What Predicts Functional Outcome after Treatment for Patellofemoral Pain?

PATTYN, ELS1; MAHIEU, NELE1; SELFE, JAMES2; VERDONK, PETER3; STEYAERT, ADELHEID4; WITVROUW, ERIK1

Medicine & Science in Sports & Exercise:
doi: 10.1249/MSS.0b013e31825d56e3
Clinical Sciences
Abstract

Purpose: Although physical therapy is known to be effective in treating patellofemoral pain (PFP), there is considerable individual variation in the treatment response. It is unclear why some patients benefit from a specific treatment while others do not experience improvement. This study, using a prospective study design, aims to identify factors that could predict the short-term functional outcome and account for the variation frequently seen in the outcome after conservative treatment of PFP.

Methods: Thirty-six patients (20 female and 16 male with a mean age of 23.8 ± 6.7 yr) followed a physical therapy rehabilitation program of 7 wk. Before this treatment, all patients were evaluated on subjective symptoms (pain on visual analog scales in millimeters) and functional performance (step test expressed as highest level, single-legged hop test in centimeters, and triple-hop test in centimeters). The concentric and eccentric knee extensor strength at 60°·s−1 and 240°·s−1 (N·m) were measured as well as the quadriceps muscle size by calculating the cross-sectional area (cm2) with magnetic resonance imaging. The success of the treatment was evaluated by the functional Kujala anterior knee pain scale. A linear regression model was used to identify predisposing factors for the functional outcome.

Results: The total quadriceps cross-sectional area (P = 0.010), the eccentric average peak torque at 60°·s−1 (P = 0.015), and the frequency of pain at baseline (P = 0.012) have been indicated as predisposing variables in the short-term functional outcome after a physical therapy rehabilitation program for PFP (adjusted R2 = 0.46).

Conclusion: Patients with a greater quadriceps muscle size, lower eccentric knee strength, and less pain have a better short-term functional outcome after conservative treatment for PFP.

Author Information

1Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3B3, Ghent, BELGIUM; 2Division of Physiotherapy and Sports Therapy, School of Sport, Tourism and The Outdoors, University of Central Lancashire, Preston, Lancashire, England, UNITED KINGDOM; 3Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, Ghent, BELGIUM; and 4Department of Physical and Rehabilitation Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, BELGIUM

Address for correspondence: Els Pattyn, PT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3B3, B9000 Ghent, Belgium; E-mail: e.pattyn@UGent.be.

Submitted for publication October 2011.

Accepted for publication May 2012.

©2012The American College of Sports Medicine