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BackgroundPatellofemoral pain (PFP) has traditionally been viewed as self-limiting, but recent studies show that a large proportion of patients report chronic knee pain at long-term follow-up. We identified those patients with an unfavourable recovery (‘moderate improvement’ to ‘worse than ever’ measured on a Likert scale) and examined whether there is an association between PFP and osteoarthritis (OA) at 5–8-year follow-up.MethodsLong-term follow-up data were derived from 2 randomised controlled trials (n=179, n=131). Patient-reported measures were obtained at baseline. Pain severity (100 mm visual analogue scale (VAS)), function (Anterior Knee Pain Scale (AKPS)) and self-reported recovery were measured 5–8 years later, along with knee radiographs. Multivariate backward stepwise linear regression analyses were used to evaluate the prognostic ability of baseline pain duration, pain VAS and AKPS on outcomes of pain VAS and AKPS at 5–8 years.Results60 (19.3%) participants completed the questionnaires at 5–8-year follow-up (45 women, mean age at baseline 26 years) and 50 underwent knee radiographs. No differences were observed between responders and non-responders regarding baseline demographics, and 3-month and 12-month pain severity and recovery. 34 (57%) reported unfavourable recovery at 5–8 years. 48 out of 50 participants (98%) had no signs of radiographic knee OA. Multivariate models revealed that baseline PFP duration (>12 months; R2=0.22) and lower AKPS (R2=0.196) were significant predictors of poor prognosis at 5–8 years on measures of worst pain VAS and AKPS, respectively.Summary and conclusionMore than half of participants with PFP reported an unfavourable recovery 5–8 years after recruitment, but did not have radiographic knee OA. Longer PFP duration and worse AKPS score at baseline predict poor PFP prognosis. Education of health practitioners and the general public will provide patients with more realistic expectations regarding prognosis.

Background Patellofemoral pain (PFP) is a common musculoskeletal disorder resulting in anterior knee pain. Physiotherapy is the current standard treatment, while surgical intervention (tibial tubercle transfer [TTT]) is reserved for chronic cases when nonoperative treatment has failed. TTT can result in clinically meaningful improvement in patients with patellofemoral maltracking without instability. However, to date, no randomised controlled trials (RCT) have compared TTT combined with a physiotherapy (PT) programme to PT alone as the initial treatment for PFP. Methods A single-centre nonblinded RCT in 40 patients with chronic PFP (> 1 year) and tibial tubercle-trochlear groove (TT-TG) > 15 mm will be randomised to either TTT followed by PT or to PT alone in a 1:1 ratio in a concealed manner. The primary outcome is knee pain at 18 weeks for the TTT group (6 weeks splint phase + 12 weeks PT) and at 12 weeks for the PT group, measured by the visual analog scale (VAS). Secondary outcomes include Patient-Reported Outcome Measures (PROMs) using the Kujala score, International Knee Documentation Committee (IKDC) ‘Subjective Knee Form’, Tegner Activity score and EuroQol 5D-5 L for quality of life. Range of motion (ROM) is measured using the decline step-down test (DSDT). Between-group differences will be analysed using multivariable linear regression analysis, while longitudinal differences will be assessed with linear mixed models for repeated measures. The difference in direct medical costs will also be assessed. Discussion The REVITALISE study is the first randomised study to compare surgical intervention (TTT) followed by PT to PT alone in patients with chronic PFP. This study will generate level-1 evidence on the most effective treatment for chronic PFP, which can be integrated into the national guideline to aid orthopaedic surgeons and physiotherapists in their decision-making and ultimately improve our care for patients with chronic PFP. Trial registration Study Identifier NCT06227806, registered on 26 Jan 2024 on ClinicalTrials.gov. The study underwent independent peer review and received approval from the ethical review board (number NL80956.091.22).

Background Patellofemoral pain is a prevalent knee condition affecting up to 40% of individuals, especially females aged teens to 50 s. Standard treatments, including exercise therapy, often yield insufficient long-term results, partly due to low compliance and psychological factors like depression and catastrophizing of pain. A digital therapeutics “MORA Cure PFP,” which combines structured progressive exercise and cognitive behavioral therapy via an app, offers a solution to overcome the limitations of conventional treatment for patellofemoral pain patients. Methods To evaluate the safety and efficacy of MORA Cure PFP, a two-arm controlled trial will enroll 216 patients diagnosed with patellofemoral pain randomly assigned in a 1:1 ratio to treatment and control groups. The treatment group will use the app, while the control group will perform self-guided exercises using educational materials. This trial aims to determine if the treatment group shows greater reduction in usual pain intensity scores at 8 weeks compared to the control group. Additional assessments include worst pain, knee function, depression, and pain catastrophizing levels. Discussion Key design elements of the clinical trial, such as control group selection, inclusion/exclusion criteria, number of patients, and primary endpoint, were designed with consideration for not only medical perspectives but also regulatory aspects of software as a medical device, including device approval and health technology assessment. Trial registration ClinicalTrials.gov., NCT06260865, registered 15th February 2024.

Backgrounds Patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders. Flatfoot and weakness of the hip and core muscles have been introduced as distal and proximal factors associated with this syndrome, respectively. The aim of this study is to investigate the effectiveness of a combination of a proximal strengthening exercise (PSE) program and a foot orthosis (PSEFO) on pain and function in women with PFPS and a pronated foot (PF). Methods In this randomized clinical trial (RCT), 117 female patients aged 18–40 years will be recruited through online announcements on cyberspace as well as those installed in rehabilitation and healthcare centers and gyms. Considering the inclusion criteria, the participants will be randomized into three groups of 39 (group I: practicing PSEs and wearing PSEFO; group II: practicing only PSEs; and group III: control group [CG]). Randomization will be conducted using the sequentially numbered, opaque, sealed envelope (SNOSE) technique. The intervention groups (groups I and II) will perform PSEs at gyms for 2 months at the rate of three sessions per week (each session lasting 45–60 min) under the guidance of a trainer. In addition to the PSE, group I participants will receive prefabricated polyurethane FOs with an 8° varus wedge. They will be asked to wear the orthosis for 2 h a day and then slowly increase their wearing time to a full day. The CG participants will follow their routine lives during this study. Pain, as the primary outcome, will be measured by the visual analog scale before and after the 8-week intervention program. Additionally, quality of life, disability, Q angle, performance, and dynamic balance will be evaluated as secondary outcomes using the 36-item Short Form Health Survey, the Kujala score, a goniometer, the step-down test, the unilateral squat test, the anteromedial lunge test, the bilateral squat test, and the Y-balance test, respectively. Discussion In this RCT, the effectiveness of PSEs focusing on the hip and core muscles, with and without FOs, on pain and performance among women with PFPS and PF will be investigated and compared. Trial registration The present study was approved by the Research Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (code: IR.GUILAN.REC.1402.021) and registered on the Iranian Registry of Clinical Trials (IRCT, code: IRCT20230604058380N1) at 28 July 2023.

Background Patellofemoral pain (PFP) is the most prevalent orthopedic problem in active young adults. Due to its multifactorial etiology, a variety of therapeutic measures have been adopted to treat PFP, including exercise therapy, electrotherapy, and manual therapy. It has also been suggested that whole body vibration (WBV) can improve neuromuscular function in persons with knee problems. The aim of the present study was to evaluate the effects of adding WBV to routine exercise programs on flexibility, vertical jump height, agility and pain in athletes with PFP. Methods Twenty-four male athletes with PFP were randomized into two groups of WBV + exercise ( n  = 12) or exercise only ( n  = 12). Participants received their interventions during 4 consecutive weeks (12 sessions). Pain intensity, flexibility and agility were assessed respectively as score on a numerical rating scale, the sit-and-reach test, and a modified T-test, and vertical jump height was measured to the nearest centimeter. The tests were done before and after the interventions, and the results were compared between the two groups. Independent t-tests and paired t-tests were used for between- and within-group comparisons, respectively. Results After the interventions, all variables for vertical jump height, flexibility, agility and pain intensity improved significantly in both groups ( p  < 0.05). The flexibility test showed significantly greater improvement in the WBV + exercise group ( p <0.001), whereas for vertical jump height, agility and pain intensity, there were no statistically significant differences between groups ( p >0.05). Conclusions The present findings showed that exercise therapy with and without WBV can significantly decrease pain and increase agility, vertical jump height and flexibility in athletes with PFP. Adding WBV to routine exercise therapy, however, can augment the effects of the latter on flexibility. Trial registration IRCT, IRCT20090831002391N39. Registered 7 February 2018, https://en.irct.ir/search/result?query=IRCT20090831002391N39 .

Background Patellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied. Methods This assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework. Discussion Exercise therapy and patient education are considered the “best management” options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors. Trial registration Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.

Purpose The presence of anterior knee pain remains one of the major complaints following total knee arthroplasty (TKA). Since the introduction of the mobile TKA, many studies have been performed and only a few show a slight advantage for the mobile. In our short-term follow-up study, we found less anterior knee pain in the posterior stabilized mobile knees compared to the posterior stabilized knees. The concept of self-alignment and the results from our short-term study led us to form the hypothesis that the posterior stabilized mobile knee leads to a lower incidence of anterior knee pain compared to the posterior stabilized fixed knee. This study was designed to see whether this difference remains after 7.9 years in the follow-up. A secondary line of enquiry was to see whether one was superior to the other regarding pain, function, quality of life and survival. Methods This current report is a 6–10-year (median 7.9 years) follow-up study of the remaining 69 patients with a cemented three-component TKA for osteoarthritis in a prospective, randomized, double-blinded clinical trial. Results In the posterior stabilized group, five of the 40 knees (13 %) versus five of the 29 posterior stabilized mobile group (17 %) experienced anterior knee pain. No differences were observed with regard to ROM, VAS, Oxford 12-item knee questionnaire, SF-36, HSS patella, Kujala or the AKSS score. Patients with anterior knee pain reported more pain, lower levels of the AKSS, HSS patella and the Kujala scores than the patients without anterior knee pain. Conclusion In the current clinical practice, the appearance of anterior knee pain persists as a problem; simply changing to a mobile bearing does not seem to be the solution. The posterior stabilized mobile total knee did not sustain the advantage of less anterior knee pain, compared with the posterior stabilized fixed total knee arthroplasty. Level of evidence Therapeutic study, Level II.

Background Patellofemoral pain syndrome (PFPS) is defined as pain around the patella while performing activities such as squats, running, and climbing steps. One of the inherent risk factors for PFPS is an excessively pronated foot posture. The aim of this study was to investigate the effect of foot intervention, talonavicular joint mobilization (TJM) and foot core strengthening (FCS), on PFPS. Methods Forty-eight patients with PFPS (mean age, 21.96 ± 2.34 years; BMI, 22.77 ± 2.95 kg/m 2 ) were enrolled in the study. Participants were randomly assigned in a 1:1:1 ratio to three groups, and received 12 sessions of TJM, FCS, and blended intervention at university laboratory for 4 weeks. The primary outcomes were pain while the secondary outcomes were lower extremity function, valgus knee, foot posture, and muscle activity ratio measured at baseline, after 12 sessions, and at the 4-week follow-up. Results The two-way repeated-measures ANOVA revealed significant interactions in all groups ( p  < 0.05). TJM reduced pain more than the FCS at post-test (mean difference, − 0.938; 95% Confidence interval [CI], − 1.664 to − 0.211; p  < 0.05), and blended intervention improved lower extremity function (mean difference, 6.250; 95% CI, 1.265 to 11.235; p  < 0.05) and valgus knee (mean difference, − 11.019; 95% CI, − 17.007 to − 5.031; p  < 0.05) more than the TJM at 4 weeks follow-up. TJM was more effective in post-test (mean difference, − 1.250; 95% CI, − 2.195 to − 0.305; p  < 0.05), and TJM (mean difference, − 1.563; 95% CI, − 2.640 to − 0.485; p  < 0.05) and blended intervention (mean difference, − 1.500; 95% CI, − 2.578 to − 0.422; p  < 0.05) were more effective in foot posture than the FCS in 4 weeks follow-up. Blended intervention displayed greater improvement in muscle activity than the TJM (mean difference, 0.284; 95% CI, 0.069 to 0.500; p  < 0.05) and the FCS (mean difference, 0.265; 95% CI, 0.050 to 0.481; p  < 0.05) at 4 weeks follow-up. Conclusions Our study is a novel approach to the potential impact of foot interventions on patellofemoral pain. Foot intervention including TJM and FCS is effective for pain control and function improvement in individuals with PFPS. Trial registration KCT0003176 , 16/08/2018 (retrospectively registered).

Patellofemoral pain (PFP) is a common injury that interferes with quality of life and physical activity. Clinical subgroups of patients may exist, one of which is caused by proximal muscle dysfunction.   To develop clinical prediction rules that predict a positive outcome after either a hip and core- or knee-focused strengthening program for individuals with PFP.   Secondary analysis of data from a randomized control trial.   Four university laboratories.   A total of 199 participants with PFP.   Participants were randomly allocated to either a hip and core-focused (n = 111) or knee-focused (n = 88) rehabilitation group for a 6-week program.   Demographics, self-reported knee pain (visual analog scale) and function (Anterior Knee Pain Scale), hip strength, abdominal muscle endurance, and hip range of motion were evaluated at baseline. Treatment success was defined as a decrease in visual analog scale score by ≥2 cm or an increase in the Anterior Knee Pain Scale score by ≥8 points or both. Bivariate relationships between the outcome (treatment success) and the predictor variables were explored, followed by a forward stepwise logistic regression to predict a successful outcome.   Patients with more pain, better function, greater lateral core endurance, and less anterior core endurance were more likely to have a successful outcome after hip and core strengthening (88% sensitivity and 54% specificity). Patients with lower weight, weaker hip internal rotation, stronger hip extension, and greater trunk-extension endurance were more likely to have success after knee strengthening (82% sensitivity and 58% specificity).   The patients with PFP who have more baseline pain and yet maintain a high level of function may experience additional benefit from hip and core strengthening. The clinical prediction rules from this study remain in the developmental phase and should be applied with caution until externally validated.

Patellofemoral pain (PFP) is typically exacerbated by repetitive activities that load the patellofemoral joint, such as running. Understanding the mediating effects of changes in pain in individuals with PFP might inform injury progression, rehabilitation, or both.   To investigate the effects of changing pain on muscular strength and running biomechanics in those with PFP.   Crossover study.   University research laboratory.   Seventeen participants (10 men, 7 women) with PFP.   Each participant completed knee pain-reducing and pain-inducing protocols in random order. The pain-reducing protocol consisted of 15 minutes of transcutaneous electric nerve stimulation (TENS) around the patella. The pain-inducing protocol was sets of 20 repeated single-legged squats (RSLS). Participants completed RSLS sets until either their pain was within at least 1 cm of their pain during an exhaustive run or they reached 10 sets.   Pain, isometric hip and trunk strength, and running mechanics were assessed before and after the protocols. Dependent variables were pain, normalized strength (abduction, extension, external rotation, lateral trunk flexion), and peak lower extremity kinematics and kinetics in all planes. Pain scores were analyzed using a Friedman test. Strength and mechanical variables were analyzed using repeated-measures analyses of variance. The α level was set at P < .05.   Pain was decreased after the TENS (pretest: 3.10 ± 1.95, posttest: 1.89 ± 2.33) and increased after the RSLS (baseline: 3.10 ± 1.95, posttest: 4.38 ± 2.40) protocols (each P < .05). The RSLS protocol resulted in a decrease in hip-extension strength (baseline: 0.355 ± 0.08 kg/kg, posttest: 0.309 ± 0.09 kg/kg; P < .001). Peak plantar-flexion angle was decreased after RSLS (baseline: -13.97° ± 6.41°, posttest: -12.84° ± 6.45°; P = .003). Peak hip-extension (pretest: -2.31 ± 0.46) and hip-abduction (pretest: -2.02 ± 0.35) moments decreased after both the TENS (extension: -2.15 ± 0.48 Nm/kg, P = .015; abduction: -1.91 ± 0.33 Nm/kg, P = .015) and RSLS (extension: -2.18 ± 0.52 Nm/kg, P = .003; abduction: -1.87 ± 0.36 Nm/kg, P = .039) protocols.   This study presents a novel and effective method of increasing pain in persons with PFP. Functionally increased pain after RSLS coincides with reduced hip-extensor muscle strength and decreased plantar-flexion angle during running. The TENS treatment decreased pain during running in those with PFP but failed to influence strength. Hip moments were reduced by both protocols, which may demonstrate that acute increases or decreases in pain cause runners to change their mechanics.