Patellar Maltracking Persists in Adolescent Females With Patellofemoral Pain

Abstract

Background:Patellofemoral pain is one of the most common conditions seen in sports medicine practices, particularly among adolescent females. However, the natural history of the underlying pathology in patellofemoral pain during puberty remains poorly understood.Purpose:The purpose of this longitudinal study is to assess changes in patellar maltracking patterns in subjects with patellofemoral pain as they mature from mid- to late adolescence.Study Design:Cohort study; Level of evidence, 3.Methods:Three-dimensional patellofemoral kinematic data were acquired during active knee extension-flexion using dynamic magnetic resonance imaging in 6 girls (10 knees; mean age, 14.0 years) with clinically diagnosed patellofemoral pain. The subjects then returned as late adolescents (mean age, 18.5 years) for follow-up scanning. Three-dimensional patellofemoral kinematic parameters were evaluated across the range of motion, but comparison between time points was restricted to 10° of flexion. Participation in impact and nonimpact physical activities, pain score based on the visual analog scale, and the anterior knee pain score were also compared across initial and follow-up visits.Results:All subjects reported improved patellofemoral pain symptoms at follow-up, and one subject reported complete resolution. However, relative to the initial visit, no differences were found in patellar maltracking. There was a decrease in hours engaged in impact physical activities for all subjects at follow-up.Conclusion:This study provides insight into the natural history of patellofemoral pain in adolescent females. The relatively unchanged patellofemoral maltracking across subjects suggests that potential anatomic and kinematic abnormalities contributing to patellofemoral pain during mid-adolescence persist during skeletal maturation. Symptom improvement for these subjects did not result from a change in patellofemoral tracking, but rather from other causes.

Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis

“…Indeed, a recent re-analysis of Sandow and Goodfellow’s data does not seem to support their own conclusions, with Luhann et al [ 100 ] highlighting that of the original 54 adolescents, 94% still had pain at final follow-up, with 54% reporting same or worse severity of symptoms. This pattern of poor long term prognosis continues in the adult populations, with a large proportion (> 50%) of people still reporting pain and dysfunction five to eight years after a six weeks evidenced based treatment programme [ 101 ]; yet the impression that PFP is a benign and self-limiting condition, with non-intervention advised, has continued to guide funders and stakeholders decision making for decades [ 102 ]. In the context of the high incidence and prevalence numbers, poor long term prognosis and high disability levels, PFP should be an urgent research priority.…”

Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique

“…Other authors have used dynamic MRI protocols, to investigate the correlation between patellofemoral morphology and kinematics, as well as the difference to healthy controls. Carlson et al investigated in the patellofemoral morphology and patellar tracking of female adolescent patients, who showed symptoms of patellofemoral pain 40,44 . However, these measuring techniques did not allow quantification of patellar tracking and the reliability was not tested.…”

The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions

“…Some reports have provided measurements during unrealistic conditions, such as PFP evaluation in the supine position only [34] or while leaning on the equipment during the loading task [23]. For example, in a study by Esfandiarpour et al [19], the lunge test was performed with one leg supported on the ground, while the knee of the other leg was flexed at 90˚.…”

“…Carlson et al showed that a strongly contracted quadriceps reduce the bony constraint on the patella, causing the patella to deviate from normal tracking along the femoral groove [34]. Especially, in weight-bearing conditions, an activation imbalance of quadriceps causes the abnormal action of the patella in the PFP group [19].…”