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Activity modification, load management yields successful outcomes in patellofemoral pain
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For patients with patellofemoral pain, a treatment strategy focused on activity modification and load management correlated with high rates of successful outcomes at 12 and 52 weeks, according to recently published results.
Researchers identified 151 adolescent patients aged 10 years to 14 years with patellofemoral pain. At 1 to 4 weeks, patients and parents met with a physical therapist to modify activity to decrease patellofemoral joint loading with the use of an activity ladder and pain monitoring. Patients underwent home-based exercises at 5 to 8 weeks and at 9 to 12 weeks underwent return-sport guidance. The seven-point global rating of change was the primary outcome and 12 weeks was the primary endpoint. Successful outcomes were those that patients reported as “much improved” or “improved”. Other outcomes included the KOOS, hip and knee torque, sports participation, treatment satisfaction and painkiller use.
After 12 weeks, 87% of patients had completed the full questionnaire. Eighty-six percent of those respondents reported a successful outcome at that time vs. 77% at 6 months and 81% at 12 months. Three KOOS subscales saw significant clinically relevant improvements that included pain, sport/recreation and quality of life, per investigators.
According to researchers, hip and knee torque increased between 20% to 33%. Overall, 68% of patients returned to sport after 3 months. At 6 months, 79% of patients returned to sport, and 81% at 12 months. Ninety percent of patients were satisfied with their treatment and 95% said they would recommend the treatment to a friend. There were no specific patient characteristics that correlated with prognosis – by Monica Jaramillo
Disclosures: Researchers reported they received funding from the Danish Research Council (DFF-4004-00247B) and the Danish Physiotherapy Association.
Perspective
Back to TopDaniel W. Green, MD, MS
In the 2019 American Journal of Sports Medicine article, Rathleff studied 151 children from ages 10 to 14 years with symptomatic anterior knee pain with either Osgood slaughters disease or patellofemoral pain. The authors believed that the etiology of this type of knee pain was likely due to intense and repetitive loading of the patellofemoral joint with insufficient recovery. They prospectively studied the effectiveness of a well-defined 12-week program which combined activity modification, education, exercises and an activity ladder to assist the young athletes to return to pain-free activities. After the initial visit, the program was administered with four visits with a physical therapist session with both the young patient and parent.
The program demonstrated an 86% success rate with improved KOOS scores. While the study did not include a control or no treatment group, the high success rate compared favorably to previous programs with success rates lower than 30%.
I believe that this well-written article, along with its appendix, provides clinicians with a concrete and straightforward treatment program for patellofemoral pain and Osgood shatter disease in the young athletic population.
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