|Year : 2016 | Volume
| Issue : 3 | Page : 192-195
Evaluation of patellofemoral pain syndrome in national level weight lifters with anterior knee pain
Gaurai Mangesh Gharote, Sonal Mukeshkumar Shah, Ujwal Laxman Yeole, Pravin Pandurang Gawali, Roshan Gopal Adkitte
Department of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra, India
|Date of Web Publication||28-Sep-2016|
Gaurai Mangesh Gharote
Department of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Patellofemoral pain syndrome (PFPS) is an overuse injury in athletes usually chronic. It is the most common cause of anterior knee pain in athletic population. Purpose: To evaluate the prevalence of PFPS in weight lifters with persistent anterior knee pain from at least from 3 months. Materials and Methods: The data for the study had been collected from various sports institutions across Pune and under 20 matches 2015. The survey comprised 50 players (44 male and 6 female) aged 15-30 years. Kujala questionnaire/anterior knee pain scale (AKPS) was used in the entire athletic population to judge the severity of pain. The players further were assessed by patellar grinding test which was followed by radiological investigations (X-ray finding). The athletic population that was diagnosed positive on the patellar grinding test underwent screening for radiological examination. Results: It was observed that 80% players with anterior knee pain were diagnosed with PFPS on the patellar grinding test and 62.5% of those 80% were diagnosed on X-ray investigations. Kujala or AKPS on interview reported 18% of lifters with fair results, 46% with good results, and 36% with excellent results. It was also observed the bilateral limbs were affected in 22%, in unilateral limb dominant was more affected. Conclusion: PFPS was prevalent in weight lifters.
تقييم متلازمة الألم الفخذي الداغصي على المستوى القومي لحاملي الأثقال الذين يعانون من ألم في مفصل الركبة الأمامي
مقدمة: متلازمة ألم رضفة الفخذ (PFPS) يعد من إصابات الرياضيين المزمنة في معظم حالات ألام مفصل الركبةالأمامي
الغرض من الدراسة: تقييم انتشار PFPS عند رافعي الأثقال مع ألم الركبة الأمامي المستمر لمدة ثلاثة أشهر على الأقل
المواد وطرق الدراسة: تم جمع بيانات الدراسة من مختلف الألعاب الرياضية وتحت 20 مباراة عام 2015. وشمل المسح 50 لاعبا (44 من الذكور و 6 من الإناث) تراوحت أعمارهم بين 15-30 عاما. تم استخدام الاستبانة Kujala حول ألم مفصل الركبةالأمامي (AKPS) في عدد من الرياضيين للحكم على شدة الألم. تم المزيد من تقييم اللاعبين لفحص الرضفة الذي تلته الفحوصات الإشعاعية السينية). وتم تشخيص الرياضيين بعد فحص الرضفة بعد إخضاعهم للفحص الإشعاعي.
النتائج: لوحظ أن 80٪ من اللاعبين الذين يعانون ألم الركبة الأمامي تم تشخيصهم بمتلازمة ألم رضفة الفخذ وتم تشخيص 62.5٪ من هؤلاء 80٪ يعد فحوصات الأشعة السينية. ذكرت Kujala أو AKPS مقابل 18٪ من رافعي الأثقال مع نتائج مقبولة، 46٪ مع نتائج جيدة، و 36٪ مع نتائج ممتازة. ولوحظ تأثر الأطراف الثنائية عند 22٪، في الطرف من جانب واحد كانت أكثر تأثرا.
الخلاصة: كان ألم رضفة الفخذ أكثر انتشارا بين رافعي الأثقال.
Keywords: Anterior knee pain, athletes, chondromalacia patellae, Kujala pain questionnaire/anterior knee pain scale, patellofemoral pain syndrome, weight lifters
|How to cite this article:|
Gharote GM, Shah SM, Yeole UL, Gawali PP, Adkitte RG. Evaluation of patellofemoral pain syndrome in national level weight lifters with anterior knee pain. Saudi J Sports Med 2016;16:192-5
|How to cite this URL:|
Gharote GM, Shah SM, Yeole UL, Gawali PP, Adkitte RG. Evaluation of patellofemoral pain syndrome in national level weight lifters with anterior knee pain. Saudi J Sports Med [serial online] 2016 [cited 2022 Aug 13];16:192-5. Available from: https://www.sjosm.org/text.asp?2016/16/3/192/191337
| Introduction|| |
Patellofemoral pain syndrome (PFPS) is a spectrum of processes characterized by retropatellar pain (behind the knee cap) or peripatellar pain (around the knee cap) arising from overuse and overload of the patellofemoral joint or biomechanical changes in this joint.  PFPS is a term for variety of pathologies or anatomical abnormalities leading to a type of anterior knee pain.  The pain may be caused by increased subchondral bone stress attributed to the stress of articulation or from cartilaginous lesions on the patella or distal femur. ,, It is constituted by a variety of symptoms that include retropatellar pain that is frequently aggravated by sitting (movie sign), stair climbing, and vigorous activity. Complaints of crepitus, effusions, a sense of insecurity, or giving away are reported, and some patients also complain of intermittent catching while extending the knee. 
This clinical entity could be due to patellar maltracking caused by functional malalignment or dynamic valgus. Possible causes for the dynamic valgus may be decreased the strength of the hip abductors or a pes pronatus valgus. The functional malalignment is associated with quadriceps dysbalance, hamstring tightness, or iliotibial tract tightness.  Being multifactorial other causes of PFPS include the onset timing of vasti muscles and muscle strength.  Other frequently cited causes for PFPS are overuse and trauma.  A brief period of overuse of the patellofemoral joint or an increase in physical activity is reported in almost all patients with PFPS. 
Weightlifting is a sport that involves three basic activities, i.e., snatch, clean, and jerk. Lifting the barbell from the floor to the extended position is snatching - the single movement. The two movement lift from the floor to shoulder position is clean and jerk being from shoulders to the extended position. These movements if performed in a faulty manner lead to abnormal forces on the patella causing overuse injuries to the patella. Any suspected case of PFPS can be prevented by prehabilitation by early evaluation of potential risk factors or athletes involved in overuse activities. 
| Materials and methods|| |
Initially, the synopsis was submitted to the institute and was approved by the institute and the ethical committee. It was a prevalence-based study. The sample size constituted of 50 players (44 males and 6 females) aged years 15-30 years. The athletes had been examined in a screening program for medical problems. As overweight is a risk factor for PFPS the weight (kg) and height (cm) of all the athletes was measured [Table 1]. All of the athletes had nearly 3 training sessions per week for last 6 months. They were examined in their respective clubs with their prior consent. The sample size was selected on the basis of the inclusion criteria that included anterior knee pain from at least 3 months that aggravated on ascending or descending stairs, squatting or prolonged sitting, nontraumatic onset of anterior knee pain, no other cause of anterior knee pain such as ligament instability, bursitis, meniscal injury, tendonitis, and arthritis by ruling it out on radiological examination and had no history of any other knee surgery during the past 1 year.
The athletes fitting in the inclusion criteria were evaluated by the patellar grinding test (specificity - 39%)  Moreover, Kujala pain questionnaire  that only assessed the severity of the pain and was not a diagnostic criteria (reliability [interclass coefficient = 0.968] and validity [ñ =0.136, P = 0.284]).  This was followed by radiological examination of the population that was diagnosed positive on the patellar grinding test. In Kujala questionnaire, the weightlifters were interviewed by asking 13 questions about the activities that aggravated pain or symptoms that are said to cause PFPS such as limping, crepitus, swelling, squatting, and abnormal patellar movements.
Diagnosis was based on patellar grinding test and the radiological findings of the X-ray. For the patellar grinding test, the examiner pressed down slightly proximal to the upper pole or base of the patella with the web of the hand as the weight lifter lied relaxed with the knee extended. The weightlifters were then asked to contract the quadriceps muscle as the examiner pushes down. If the patient could complete and maintain the contraction without pain, the test was considered negative. If the test caused retropatellar pain or if the patient could not hold the contraction, the test was considered positive. The procedure was repeated several times, increasing the pressure applied and also compared with the unaffected side to avoid errors. 
The X-ray was taken in the lateral view to observe the degree of trochlear dysplasia which shows the altered joint space integrity, with a shallow trochlea being indicative of trochlear dysplasia. With the increasing degrees of lateral patellar tilt the median ridge superimposed and projects anterior to the lateral facet. , Due to cartilage destruction in PFPS a significant joint space narrowing that was noted on X-ray which confirmed the diagnosis.
| Results|| |
The Kujala or anterior knee pain scale (AKPS) showed 18 lifters with excellent results, 24 with good results, 9 with fair results, and none of them revealed poor results [Table 2]. This shows that severe symptoms indicative of surgery for PFPS were not present in the players. It was observed that the patellar grinding test was positive in 40 weightlifters out of 50 [Table 3] which included 34 male players and 6 female players. Out of these 40 positive on patellar grinding tests, 25 weightlifters [Table 4] revealed trochlear dysplasia on radiological examination that confirmed the diagnosis for PFPS.
All the 6 females assessed were diagnosed with PFPS.
Kujala questionnaire reported of good to fair results in females and good to excellent results in male players.
The knees were affected bilaterally in 22% and among unilateral dominant (26%) was more affected and nondominant (20%).
The results were analyzed statistically using SPSS Statistics for Windows, Version 19.0. (IBM Corp., Armonk, NY). in which the Welch t-test was used. The P = 0.0428. By conventional criteria, this difference was considered to be statistically significant, and thus the null hypothesis was rejected.
| Discussion|| |
Through the present study, it can be deduced that the prevalence of PFPS in weight lifters is 62.5% which was confirmed through the radiological findings. The higher positive percentage compared to previous studies like in the PFPS in the Iranian female athletes could be due to specific sports variation while the other studies have checked the prevalence of in general athletic group. The author Nejati et al. concluded that PFPS was prevalent among 16.74% of female athletes. The variation in the percentage could also be as the players assessed were during the on season. 
The Kujala questionnaire or AKPS that assess the quality of pain revealed that 18% of lifters reported with fair results, 46% with good results and 36% with excellent results which shows in spite of the pain the players carried out their play. All these players were assessed during the on season. Few previous studies till date has been conducted showing such variations on the pain through the test and the assessing it through the scale. This draws us to psychological variations about pain in the weight lifters and also stated that the players carried out the sport in spite of the pain.
Through the present analysis, it is observed that the adolescents were more affected which supports the results of Nδslund et al.,  who stated that PFPS affected 15-33% of the adult population and 21-45% of adolescents. Kannus et al., (1987) also supported this statement.
The present study also observed that out of 6 female and 44 male players all the 6 females were affected by PFPS while the 34 males were diagnosed with PFPS on grinding test. This probably shows higher incidence in females but taking limitation of the sample size this finding could vary. Nejati et al., support this statement. 
| Conclusion|| |
According to the present study, it was thus found that PFPS is prevalent in weight lifters with already existing anterior knee pain and that PFPS is more common in younger or adolescent age groups.
The authors would like to express their gratitude toward the institute and the ethical committee of Tilak Maharashtra Vidyapeeth, who granted us the permission to carry out this research.
We also thank all the sports institutes for their kind cooperation and Mangesh Gharote to help us out with the statistical analysis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
LaBella C. Patellofemoral pain syndrome: Evaluation and treatment. Prim Care Clin Pract 2004;31;977-1003.
Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Vanden Berghe L, Cerulli G. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc 2005;13:122-30.
Besier TF, Gold GE, Beaupré GS, Delp SL. A modeling framework to estimate patellofemoral joint cartilage stress in vivo
. Med Sci Sports Exerc 2005;37:1924-30.
Kettunen JA, Visuri T, Harilainen A, Sandelin J, Kujala UM. Primary cartilage lesions and outcome among subjects with patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 2005;13:131-4.
Gerbino PG 2 nd
, Griffin ED, d′Hemecourt PA, Kim T, Kocher MS, Zurakowski D, et al.
Patellofemoral pain syndrome: Evaluation of location and intensity of pain. Clin J Pain 2006;22:154-9.
Al-Hakim W, Jaiswal PK, Khan W, Johnstone D. The non-operative treatment of anterior knee pain. Open Orthop J 2012;6:320-6.
Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, et al.
Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 2014;22:2264-74.
Chester R, Smith TO, Sweeting D, Dixon J, Wood S, Song F. The relative timing of VMO and VL in the aetiology of anterior knee pain: A systematic review and meta-analysis. BMC Musculoskelet Disord 2008;9:64.
Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: A systematic review. J Orthop Sports Phys Ther 2012;42:81-94.
Dye SF. The pathophysiology of patellofemoral pain: A tissue homeostasis perspective. Clin Orthop Relat Res 2005;436:100-10.
Waryasz GR, McDermott AY. Patellofemoral pain syndrome (PFPS): A systematic review of anatomy and potential risk factors. Dyn Med 2008;7:9.
Magee DJ. Orthopedic Physical Assessment. 5 th
ed. Canada: University of Alberta;2008.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993;9:159-63.
Endo Y, Stein BE, Potter HG. Radiological assessment of patellofemoral pain in athlete, sports health. Vol. 3. New York: Department of Radiology and Imaging, Hospital for Special Surgery; 2011. p. 195-210.
Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician 2007;75:194-202.
Nejati P, Forogh B, Moeineddin R, Baradaran HR, Nejati M. Patellofemoral pain syndrome in Iranian female athletes. Acta Med Iran 2011;49:169-72.
Näslund J, Näslund UB, Odenbring S, Lundeberg T. Sensory stimulation (acupuncture) for the treatment of idiopathic anterior knee pain. J Rehabil Med 2002;34:231-8.
[Table 1], [Table 2], [Table 3], [Table 4]