Contribution of Ultrasonography in Patellofemoral Pain Syndrome

Can Ultrasonography Contribute to the Diagnosis of Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adults younger than 60 years. . In this study, we aimed to evaluate the medial and lateral cartilage thickness the medial and lateral retinaculum thickness and the medial and lateral patellofemoral distance using ultrasonography and to compare with healthy controls. We also aimed to investigate the relationship between the measurements obtained in the PFPS group and pain intensity, functional scoring, and quality of life.

Study Overview

• Status: Completed
• Conditions: Quality of Life; Pain
• Intervention / Treatment: Other: Ultrasonography

Detailed Description

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adults younger than 60 years. The prevalence of PFPS was found to be 7-28.2% and the incidence was 9.2%. In this study, we aimed to evaluate the medial and lateral cartilage thickness due to the possible relationship of PFPS with osteoarthritis, the medial and lateral retinaculum thickness as it is one of the static stabilizers of the patellofemoral joint, and the medial and lateral patellofemoral distance as it indicates patellar malposition, using ultrasonography and to compare with healthy controls. We also aimed to investigate the relationship between the measurements obtained in the PFPS group and pain intensity, functional scoring, and quality of life.This study is a non-randomized and non-blinded, cross-sectional clinical study with a control group. 54 eligible volunteers who applied to the physical medicine and rehabilitation outpatient clinic of Hitit University Faculty of Medicine.27 of the participants were patients diagnosed with unilateral PFPS, and 27 were healthy individuals without knee pain. Local ethics committee approved the study (2024/36) and informed consent was obtained from all participants.Participants were between the ages of 18-45. A positive result in at least one of the following four tests was considered diagnostic for PFPS, with pain occurring around or behind the patella and aggravated by at least one activity that placed load on the patellofemoral joint during weight bearing on the flexed knee. These tests 1) Medial or lateral patellar facet tenderness 2) Clark's test 3) Patellar apprehension test 4) Patellar tilt test. The inclusion criteria for the PFPS group were that the patients had knee pain for at least 3 month, unilateral pain, no history of knee surgery, no systemic disease, and no clinical symptoms of other knee pathologies other than PFPS. In order to exclude other pathologies that cause knee pain; patellar plica tests, Apley compression and distraction tests, McMurray tests, varus-valgus stress tests, anterior and posterior drawer tests, pivot shift and Lachman tests were performed. Those with positive results in these tests were excluded from the study.

The inclusion criteria for the control group were absence of anterior knee pain, no history of knee surgery, and no systemic disease.

Individuals with clinical symptoms related to other knee pathologies, history of trauma, history of patellar dislocation or subluxation, passive motion restriction in the knee joint, hip-spine related pain, the presence of any neurological disease affecting the extremities, inflammatory disease were excluded.

Detailed history and physical examination findings were recorded. The age, education level, marital status, height, weight, body mass index (kg/m2), duration of pain, dominant and affected extremity of all patients were recorded.

Pain levels at rest and during activity were measured using the Visual Analogue Scale (VAS).Kujala patellofemoral score was used to assess functional status of patients.Quality of life was evaluated with Short form-36 (SF-36). A B-mode ultrasound examination was performed by a radiologist with more than 5 years of experience using a Samsung RS85 Prestige (Medical Systems Corporation, Seoul, South Korea) with a high frequency (4-15 MHz) linear probe.The painful knee of the PFAS group and the non-dominant knee of the control group were evaluated by ultrasonography. The medial and lateral retinaculum thickness, medial femoro-patellar distance from the medial patellar edge to the medial femoral condyle, lateral patellofemoral distance from the lateral patellar edge to the lateral femoral condyle were measured in the axial plane with the patients in the supine position with the knee flexed 30°. The medial and lateral sides of the trochlear cartilage were measured in the axial plane with the knee in 140° flexion.

• Study Type: Observational
• Enrollment (Actual): 54

Contacts and Locations

Study Locations

• Turkey
  • Çorum, Turkey
    • Çorum Erol Olçok Research and Training hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Group 1: Patients with patellofemoral pain syndrome Group 2: Healthy subjects without knee pain

Description

Inclusion Criteria:

. The inclusion criteria for the PFPS group were that the patients had knee pain for at least 3 month, unilateral pain, no history of knee surgery, no systemic disease, and no clinical symptoms of other knee pathologies other than PFPS. In order to exclude other pathologies that cause knee pain; patellar plica tests, Apley compression and distraction tests, McMurray tests, varus-valgus stress tests, anterior and posterior drawer tests, pivot shift and Lachman tests were performed. Those with positive results in these tests were excluded from the study.

The inclusion criteria for the control group were absence of anterior knee pain, no history of knee surgery, and no systemic disease.

Exclusion Criteria:

Individuals with clinical symptoms related to other knee pathologies, history of trauma, history of patellar dislocation or subluxation, passive motion restriction in the knee joint, hip-spine related pain, the presence of any neurological disease affecting the extremities, inflammatory disease were excluded.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group 2; Control group	Other: Ultrasonography; musculoskeletal ultrasonography
Group 1; Patellofemoral pain syndrome group	Other: Ultrasonography; musculoskeletal ultrasonography

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
trochlear cartilage thickness	three months

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent

Publications and helpful links

General Publications

• Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016 Jul;50(14):839-43. doi: 10.1136/bjsports-2016-096384. Epub 2016 Jun 24. No abstract available.
• Pacini P, Martino M, Giuliani L, Santilli G, Agostini F, Del Gaudio G, Bernetti A, Mangone M, Paoloni M, Toscano M, De Vito C, Ottonello C, Santilli V, Cantisani V. Patello-Femoral Pain Syndrome: Magnetic Resonance Imaging versus Ultrasound. Diagnostics (Basel). 2023 Apr 21;13(8):1496. doi: 10.3390/diagnostics13081496.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2024
• Primary Completion (Actual): July 1, 2024
• Study Completion (Actual): July 1, 2024

Study Registration Dates

• First Submitted: July 30, 2024
• First Submitted That Met QC Criteria: July 30, 2024
• First Posted (Actual): August 2, 2024

Study Record Updates

• Last Update Posted (Actual): August 2, 2024
• Last Update Submitted That Met QC Criteria: July 30, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: patellofemoral pain syndrome, ultrasonography, cartilage,
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Patellofemoral Pain Syndrome
• Other Study ID Numbers: Erololçok-dk-1

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