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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: October 2012 - Volume 44 - Issue 10 - p 1827–1833
doi: 10.1249/MSS.0b013e31825d56e3
Clinical Sciences

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 R 2 = 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.

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