treatment and prevention of anterior knee pain, especially in sports people, physical therapy

1. Anterior knee pain
Dragoo, J., Johnson, C., & McConnell, J. (2012). Evaluation and Treatment of Disorders of the Infrapatellar Fat Pad. Sports Medicine, 42(1), 51-67. doi: 10.2165/11595680-000000000-00000
Powers, C., Witvrouw, E., Davis, I., & Crossley, K. (2017). Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. British Journal Of
Sports Medicine, 51(24), 1713-1723. doi: 10.1136/bjsports-2017-098717
Sanchis-Alfonso, V., McConnell, J., Monllau, J., & Fulkerson, J. (2016). Diagnosis and treatment of anterior knee pain. Journal Of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine, 1(3), 161-173. doi: 10.1136/jisakos-2015-000033
 Accounts for up to 74% of knee pain in sport with adolescents2
 Incidence f:m - 2.23:1
 Difficult to treat – early intervention important2
o 40% have unsatisfactory outcome at 12 months if not treated
o 70 - 90% have recurrent or chronic pain. Early intervention is important
Aggravated by2
o Sitting prolonged
o Descending or ascending steps
o Running
o Squatting
o Wearing high heels
o Jumping
Possible causes1
o Impaired quadriceps function
o Excessive femoral internal
rotation
o Impaired soft tissue restraints
o Abnormal PFJ anatomy
o Altered hip kinematics
o Suboptimal foot mechanics
o Overstress
o Altered trunk mechanics
o Iatrogenic
o Muscle tightness
Non-operative Treatment1,2,3
o Structure dependent
o General principles
o Education
o Unload pain generator
o Correct foot biomechanics
o Muscle retraining