Scott J. Luhmann, Perry L. Schoenecker, Matthew B. Dobbs, and J. Eric Gordon

The aim of this study was to determine the clinical presentation of adolescent patellofemoral pain.

Reviews were carried out over a three year period, of all patients with patellofemoral pain (PFP) at a childrens hospital sports clinic.

101 patients (91 female) with 136 symptomatic knees were assessed. Mean age was 14.4 years. Knee pain was localized to the anteromedial or anterior region of the knee in 96% of patients and was typically produced with running (94%), jumping (92%) and stair use (69%). On physical examination there was usually a non antalgic gait (99%), no patellofemoral crepitation (98%), normal lower extremity angular (84%) and rotational alignment (94%), with no foot malalignment (>97%). The medial patellofemoral ligament (MPFL) was the most palpably tender area of the knee in 98% of patients. During “lateral apprehension” testing, 89% had pain at the MPFL, but not true apprehension. A “J-sign” was present at terminal knee extension in 65%. Mean Q-angle was 18.7°. Means of all radiographic measures were within normal ranges.

Most commonly, patients complained of anterior/anteromedial knee pain of insidious onset during running and jumping. The most consistent physical findings were focal tenderness at the MPFL, positive terminal J-sign, and an elevated Q-angle. Most patients required only nonsurgical treatments, but 18% underwent surgical interventions for persistent pain.

J Child Orthop. 2008 August; 2(4): 269–277 

Hewett, TE, Torg, JS, & Boden BP

The position of the trunk and the knee during non-contact ACL injuries has not been examined before.

10 female, 7 male and 6 female controls were used. The participants were analysed for coronal and sagittal plane movement during landing and cutting tasks.

The results show that lateral trunk and knee abduction angles were higher in females than males during ACL injury. They also trended to be higher then the female control group. Female ACL-injured athletes also demonstrated less forwards lean than the female controls.

The study concludes that lateral trunk and knee abduction motion are important factors of the ACL injury mechanism in female athletes.

BJSM, 2009; 43: 417-422

Vulpiani M. C., Trischitta D., Trovato P., Vetrano M., Ferretti A.

The pathology,  etiology and natural course of Achilles tendinopathy are not yet understood completely. Due to this, many forms of treatment have been used, with mixed success. Extracorporeal shockwave therapy (ESWT) has been proposed in the treatment of these tendinopathies in recent years having already shown positive results in the short-term.

This study aims to evaluate the effectiveness of ESWT in treating Achilles tendinopathies in the long-term. 105 patients (with 127 affected tendons) aged between 18 and 74 years were used in this study. All patients were diagnosed using ultrasonography, magnetic resonance imaging or X-rays. Shock wave treatment was applied using an electromagnetic shock wave generator. Subjects recieved on average four sessions (minimum three, maximum five), at a 2/7-day interval. Assessments took place before therapy and two months after the last treatment session. Medium term assesment between 6-12 months and again at 13 to 24 months were also undertaken.A satisfactory result was obtained in 47.2% of cases (60 out of 127 tendons) at two-months follow-up, which increased to 73.2% at medium-term follow-up (93 out of 127 tendons), and then reaching 76% in the last evaluation (92 out of 121 tendons).

The outcome of the described shock wave treatment appears to be satisfactory and confirms the role of this alternative treatment in the management of the tendon disorders.

Journal of Sports Medicine and Physical Fitness 2009 June;49(2):171-76

Lisa C. White, Philippa Dolphin, John Dixon

The aim of this study was to determine if there is a difference in hamstring length between patients with and without patellofemoral (pf) pain syndrome aged 18 to 35 years.

The pf group contained six males and 5 females who had been diagnosed with patellofemoral pain syndrome and the control group contained 13 males and 12 females who were completely asymptomatic.

Hamstring length was assessed using the passive knee extension method to measure popliteal angle.

The mean (standard deviation) values for hamstring length were 145.6 (8.7)° for patients with patellofemoral pain syndrome and 153.7 (10.1)° for the asymptomatic controls.

This study found that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls. It is not clear whether this is a cause or effect of the condition. Further research is suggested to study how hamstring length changes with rehabilitation, and the relationship with pain.

Physiotherapy, Volume 95, Issue 1, Pages 24-28

S M Cowan, K M Crossley, K L Bennell

This study looked at the neuromuscular control, strength and range of motion at the hip joint in patients with patellofemoral pain (PFP) syndrome. 

The study used 37 participants in total, 10 with pfp and 27 pain-free individuals.

Electromyographic activity of the vasti muscles (quads) and the anterior and posterior gluteus medius (GM) were recorded using either surface electrodes or fine wire electrodes while the participant completed a stair-stepping task. Hip and trunk side flexion strength were assessed using a hand-held dynamometer. Hip range of motion was measured with an inclinometer. Pain and disability measures were recorded for the PFP participants. Results indicated that individuals in the PFP group had a delayed activation of gluteus medius. They also displayed delayed firing of vastus medialis oblique, compared with vastus lateralis and a decrease in trunk side flexion strength.

This study reiterates the importance of re-training both gluteus medius and VMO in patients with patellofemoral pain.

British Journal of Sports Medicine 2009;43:584-588