Risk factors for patellofemoral pain: a systematic review and meta-analysis

Abstract

BackgroundPatellofemoral pain (PFP) is a prevalent condition commencing at various points throughout life. We aimed to provide an evidence synthesis concerning predictive variables for PFP, to aid development of preventative interventions.MethodsWe searched Medline, Web of Science and SCOPUS until February 2017 for prospective studies investigating at least one potential risk factor for future PFP. Two independent reviewers appraised methodological quality using the Newcastle–Ottawa Scale. We conducted meta-analysis where appropriate, with standardised mean differences (SMD) and risk ratios calculated for continuous and nominal scaled data.ResultsThis review included 18 studies involving 4818 participants, of whom 483 developed PFP (heterogeneous incidence 10%). Three distinct subgroups (military recruits, adolescents and recreational runners) were identified. Strong to moderate evidence indicated that age, height, weight, body mass index (BMI), body fat and Q angle were not risk factors for future PFP. Moderate evidence indicated that quadriceps weakness was a risk factor for future PFP in the military, especially when normalised by BMI (SMD −0.69, CI −1.02, –0.35). Moderate evidence indicated that hip weakness was not a risk factor for future PFP (multiple pooled SMDs, range −0.09 to −0.20), but in adolescents, moderate evidence indicated that increased hip abduction strength was a risk factor for future PFP (SMD 0.71, CI 0.39, 1.04).ConclusionsThis review identified multiple variables that did not predict future PFP, but quadriceps weakness in military recruits and higher hip strength in adolescents were risk factors for PFP. Identifying modifiable risk factors is an urgent priority to improve prevention and treatment outcomes.

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

“…Considering the abduction squatting after the exercises protocol, there was a significant VM RMS increase and a tendency for VL RMS increase, although not significant. Felicio et al 37 compared the myoelectric activation of patellar and pelvis stabilizers between the free and isometric thigh adduction and 6 Motriz, Rio Claro, v.26, Issue 1, 2020, e10190103 abduction squatting in healthy participants 37 . The results proved that the squatting associated with thigh abduction produced moderate and greater activations than those achieved with free squatting for the vastus medialis oblique, vastus lateralis oblique, vastus lateralis longus and gluteus medius muscles 37 .…”

“…PFP presents point-prevalence of 22.7% in the general population [2][3][4] with women being 2 times more likely to present PFP than men 3 . In spite of PFP is multifactorial in nature, it is identified as risk factor the quadriceps weakness 5,6 and biomechanical deficits at the trunk, hip, knee and foot 7,8 .…”

“…It has been demonstrated that subjects with PFP have deficits of isometric / dynamic strength and power in the hip muscles (abductors and extensors) 9 . However, the hip muscle abductors weakness can not be considered a PFP risk factor 10,11 , but a consequence of the pain complaint and inactivity 11 . The most recent consensus from the International Patellofemoral Pain Research Retreatment suggests the use of specific knee and hip exercises (isolated or combined) as best management for PFP in the short-, medium-and long-term 12 .…”

Anterior Knee Pain Risk Differs Between Male and Female Military Tactical Athletes

“…35 Additionally incorporating quadriceps strengthening programs should implemented across branches, with a focus on land-based groups, to minimize the risk of patellofemoral pain. 36 These implementation programs should be evaluated for their efficacy at decreasing AKP risk in the military, as they have been shown to be beneficial in both clinical and research settings. 35,37,38…”

Peer Review #1 of "The effects of gluteal squeezes compared to bilateral bridges on gluteal strength, power, endurance, and girth (v0.1)"

“…Gluteal strength has also been linked to falls in an elderly population (Inacio et al, 2014) and medial tibial pain in college-aged females (Verrelst et al, 2014). Gluteus maximus strength (hip extension and external rotation), specifically, has been linked to patellofemoral pain in multiple studies (Thomson et al, 2016;Van Cant et al, 2014) while the relationship between gluteus medius strength and patellofemoral pain seems more unlear (Neal et al, 2019). It appears, therefore, that gluteal strength is associated with injuries and pathology from the lower back to the lower leg.…”