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STUDY DESIGN: Systematic review. OBJECTIVES: To systematically outline the risk factors for patellofemoral pain syndrome (PFPS).
BACKGROUND: PFPS is the most commonly diagnosed condition in young individuals with knee complaints. The high incidence among athletes suggests a possibility for prevention. The first step towards prevention is identification of possible risk factors.
METHODS: Prospective studies, including 20 or more patients with PFPS that examined at least 1 possible risk factor for PFPS were included. An assessment list was applied to evaluate the quality of the studies. A meta-analysis was conducted using a random effect model. Significant differences were based on calculated mean differences with matching 95% confidence intervals (CI). For dichotomous data, odds ratios or relative risks were calculated.
RESULTS: Of the 3845 potentially relevant articles, 7 were included in this review. These studies examined a total of 135 variables and pooling was possible for 13 potential risk factors. The pooled data showed that knee extension peak torques were significantly lower in the PFPS group compared to controls. Mean differences in torque, with negative differences reflecting lower means in the PFPS group, were as follows: a) standardized relative to body weight at 60º/s = -0.24 Nm (95%CI -0.39,-0.09); b) standardized relative to body weight at 240º/s = -0.11 Nm (95%CI -0.17,-0.05); c) standardized relative to body mass index at 60º/s = -0.84 Nm (95%CI -1.23,-0.44); d) standardized relative to body mass index at 240º /s = -0.32 Nm (95%CI -0.52, -0.12); e) non-standardized in a concentric mode at 60º /s = -17.54 Nm (95%CI -25.53, -9.54); f) non-standardized in a concentric mode at 240º/s = -7.72 Nm (95%CI -12.67,-2.77).
CONCLUSION: A lower knee extension strength expressed by peak torque appears to be a risk factor for PFPS based on meta-analyses of pooled results from multiple studies. Because several other risk factors for PFPS were described only in single studies, these additional risk factors, as well as those with conflicting evidence, need to be confirmed in future studies.
This review systematically summarises factors associated with patellofemoral pain syndrome (PFPS). A systematic literature search was conducted. Studies including ≥20 patients with PFPS that examined ≥1 possible factor associated with PFPS were included. A meta-analysis was performed, clinical heterogeneous data were analysed descriptively. The 47 included studies examined 523 variables, eight were pooled. Pooled data showed a larger Q-angle, sulcus angle and patellar tilt angle (weighted mean differences (WMD) 2.08; 95% CI 0.64, 3.63 and 1.66; 95% CI 0.44, 2.77 and 4.34; 95% CI 1.16 to 7.52, respectively), less hip abduction strength, lower knee extension peak torque and less hip external rotation strength (WMD –3.30; 95% CI –5.60, –1.00 and –37.47; 95% CI –71.75, –3.20 and –1.43; 95% CI –2.71 to –0.16, respectively) in PFPS patients compared to controls. Foot arch height index and congruence angle were not associated with PFPS. Six out of eight pooled variables are associated with PFPS, other factors associated with PFPS were based on single studies. Further research is required.
Re: Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review
The effect of shoe torsional stiffness on lower extremity kinematics and biomechanical risk factors for patellofemoral pain syndrome during running
Eveline S. Graf & Darren Stefanyshyn Footwear Science; Volume 4, Issue 3, 2012
Objective: The effect of footwear torsional stiffness on lower extremity biomechanics is not well known, although there are indications that it could affect rearfoot and ankle kinematics. These variables have previously been linked to the development of patellofemoral pain syndrome (PFPS) in runners. Therefore, the aim of this study was to compare the rearfoot and ankle frontal plane kinematics and knee abduction angular impulse between shoes with different torsional stiffness during running.
Methods: Nineteen experienced runners performed heel-toe running at 3.7 m s−1 in three running shoes with different torsional stiffness. Using surface-mounted markers and a force plate, the kinematics and kinetics of the rearfoot, ankle and knee were measured. Torsion, rearfoot and ankle eversion, tibial rotation, knee abduction impulse, and vertical ground reaction force (GRF) peak were compared between footwear conditions using repeated-measures ANOVA.
Results: The torsion angle was significantly different between shoes but none of the other variables showed a difference between conditions. Focusing only on the part of the stance phase with forefoot–ground contact, significant differences were reported in the range of motion (ROM) of rearfoot and ankle eversion. The differences in torsional stiffness of the running shoes did not alter the rearfoot/ankle kinematics or the knee angular impulse, which are variables that have been described as risk factors for PFPS.
Conclusions: During heel-toe running, the shoe torsional stiffness does not seem to have an effect on the injury risk for PFPS. However, there are indications that, for movements performed mainly on the forefoot, this shoe characteristic could have relevance.