DEMOGRAPHIC AND EPIDEMIOLOGICAL TRENDS IN PATELLOFEMORAL PAIN

Neal R Glaviano, Michelle Kew, Joseph M Hart, Susan Saliba, Neal R Glaviano, Michelle Kew, Joseph M Hart, Susan Saliba

Abstract

Background: Understanding the demographics of patellofemoral pain is important to determine the best practices in diagnosis and treatment of this difficult pathology. The occurrence of patellofemoral pain has been reported from isolated sports medicine clinics and from within the military, but its incidence has never been examined in the general population within the United States.

Purpose: The purpose of this study was to examine the reported occurrence of patellofemoral pain for those individuals seeking medical care and to compare that to all other pathologies that result in anterior knee pain, such as tendinopathies, patella subluxation, osteoarthritis, or meniscal and bursal conditions. Occurrence rates were examined across sex, age and region within a large healthcare provider database that contains over 30 million individuals.

Methods: Data were queried with the PearlDiver Patient Record Database, a national database containing orthopedic patient records. Two common International Classification of Disease, Ninth Revision (ICD-9) codes for patellofemoral pain (717.7 - Patella Chondromalacia and 719.46 - Pain in joint, lower leg) were utilized and were searched from the years 2007-2011. The top twenty additional ICD-9 codes that were concurrently coded with 717.7 and 719.46 were removed from the data. Chi-squared and Mantel-Haenszel tests were utilized to identify statistically significant differences in the diagnosis of patellofemoral pain between sex, age, and year.

Results: During this five-year period, there were 2,188,753 individuals diagnosed with patellofemoral pain. The diagnosis was more common in females compared to males with 1,211,665 and 977,088 cases respectfully (p<0.001). Statistically significant differences between ages was found, with 50-59 year olds having the most cases with 578,854, p<0.001. And, during the five-year examination period, there was a steady increase between 2007-2011, p<0.01.

Conclusion: Patellofemoral pain was diagnosed between 1.5% and 7.3% of all patients seeking medical care within the United States. Females experienced patellofemoral pain more often than males and there was a steady increase of cases in the United States during the 2007-2011 examination period. The diagnosis of patellofemoral pain increased with age and the 50-59 year old age group had the most cases.

Level of evidence: 2b.

Keywords: Anterior knee pain; chondromalacia; epidemiology.

Figures

Figure 1.
Figure 1.
Flow Diagram.
Figure 2.
Figure 2.
PFP breakdown by Region (In Percentages).
Figure 3.
Figure 3.
Percentage of PFP by Age Group.
Figure 4.
Figure 4.
Breakdown of all sources of AKP by Sex

References

    1. Aminaka N Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train. 2008;43(1):21‐28.
    1. Bolgla LA Boling MC. An update for the conservative management of patellofemoral pain syndrome: A systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther. 2011;6(2):112‐125.
    1. Crossley K Bennell K Green S McConnell J. A systematic review of physical interventions for patellofemoral pain syndrome. Clin J Sport Med. 2001;11(2):103‐110.
    1. Davis IS Powers CM. Patellofemoral pain syndrome: Proximal, distal, and local factors, an international retreat, April 30‐May 2, 2009, Fells Point, Baltimore, MD. J Orthop Sports Phys Ther. 2010;40(3):A1‐16.
    1. Duffey MJ Martin DF Cannon DW Craven T Messier SP. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc. 2000;32(11):1825‐1832.
    1. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. 2002;30(3):447‐456.
    1. Callaghan MJ Selfe J. Has the incidence or prevalance of patellofemoral pain in the general population in the united kingdom been properly evaluated? Phys.Ther.Sport. 2007;8:37‐43.
    1. Crossley K Bennell K Green S Cowan S McConnell J. Physical therapy for patellofemoral pain: A randomized, double‐blinded, placebo‐controlled trial. Am J Sports Med. 2002;30(6):857‐865.
    1. Thomee R Augustsson J Karlsson J. Patellofemoral pain syndrome. A review of current issues. Sports medicine (Auckland, N.Z.). 1999;28(4):245‐262.
    1. Tuna B Semiz‐Oysu A Pekar B Bukte Y Hayirlioglu A. The association of patellofemoral joint morphology with chondromalacia patella: A quantitative MRI analysis. Clinical Imaging. 2014;38(4):495‐498.
    1. Rothermich MA Glaviano NR Li J Hart JM. Patellofemoral pain: Epidemiology, pathophysiology, and treatment options. Clin Sports Med. 2015;34(2):313‐327.
    1. Willson JD Binder‐Macleod S Davis IS. Lower extremity jumping mechanics of female athletes with and without patellofemoral pain before and after exertion. Am J Sports Med. 2008;36(8):1587‐1596.
    1. Willson JD Davis IS. Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands. Clin Biomech (Bristol, Avon). 2008;23(2):203‐211.
    1. Hewett TE Myer GD Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: A prospective study. Am J Sports Med. 2005;33(4):492‐501.
    1. Nakagawa TH Moriya ET Maciel CD Serrao FV. Trunk pelvis, hip, and knee kinematics #hip |strength, and gluteal muscle activation during a single‐leg squat in males and females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2012;42(6):491‐501.
    1. Brindle TJ Mattacola C McCrory J. Electromyographic changes in the gluteus medius during stair ascent and descent in subjects with anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 2003;11(4):244‐251.
    1. Kernozek TW Torry MR Van Hoof H Cowley H Tanner S. Gender differences in frontal and sagittal plane biomechanics during drop landings. Med Sci Sports Exerc. 2005;37(6):1003‐12; discussion 1013.
    1. Heintjes E Berger M Bierma‐Zeinstra SM. Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003;4(CD003472).
    1. Fairbank JC Pynsent PB van Poortvliet JA Phillips H. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br. 1984;66(5):685‐693.
    1. Blond L Hansen L. Patellofemoral pain syndrome in athletes: A 5.7‐year retrospective follow‐up study of 250 athletes. Acta Orthop Belg. 1998;64(4):393‐400.
    1. Utting MR Davies G Newman JH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee. 2005;12(5):362‐365.
    1. Thomas MJ Wood L Selfe J Peat G. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: A systematic review. BMC Musculoskelet Disord. 2010;11:201‐2474‐11‐201.
    1. Kannus P Aho H Jarvinen M Niittymaki S. Computerized recording of visits to an outpatient sports clinic. Am J Sports Med. 1987;15(1):79‐85.
    1. DeHaven KE Lintner DM. Athletic injuries: Comparison by age, sport, and gender. Am J Sports Med. 1986;14(3):218‐224.
    1. Boling M Padua D Marshall S Guskiewicz K Pyne S Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725‐730.
    1. Devereaux MD LS. Patellofemoral arthralgia in athletes attending a sports injury clinic. Br J Sports Med. 1984;18:18‐21.
    1. Witvrouw E Callaghan MJ Stefanik JJ, et al. Patellofemoral pain: Consensus statement from the 3rd international patellofemoral pain research retreat held in vancouver, september 2013. Br J Sports Med. 2014;48(6):411‐414.
    1. Rathleff MS Skuldbol SK Rasch MN Roos EM Rasmussen S Olesen JL. Care‐seeking behaviour of adolescents with knee pain: A population‐based study among 504 adolescents. BMC Musculoskelet Disord. 2013;14:225‐2474‐14‐225.
    1. Myer GD Ford KR Barber Foss KD, et al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon). 2010;25(7):700‐707.
    1. Ireland ML Willson JD Ballantyne BT Davis IM. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003;33(11):671‐676.
    1. McConnell J. Management of patellofemoral problems. Man Ther. 1996;1(2):60‐66.
    1. Witvrouw E Cambier D Danneels L, et al. The effect of exercise regimens on reflex response time of the vasti muscles in patients with anterior knee pain: A prospective randomized intervention study. Scand J Med Sci Sports. 2003;13(4):251‐258.
    1. Taunton JE Ryan MB Clement DB McKenzie DC Lloyd‐Smith DR Zumbo BD. A retrospective case‐control analysis of 2002 running injuries. Br J Sports Med. 2002;36(2):95‐101.
    1. von Elm E Altman DG Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495‐1499.
    1. Souza RB Powers CM. Differences in hip kinematics #muscle |strength, and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther. 2009;39(1):12‐19.
    1. Milgrom C Finestone A Eldad A Shlamkovitch N. Patellofemoral pain caused by overactivity. A prospective study of risk factors in infantry recruits. J Bone Joint Surg Am. 1991;73(7):1041‐1043.
    1. Whitman P Melvin M Nicholas J. Common problems seen in a metropolitan sports injury clinic. Phys.Sportsmed. 1981;9:105‐108.
    1. Baquie P Brukner P. Injuries presenting to an australian sports medicine centre: A 12‐month study. Clin J Sport Med. 1997;7(1):28‐31.
    1. Nejati P Forogh B Moeineddin R Baradaran H Nejati M. Patellofemoral pain syndrome in iranian female athletes. Acta Medica Iranica. 2011;49(3):169‐172.
    1. Grenholm A Stensdotter AK Hager‐Ross C. Kinematic analyses during stair descent in young women with patellofemoral pain. Clin Biomech (Bristol, Avon). 2009;24(1):88‐94.
    1. Kaya D Citaker S Kerimoglu U, et al. Women with patellofemoral pain syndrome have quadriceps femoris volume and strength deficiency. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):242‐247.
    1. Powers CM Landel R Perry J. Timing and intensity of vastus muscle activity during functional activities in subjects with and without patellofemoral pain. Phys Ther. 1996;76(9):946‐55.
    1. Dolak KL Silkman C Medina McKeon J Hosey RG Lattermann C Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: A randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):560‐570.
    1. McAlindon TE Snow S Cooper C Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: The importance of the patellofemoral joint. Ann Rheum Dis. 1992;51(7):844‐849.
    1. Duncan RC Hay EM Saklatvala J Croft PR. Prevalence of radiographic osteoarthritis‐‐it all depends on your point of view. Rheumatology (Oxford). 2006;45(6):757‐760.
    1. Wood L Muller S Peat G. The epidemiology of patellofemoral disorders in adulthood: A review of routine general practice morbidity recording. Prim Health Care Res Dev. 2011;12(2):157‐164.
    1. Narkbunnam R Chareancholvanich K Hanroongroj T. Sagittal plane evaluation of patellofemoral movement in patellofemoral pain patients with no evidence of maltracking. Knee Surg Sports Traumatol Arthrosc. 2013.
    1. Rutland M O'Connell D Brismee JM Sizer P Apte G O'Connell J. Evidence‐supported rehabilitation of patellar tendinopathy. N Am J Sports Phys Ther. 2010;5(3):166‐178.

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