Patellofemoral Pain Syn-drome

2016 년 5 월 11 일재활의학과

김 종 규

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Peripatellar pain• Common causes

• Patellar dislocation or subluxation• Patellar tendinitis• Osgood-Schlatter’s disease• Sinding-Larsen-Johansson disease• ITB friction syndrome• Bursitis• Osteoarthritis• Patellar fracture• Quadriceps strain• Gaut• Etc.

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Anterior Knee Pain• Patellofemoral pain syndrome

• Patellofemoral joint syndrome

• Jumper’s knee

• Chondromalacia patellae

• Peripatellar synovitis

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Patellofemoral Pain Syndrome• Anterior knee pain• Most common cause in young population• Young female atheletes• Gradual onset

• Aggravated at• Squat• Stair up/down• Sit to stand• Knee flexion

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PFPS• Sympoms

• Feeling of instability• Localized pain• Crepitus• Edema• Feeling of muscle weakness

• Cannot squat• Cannot stair up/down

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PFPS• Pain sources

• Peripatellar synovitis without obvious cartilage damage

• Soft tissues such as lateral retinaculum• Infrapatellar fat pad

• Self limited conditions• No disability• Benign neglect

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Pathophysiology • Increased tension of patella to lateral side due to

• Overpronation of foot• Increased Q-angle• VMO weakness• Muscle power imbalance

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Q-angle

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Q-angle

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VMO weakness

Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.

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1. Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syn-

drome. JCLB. Elsevier B.V; 2012 Jul 1;27(6):525–31.

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1. Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syn-

drome. JCLB. Elsevier B.V; 2012 Jul 1;27(6):525–31.

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Physical Exam• Palpation

• Localized edema/tenderness

• Patellar glide test• Lateral glide, more than 50%

• Patellar tilt test• Lateral tilt, less than 0 degree

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Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.

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Treatment • Reduction pain & inflammation

• Ice, NSAIDs, ultrasound, ultrasound, mobilization

• Address extrinsic contributing factors• Reduce excessive load to patellofemoral joint

• Address intrinsic contributing factors• Remote factors: hip muscle retraining, flexibility, foot or-

thoses• Local factors: patellar taping, bracing, Q-ceps strength-

ening

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Orthoses• Reduction of foot over-pronation• Reduction of Q-angle

• Insoles/foot orthoses

• Limited evidences

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Patellar Taping

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McConnel Taping

Modified from http://youtube.com/watch?v=jBRdsK3zRyk

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Patellar Brace

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Physical Therapy• Ultrasound

• Laser

• Mobilization

• Manual Therapy

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Exercise• Quadriceps Exercise• Mobilization• VMO retraining• Biofeedback

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VMO Retraining

Modified from https://www.youtube.com/watch?v=S5BDi8Oj5eM

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Squat vs Leg extension

Modified from https://www.youtube.com/watch?v=UXJrBgI2RxA and https://www.youtube.com/watch?v=cfBsnDoQhEk

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Sumo-Squat

Modified from https://www.youtube.com/watch?v=9ZuXKqRbT9k

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Pharmacological Treatment• Intra-articular glycosaminoglycan

• NSAIDs, Aspirin

• Corticosteroid

• Botulinum Toxin?

• Surgery – arthroscopic lateral release

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Cochrane Review (2008)

Heintjes EM, Berger M, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. 2008

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05/01/2023 1.PG2166. Botulinum Toxin Type A for Nonsurgical Lateral Release in Patellofemoral Pain Syndrome: A Case Study. 2011 May 19;:1–3.

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Botulinum Toxin

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Surgery

Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.

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Questions

Patellofemoral Pain Syndrome

Chondromalacia Patellae

Patellofemoral OA?

?

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Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.

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1. Väätäinen U, Lohmander LS, Thonar E, Hongisto T, Ågren U, Rönkkö S, et al. Markers of car-tilage and synovial metabolism in joint fluid and serum of patients with chondromalacia of the patella.

Osteoarthritis and Cartilage. 1998 Mar;6(2):115–24.

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1. Naslund JE, Odenbring S, Näslund U-B, Lundeberg T. Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome. British Journal of Sports Medicine. BMJ Publishing Group Ltd and

British Association of Sport and Exercise Medicine; 2005 Mar;39(3):162–5.

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Take Home!• Patellofemoral Pain Syndrome

• Common cause of anterior knee pain

• Biomechanical problems of patella

• Exercise – VMO retraining

• Only Naproxen (VIMOVO) has evidence

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감사합니다 .