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

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.

Effect of Agility and Perturbation Training on Pain, Balance and Functional Ability in Subjects with Patellofemoral Pain Syndrome

Background: Agility and Perturbation training have been advocated to improve pain, balance and functional abilities in subjects with osteoarthritis of knee but effect of same on Patellofemoral pain have not been explored in studies. The above techniques would be helpful along with standard rehabilitation programs in reducing dynamic knee instability or improving dynamic stability upon return to high level physical activity and have an additive effect of reducing pain in OA knee. Objective: The purpose of the study is to find the effect of Agility and Perturbation training on improvement of pain, balance and functional abilities in subject with Patellofemoral Pain Syndrome. Method: A randomized controlled study with 40 individuals has been taken with patellofemoral pain syndrome. 20 subjects have been selected for control group and 20 subjects for study group. Outcome measures includes Kujala function scale, Y balance test and Numeric pain rating scale were measured before and immediately after the treatment. Results: Analysis using Mann Whitney U Test and Independent t between the groups found that when pre intervention means of NPRS, Composite score YBT and Kujala Score were compared there is a statistically significant difference between the groups. When post intervention means of NPRS and Kujala score were compared between the groups there is no statistically significant difference between the groups. When post intervention means of Composite score YBT were compared there is a statically significant difference. Conclusion: The present study concludes that Agility and Perturbation training shown significant improvement of pain, function and balance in subject with Patellofemoral Pain Syndrome. Key words: Patellofemoral Pain Syndrome, Kujala function Scale, Y balance test.