek medical treatment, often through their general practitioner. This means that at some point, we are likely to meet them (and their parents) in the clinic.


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Figure 1: Occurrence of knee pain among adolescents from 12 to 19 years of age. (M.S. Rathleff, 2014)


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Patellofemoral pain among adolescents One of the most common knee conditions among adolescents is patellofemoral pain (PFP). The most frequently self-reported symptoms in PFP are diffuse peri-patellar and retro-patellar localised pain (6). Pain is


typically provoked by activities of daily living that require loading on a flexed knee such as stair walking, squatting and jumping (6). The pathology behind PFP is unknown but PFP is likely to be an umbrella diagnosis composed of different pathologies which ultimately lead to similar symptoms (7). Proposed structures involved include the subchondral bone, lateral retinaculum, synovial lining and/or the highly innervated infrapatellar fat pad (8). Adolescents with PFP are common in the clinic but just how common is it in the adolescent population? To answer this question we conducted a population-based study among 2200 adolescents between 15–19 years of age. To our surprise we found a prevalence of 7% with females


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Proportion of adolescents with knee pain (%)


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