Kinematic and Neuromuscular Deficiencies Phenotypes Associated With Patellofemoral Pain Syndrome (PHENOPAT)

Kinematic and Neuromuscular Deficiencies Phenotypes Associated With Patellofemoral Pain Syndrome : a Cross-sectional Interventional Study

The purpose of this study is to describe and compare the kinematic deficiencies specifically associated with each of the 3 main clinical phenotypes of patellofemoral pain syndrome. The prevalence of patellofemoral pain is high with a high rate of chronicity and recurrence and an overrepresentation of young, athletic and female populations. There are multiple classifications of patellofemoral pain syndrome. A pragmatic classification distinguishes 3 main clinical phenotypes of patellofemoral pain syndrome: with objectively displaceable patella, with extra-patellar alignment problems and without alignment problems.

The pathophysiology of patellofemoral pain syndrome is multifactorial involving static and dynamic dysfunctions of the hip, knee and foot, which remain incompletely elucidated to date. The links between the clinical and biomechanical aspects are still unclear and the kinematic and neuromuscular deficiencies associated with the 3 main clinical phenotypes are poorly understood. A validated non-invasive device allows the 3D evaluation of femorotibial rotations during walking.

Study Overview

• Status: Completed
• Conditions: Patellofemoral Pain Syndrome
• Intervention / Treatment: Other: EOS Radiation; Behavioral: Semi-structured interview

Detailed Description

The diagnostic process is based on clinical examination. The evolution of measuring tools like radios, RMI and kinematics device allows a more precise diagnostic of patellofemoral Pain syndrome. We still don't know what kind of gait parameters could help to categorize the different phenotypes. With a better understanding of these phenotypes the investigators will be able to propose a better personalized rehabilitation.

Patellofemoral pain syndrome is defined as an anterior knee pain in front of and around the patella. The diagnosis of patellofemoral pain syndrome is based on clinical examination and standard imaging.

The pathophysiology of the patellofemoral pain syndrome is multifactorial involving static and dynamic dysfunctions of the hip, knee and foot, which remain incompletely elucidated to date. The prevalence of patellofemoral pain is high with a high rate of chronicity and recurrence and an overrepresentation of young, athletic and female populations. A pragmatic classification distinguishes 3 main clinical phenotypes of patellofemoral pain syndrome: with objectively displaceable patella, with extra-patellar alignment problems and without alignment problems.

The links between the clinic and biomechanics are still unclear and the kinematics and neuromuscular impairments associated with the 3 main clinical phenotypes are poorly understood.

The KneeKG is an optoelectronic kinematic assessment device using non-invasive sensors and dedicated to real-time measurement of 3D femoro-tibial position and rotations. The kinematic, neuro-muscular, postural and proprioceptive assessments will allow us to better understand the pathophysiology of the patellofemoral pain syndrome, to establish a more accurate diagnosis of the disease, and provide a better understanding of its causes.

Several studies have shown that better adherence to exercise is associated with greater benefit in terms of pain and function in chronic pathologies.

Semi-structured interviews will enable the investigators to assess the impact of information derived from kinematic examination of the knees on adherence to treatment.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Île-de-France Region
    • Paris, Île-de-France Region, France, 75014
      • Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis - hôpital Cochin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 66 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Medical diagnosis of SDFP :
• Anterior pain of the knee, mechanical, in front of and around the patella noted at more than 3/10 on a simple numerical scale (ligament or meniscal damage, synovial plicae, tendinopathies, apophysitis, neuromas, and osteoarthritis FT are differential diagnoses),
• Pain during any of the following activities: Going up / down stairs, squats, jumps, jogging, sitting, crouching.
• Duration of knee anterior pain greater than 1 month
• Affiliation to a social insurance
• Signature of the consent to participate

Exclusion Criteria:

• Neurological disorders affecting the lower extremities
• Radiographic FT osteoarthritis
• History of surgery or trauma to the lower limb less than 1 year old
• Intra-articular knee infiltration ≤ 2 months
• Cognitive or behavioral problems making it impossible to assess
• Participates in intervention research or is in the exclusion period following a previous research, if applicable
• Unable to speak, read and write French
• Patients under guardianship or curatorship,
• Patients receiving AME (French State Medical aid)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patellofemoral pain syndrome; Kinematic and neuromuscular assessment	Other: EOS Radiation; One EOS exam of lower extremities; Other Names: EOS X-ray exams; Behavioral: Semi-structured interview; Semi-structured interview to identify factors influencing patient adherence behavior for a sub-group of 15 patients. By phone, between 1 to 3 months after inclusion.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Amplitude of rotation	Amplitude of rotation of the femur with respect to the tibia in the bearing phase in the 3 planes of space	Day of inclusion (up to 10 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Semi-structured interview	Semi-structured interview for a sub-group of 15 patients identify factors influencing patient adherence behavior.	From month 1 to month 3
Length measures	EOS femoro-tibial alignment	Day of inclusion (up to 10 days)
Q angle (in degree)	EOS femoro-tibial alignment	Day of inclusion (up to 10 days)
Varus valgus(in degree)	EOS femoro-tibial alignment	Day of inclusion (up to 10 days)
Peak torque (N.m)	Quadriceps isokinetic strenght	Day of inclusion (up to 10 days)
Total work (N.m)	Quadriceps isokinetic strenght	Day of inclusion (up to 10 days)
Peak torque (N.m)	Hamstrings isokinetic strenght	Day of inclusion (up to 10 days)
Total work (N.m)	Hamstrings isokinetic strenght	Day of inclusion (up to 10 days)
Quadriceps/Hamstring ratio : 2 measure/leg		Day of inclusion (up to 10 days)
Peak torque (N.m)	Hip abductors static strenght	Day of inclusion (up to 10 days)
Average torque (N.m)	Hip abductors static strenght	Day of inclusion (up to 10 days)
Time for reaching peak (s)	Hip abductors static strenght	Day of inclusion (up to 10 days)
Time difference in the onset between the m.vastus lateralis and m.vastus medialis contraction in ms	Activity of the quadriceps measured. Electromyogram was used to quantify the electric potential of quadriceps and referred to as 'quadriceps muscle EMG activity' throughout	Day of inclusion (up to 10 days)
Y test	Static and dynamic unipodal balance	Day of inclusion (up to 10 days)
Eccentric step-down test	Static and dynamic unipodal balance	Day of inclusion (up to 10 days)
Lateral step down test	Static and dynamic unipodal balance	Day of inclusion (up to 10 days)
Unipodal stabilometric evaluation	Static and dynamic unipodal balance	Day of inclusion (up to 10 days)
Foot posture index	Foot static	Day of inclusion (up to 10 days)
Navicular drop test	Foot static	Day of inclusion (up to 10 days)
Ober's test	Muscle hypoextensibility. Quadriceps, harmstrings, calves,	Day of inclusion (up to 10 days)
Visual Analog Scale	Determine pain / No pain = 0, maximal pain =100	Day of inclusion (up to 10 days)
Anterior knee pain scale (AKPS)	Questionnaire to determine pain / 13 questions, minimum score = 0 point, maximum score = 100 points	Day of inclusion (up to 10 days)
12-Item Short Form Survey (SF-12)	Quality of life, to determine pain	Day of inclusion (up to 10 days)

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris
• Collaborators: URC Necker Cochin, France
• Investigators: Principal Investigator: Marvin COLEMAN, MSc, PhD student, Assistance Publique - Hôpitaux de Paris

Study record dates

Study Major Dates

• Study Start (Actual): December 9, 2022
• Primary Completion (Actual): September 27, 2024
• Study Completion (Actual): February 27, 2025

Study Registration Dates

• First Submitted: June 14, 2022
• First Submitted That Met QC Criteria: June 27, 2022
• First Posted (Actual): July 1, 2022

Study Record Updates

• Last Update Posted (Estimated): September 15, 2025
• Last Update Submitted That Met QC Criteria: September 8, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: assessment; clinical phenotypes; 3D Kinematics; Patellofemoral pain syndrome; dynamic deficiencies
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Patellofemoral Pain Syndrome
• Other Study ID Numbers: APHP211433; 2021-A01928-33 (Other Identifier: France : Ministry of Health)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No