Botulinum toxin injections as salvage therapy is beneficial for management of patellofemoral pain syndrome

Abstract Purpose Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection. Materials and methods A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected. Results The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up. Conclusions A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS. Level III evidence Retrospective cohort study.

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Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial

Acupuncture in Medicine ◽

10.1177/0964528420912253 ◽

2020 ◽

Vol 38 (6) ◽

pp. 371-379

Author(s):

Shabnam Behrangrad ◽

Maryam Abbaszadeh-Amirdehi ◽

Amin Kordi Yoosefinejad ◽

Seyed Mokhtar Esmaeilnejadganji

Keyword(s):

Functional Status ◽

Mechanical Stimulation ◽

Rating Scale ◽

Pressure Pain Threshold ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Dry Needling ◽

Myofascial Trigger Points

Background: To compare the effectiveness of ischaemic compression (IC) applied directly to the knee versus dry needling (DN) with respect to pain, functional status and sensitivity to mechanical stimulation of vastus medialis obliquus (VMO) myofascial trigger points (MTrPs) in patients with patellofemoral pain syndrome (PFPS). Methods: A total of 54 patients with unilateral PFPS aged 20–30 years were selected randomly from patients referred to physical therapy clinics of Babol University of Medical Sciences in Iran. Twenty-seven patients were allocated to either IC or DN groups. Three sessions of treatment were applied over 1 week with follow-up at 1 week, 1 month and 3 months. Primary outcome measures comprised the Kujala questionnaire score for functional status, numerical pain rating scale (NPRS) for pain intensity and pressure pain threshold (PPT) for sensitivity to mechanical stimulation; these were measured and recorded before treatment and 1 week, 1 month and 3 months after the last treatment session. Results: There were no statistically significant differences in the between-group comparisons of any variables at the various follow-up points. Both groups (n = 27 participants each) had significant improvements (p < 0.05) in pain, functional status and PPT values at follow-up. Conclusions: There were no differences in markers of pain, function or pressure sensitivity over a 3-month follow-up period between patients with PFPS treated with DN and IC. Temporal improvements in both groups suggested that the two techniques may be similarly effective for the treatment of PFPS.

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Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review

Journal of Chiropractic Medicine ◽

10.1016/j.jcm.2016.10.003 ◽

2017 ◽

Vol 16 (2) ◽

pp. 139-146 ◽

Cited By ~ 7

Author(s):

Gemma Victoria Espí-López ◽

Anna Arnal-Gómez ◽

Mercè Balasch-Bernat ◽

Marta Inglés

Keyword(s):

Systematic Review ◽

Physical Therapy ◽

Manual Therapy ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain

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Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up

British Journal of Sports Medicine ◽

10.1136/bjsm.2010.079020 ◽

2011 ◽

Vol 46 (4) ◽

pp. 243-246 ◽

Cited By ~ 19

Author(s):

Jyrki A Kettunen ◽

Arsi Harilainen ◽

Jerker Sandelin ◽

Dietrich Schlenzka ◽

Kalevi Hietaniemi ◽

...

Keyword(s):

Knee Arthroscopy ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain

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Effectiveness of local exercise therapy versus spinal manual therapy in patients with patellofemoral pain syndrome: medium term follow-up results of a randomized controlled trial.

10.21203/rs.3.rs-228350/v1 ◽

2021 ◽

Author(s):

Aldo Georges Celine Scafoglieri ◽

Jona Van den Broeck ◽

Stijn Willems ◽

Rob Tamminga ◽

Henk van der Hoeven ◽

...

Keyword(s):

Knee Pain ◽

Manual Therapy ◽

Exercise Therapy ◽

Intervention Group ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Medium Term ◽

Thoracolumbar Region

Abstract Background Increasing evidence has shown benefits of spinal manipulations in patients with patellofemoral pain syndrome (PFPS). There is scarcity regarding medium term effects of spinal manual therapy on outcome measures in PFPS patients. Therefore, the aim of the present study was to compare the effectiveness of local exercise therapy and spinal manual therapy for knee pain, function and maximum voluntary peak force (MVPF) velocity of the quadriceps. Methods Forty-three patients with PFPS were randomly assigned to an intervention group. The local exercise group received six sessions of supervised training of the knee-and hip muscles with mobilization of the patellofemoral joint. The spinal manual therapy group received six interventions of high velocity low thrust manipulations at the thoracolumbar region, sacroiliac joint, and/or hip. Maximum, minimum and current pain were measured using the visual analogue scale. Function was assessed with the anterior knee pain scale (AKPS) and MPFV was recorded using a Biodex System 3 dynamometer. Patients were assessed before intervention, after 6 weeks of intervention and at 6 weeks follow-up. Results Pain and functionality improved more following spinal manipulative therapy than local exercise therapy. After 6 weeks of intervention the between-group difference (local versus spinal) for maximal pain was 23.4 mm [95% CI: 9.3, 37.6; effect size (ES): 1.04] and − 12.4 [95% CI: -20.2, -4.7; ES: 1.00] for the AKPS. At 6 weeks of follow-up the between-group difference for maximal pain was 18.7 mm [95% CI: 1.4, 36.0; ES: 0.68] and − 11.5 [95% CI: -19.9, -3.3; ES: -0.87] for the AKPS. Conclusions This study suggests that spinal manual therapy is more effective than local exercise therapy in improving pain and function in patients with PFPS in the medium term. Combining spinal manual therapy with local exercise therapy may be an important element in the successful rehabilitation of patients with PFPS.

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