2016 Patellofemoral (Knee cap) consensus statements - (Part 1 and 2) Crossley et al (2016)
The International Patellofemoral Pain Research Group consists of expert clinicians and researchers who pool the best available current research on the topic of patellofemoral pain (PFP). The following is a summary of their 2016 consensus statement
What is PFP?
-Pain around or behind the patella (kneecap)
-Pain provoked by at least one weight bearing activity, with knee bent eg. Running, hopping, jumping, squatting, negotiating stairs
Symptoms may also include crunching/grinding sensations around the kneecap, mild swelling, and pain with sitting and/or getting out of a chair
80% of people who get anterior (front) knee pain while squatting have a diagnosis of PFP. 7-28% of young adolescents have PFP at any one time.
What is the best treatment for PFP?
Based on high quality research published between 2010 and 2015, the consensus group came to 6 recommendations for the management of PFP (excluding patellofemoral OA though symptoms and treatment are often similar).
Intervention / Effect / What does that mean?
Recommended to reduce pain in the short (<6months), medium (6-12months) and long term (>12months), and improve function in the medium and long term
Exercise has the most evidence for effectiveness in treating PFP compared. All populations, compared to control groups and placebo groups (ie. Groups not doing targeted exercise rehab)
2. Combination of hip and knee exercises
Recommended to reduce pain and improve function in the short, medium and long term
Exercises targeting gluteal strength and control prescribed in conjunction with knee specific exercises are more effective than knee exercises alone
3. Combined interventions
Recommended to reduce pain in adults with patellofemoral pain in the short and medium term.
Address all contributing factors to an individuals PFP eg. Use exercise, education, orthotics and patella taping as suitable for that person, rather than one treatment option alone.
4. Foot orthoses (shoe inserts)
Recommended to reduce pain in the short term
Trial off the shelf orthoses if indicated in a specific patient.
5. Patellofemoral, knee and lumbar mobilisations
Manipulating (aka adjusting or cracking) the knee joint is not effective in treating PFP. This doesn’t apply to some types of massage which may be effective in combination with other strategies such as exercise. Manipulting the back or Lumbar spine has no effect.
6. Electrophysical agents
Machines such as laser, ultrasound etc should not be used for PFP
Limitations: Each individual with PFP is different and hence there is no single strategy for everyone (adolescents/adults, male/female, individual anatomy, sport/occupational requirements). Also, some interventions don’t yet have a lot of research undertaken on their effectiveness.
2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Crossley, K.M., Stefanik, J.J., Selfe, J., Collins, N.J., Davis, I.S., Powers, C.M., McConnell, J., Vincenzino, B., Bazett-Jones, D.M., Esculier, J., Morrissey, D., and Callaghan, M.J.
2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Crossley, K.C., van Middelkoop, M., Callaghan, M.J., Collins, N.J., Rathleff, M.S and Barton, C.J.