Implications of knee crepitus to the overall clinical presentation of women with and without patellofemoral pain

Silva, Danilo de Oliveira; Barton, Christian J; Crossley, Kay M; Waiteman, Marina Cabral; Taborda, Bianca; Ferreira, Amanda Schenatto; Azevedo, Fábio Mícolis de

doi:10.1016/j.ptsp.2018.07.007

Cited by 26 publications

(19 citation statements)

References 33 publications

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“…The step-down is considered an important objective function test for patients with PFP, since it mimics the function of stair descent, that is a common aggravating factor; besides that, Loudon et al 45 showed a high intrarater reliability for this measurement. De Oliveira Silva, et al 46 related that people with PFP present deficits in the number of step-downs compared to asymptomatic people. So, we recommend that the step-down test should be incorporated to all clinical assessments of people with PFP.…”

Section: Discussionmentioning

confidence: 99%

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

Lima

Flor

Barbosa

et al. 2020

Motriz: rev. educ. fis.

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Aims: The purpose of our study was to compare the hip and knee muscle activity before and after a hip abduction exercise program in women with patellofemoral pain (PFP). Methods: Eleven women with PFP were included in our pre/post design study. Participants were assessed before and after 12-week hip abduction exercise program. All participants performed 6 stair climbing repetitions, 3 sets of rope jumps over 30 s and 5 sets of 8 squats to standardize the physical activity level before data collection. We recorded the electromyographic activity from gluteus medius, vastus medialis (VM) and vastus lateralis (VL) for double-legged squat with and without isometric hip abduction. Additionally, participants were asked to perform a step-down test to assess objective function (maximum number of repetitions over 30 s) and completed a clinical evaluation. Results: Longer duration of VM (Mean difference [95% CI]) = -0.97 [-1.48; -0.46], ES [effect size] = 0.66) and VL (-0.81 [-1.35; -0.27], ES = 0.54) were found after the hip abduction exercise program only for free squat. The participants also performed higher number of step-down repetitions (-3.54 [-5.84; -1.25], ES = 1.03) after the hip abduction exercise program and showed improvement in pain reports. Conclusion: A 12-week hip abduction exercise program changed the quadriceps muscle activation pattern and improved pain and objective function of women with PFP. The exercises promoted a longer VM and VL activation duration. Additionally, they promoted a clinical improvement in the patients with PFP.

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Section: Discussionmentioning

confidence: 99%

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

Lima

Flor

Barbosa

et al. 2020

Motriz: rev. educ. fis.

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“…Knee crepitus is a common sign of young 10,11 and elderly individuals with knee pain as well as in asymptomatic individuals. 23 In most cases, the noise around the knee is physiological and is not associated with knee pain and physical function, as evidenced by our findings in a OA population and by a recent study with women with patellofemoral pain.…”

Section: Discussionmentioning

confidence: 99%

“…The same clinical test has been used in other studies. 10,11 The KL grade is a radiologic grading system for knee OA, which determines the severity of radiographic OA based of the presence and degree of osteophytes, jointspace narrowing (JSN), sclerosis, and deformity affecting the tibiofemoral joint, irrespective of clinical symptoms. KL defines OA in five grades (0 ---normal to 4 ---severe).…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Crepitus is an objective and easy to perform clinical test defined as an audible grinding noise and/or palpable vibrations during joint movement. 10,11 The presence of knee crepitus is possibly the first symptom of patellofemoral OA 12 and is associated with magnetic resonance imaging features of patellofemoral OA. 13 Moreover, knee crepitus is one of the 5 clinical criteria that could be considered for diagnosing OA without the need for radiographic examination.…”

Section: Introductionmentioning

confidence: 99%

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Knee crepitus is not associated with the occurrence of total knee replacement in knee osteoarthritis – a longitudinal study with data from the Osteoarthritis Initiative

Pazzinatto

Silva

Azevedo

et al. 2019

Brazilian Journal of Physical Therapy

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Objective(s): To investigate whether the presence of knee crepitus is associated with the occurrence of total knee replacement (TKR), quality of life and deficits in physical function at long-term. Methods: Setting-This observational study uses longitudinal data (up to 4-year follow-up) from the Osteoarthritis Initiative (OAI). Participants-4566 participants. Main Outcome Measure(s)-Logistic regression models were used to test if baseline knee crepitus is associated with the occurrence of TKR. Linear mixed models with adjustment for confounding variables (age, gender, BMI and Kellgren-Lawrence grade) were used to test the association between baseline knee crepitus and longitudinal changes in the pain, self-reported physical function, quality of life and performance-based function. Results: The presence of knee crepitus at baseline does not predict the occurrence of TKR at 36 months (p = 0.58 and 0.67 for right and left knees, respectively). The crepitus group presented a slightly knee extension strength decline from baseline to 48 months (p = 0.03 for the right and 0.01 for the left knee; between group difference = 2% for both right [95%CI = −0.12; −0.01] and left knees [95%CI = −0.13; −0.02]).

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“…Participants were included if they presented anterior or retropatellar pain (1) corresponding to at least thirty on a 100-mm visual analog scale (VAS) in the previous week; (2) for at least 3 months; or (3) during at least two or more activities from prolonged sitting, squatting, kneeling, running, ascending and descending stairs, jumping, and landing. Exclusion criteria included a history of any lower limb surgery, history of patellar subluxation or dislocation, ligament or meniscus tears assessed clinically, presence of neurological diseases, or individuals who had received oral steroids and opiate treatment in the last month [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study

Silva¹,

Pazzinatto²,

Crossley³

et al. 2020

J Med Internet Res

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Background Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation. Objective This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care. Methods Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks. Results A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2. Conclusions Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.

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Implications of knee crepitus to the overall clinical presentation of women with and without patellofemoral pain

Abstract: Kinesiophobia, catastrophism, knee stiffness, strength and physical function are all impaired in women with PFP, regardless of crepitus. In pain-free women, crepitus was associated with poorer objective function.

Cited by 26 publications

References 33 publications

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study

Knee crepitus is not associated with the occurrence of total knee replacement in knee osteoarthritis – a longitudinal study with data from the Osteoarthritis Initiative

Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study

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