Prospective Predictors of Patellofemoral Pain Syndrome: A Systematic Review With Meta-analysis

Evangelos Pappas, Wing M Wong-Tom, Evangelos Pappas, Wing M Wong-Tom

Abstract

Context: Patellofemoral pain syndrome (PFPS) is one of the most common overuse injuries.

Objective: To assess the collective evidence of predisposing factors to PFPS.

Data sources: MEDLINE (1960-June 2010), EMBASE (1980-June 2010), and CINAHL (1982-June 2010).

Study selection: Studies were included if patients were asymptomatic at baseline testing (free of PFPS) and were prospectively followed for the development of the disorder. Only studies that assessed at least 1 variable that can be measured at a typical clinic were included. After duplicates were removed, 973 studies were assessed from their titles or abstracts, 20 from the full text, and from these, 7 met the inclusion criteria.

Data extraction: Data were extracted for age, weight, height, sample size, patient type (military vs civilian), follow-up periods, diagnostic methods, and diagnostic criteria. Means and standard deviations were extracted for all outcome variables.

Results: Meta-analyses were performed for height, weight, leanness, Q angle, number of sit-ups, knee extension strength, and peak knee valgus angle during landing. Lower knee extension strength was the only variable that was predictive of PFPS (P < 0.01). Other variables that were identified as predictive of PFPS by single studies were vertical jump, push-ups, knee flexion and hip abduction strength, thumb-to-forearm flexibility, quadriceps and gastrocnemius flexibility, genu varum, navicular drop, knee valgus moment at initial contact during landing, social support, and palliative reaction.

Conclusions: It appears that anthropometric variables are not associated with PFPS, while knee extension strength deficits appear to be predictors of PFPS.

Keywords: anterior knee pain; clinical measures; etiology.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
Figure 2.
Figure 2.
Meta-analysis on the number of sit-ups.
Figure 3.
Figure 3.
Meta-analysis on knee extension strength.
Figure 4.
Figure 4.
Meta-analysis on Q angle.
Figure 5.
Figure 5.
Meta-analysis on knee valgus angle during landing from a jump.

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