ARDC Research Link Australia

Publication

Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis

Publisher: Wiley

Date: 09-2003

DOI: 10.1016/S0736-0266(03)00054-8

Publication

Publisher: BMJ

Date: 25-11-2015

DOI: 10.1136/BJSPORTS-2015-095542

Publication

Prognostic factors for patellofemoral pain: a multicentre observational analysis

Publisher: BMJ

Date: 13-12-2012

DOI: 10.1136/BJSPORTS-2012-091696

Abstract: Describe proportions of in iduals with patellofemoral pain (PFP) with an unfavourable recovery over 12 months identify clinical predictors of poor recovery at 3 and 12 months and determine baseline values of predictors that identify those with poor 12-month prognosis. An observational analysis utilised data from 310 in iduals with PFP enrolled in two randomised clinical trials. Thirteen baseline variables (participant, PFP, study characteristics) were investigated for their prognostic ability. Pain, function and global recovery were measured at 3 and 12 months. Multivariate backward stepwise regression analyses (treatment-adjusted, p<0.10) were performed for each follow-up measure. Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months. 55% and 40% of participants had an unfavourable recovery at 3 and 12 months, respectively. Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity (β 11.36 to 24.94), Anterior Knee Pain (AKP) Scale (-4.44 to -11.33) and global recovery (OR: 2.32 to 6.11). Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures (p 2 months and AKP Scale score 2 months is the most consistent prognostic indicator, followed by AKP Scale score <70. Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP, and promote early intervention to maximise prognosis. Australian study: Australian Clinical Trials Registry (ACTRN012605000463673), ClinicalTrials.gov (NCT00118521) Dutch study: International Standard Randomised Controlled Trial Number Register (ISRCTN83938749).

Publication

Date: 08-03-2023

DOI: 10.1136/BJSPORTS-2022-106099

Abstract: Investigate sex/gender differences in self-reported activity and knee-related outcomes after anterior cruciate ligament (ACL) injury. Systematic review with meta-analysis. Seven databases were searched in December 2021. Observational or interventional studies with self-reported activity (including return to sport) or knee-related outcomes after ACL injury. We included 242 studies (n=123 687, 43% females/women/girls, mean age 26 years at surgery). One hundred and six studies contributed to 1 of 35 meta-analyses (n=59 552). After ACL injury/reconstruction, very low-certainty evidence suggests females/women/girls had inferior self-reported activity (ie, return to sport, Tegner Activity Score, Marx Activity Scale) compared with males/men/boys on most (88%, 7/8) meta-analyses. Females/women/girls had 23%–25% reduced odds of returning to sport within 1-year post-ACL injury/reconstruction (12 studies, OR 0.76 95% CI 0.63 to 0.92), 1–5 years (45 studies, OR 0.75 95% CI 0.69 to 0.82) and 5–10 years (9 studies, OR 0.77 95% CI 0.57 to 1.04). Age-stratified analysis ( years) suggests female athletes/girls had 32% reduced odds of returning to sport compared with male athletes/boys (OR 0.68, 95% CI 0.41 to 1.13, I 2 0.0%). Very low-certainty evidence suggests females/women/girls experienced inferior knee-related outcomes (eg, function, quality of life) on many (70%, 19/27) meta-analyses: standardised mean difference ranging from −0.02 (Knee injury and Osteoarthritis Outcome Score, KOOS-activities of daily living, 9 studies, 95% CI −0.05 to 0.02) to −0.31 (KOOS-sport and recreation, 7 studies, 95% CI −0.36 to –0.26). Very low-certainty evidence suggests inferior self-reported activity and knee-related outcomes for females/women/girls compared with males/men/boys after an ACL injury. Future studies should explore factors and design targeted interventions to improve outcomes for females/women/girls. CRD42021205998.

Publication

Publisher: BMJ

Date: 11-10-2019

DOI: 10.1136/BJSPORTS-2018-100488

Publication

Determining meaningful thresholds for patient-reported outcomes following interventions for anterior cruciate ligament or meniscus injury: A systematic review

Publisher: Center for Open Science

Date: 25-01-2023

DOI: 10.31219/OSF.IO/6BMWJ

Abstract: This systematic review aims to (i) identify all published PROMs where thresholds were measured with the aim of defining meaningful outcomes in in iduals who have experienced an ACL or meniscus injury and (ii) synthesize the literature to provide estimates for thresholds defining meaningful outcomes in these PROMs, in in iduals who ruptured their ACL or sustained a meniscal injury.

Publication

Publisher: BMJ

Date: 06-11-2017

DOI: 10.1136/BJSPORTS-2017-098717

Publication

Lower-limb biomechanics in football players with and without hip-related pain

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 20-02-2020

DOI: 10.1249/MSS.0000000000002297

Abstract: This study aimed to evaluate the differences in lower-limb biomechanics between adult subelite competitive football players with and without hip-related pain during two contrasting tasks—walking and single-leg drop jump (SLDJ)—and to determine whether potential differences, if present, are sex dependent. Eighty-eight football players with hip-related pain (23 women, 65 men) and 30 asymptomatic control football players (13 women, 17 men) who were currently participating in competitive sport were recruited. Biomechanical data were collected for the stance phase of walking and SLDJ. Pelvis, hip, knee, and ankle angles, as well as the impulse of the external joint moments, were calculated. Differences between groups and sex-specific effects were calculated using linear regression models. Compared with their asymptomatic counterparts, football players with hip-related pain displayed a lower average pelvic drop angle during walking ( P = 0.03) and a greater average pelvic hike angle during SLDJ ( P 0.05). Men with hip-related pain displayed a smaller total range of motion (excursion) for the transverse plane pelvis angle ( P = 0.03) and a smaller impulse of the hip external rotation moment ( P 0.01) during walking compared with asymptomatic men. Women with hip-related pain displayed a greater total range of motion (excursion) for the sagittal plane knee angle ( P = 0.01) during walking compared with asymptomatic women. Overall, few differences were observed in lower-limb biomechanics between football players with and without hip-related pain, irrespective of the task. This outcome suggests that, despite the presence of symptoms, impairments in lower-limb biomechanics during function do not appear to be a prominent feature of people with hip-related pain who are still participating in sport.

Publication

Between-Limb Differences in Patellofemoral Joint Forces During Running at 12 to 24 Months After Unilateral Anterior Cruciate Ligament Reconstruction

Publisher: SAGE Publications

Date: 06-05-2020

DOI: 10.1177/0363546520914628

Abstract: Patellofemoral joint (PFJ) osteoarthritis may occur after anterior cruciate ligament reconstruction (ACLR). The mechanisms underpinning the development of PFJ osteoarthritis are not known but may relate to altered PFJ loading. Few studies have assessed PFJ loads during high-impact tasks, such as running, beyond the acute rehabilitation phase (ie, months) after ACLR. The purpose was to compare between-limb joint angles, joint moments, and PFJ contact force during running in in iduals at 12 to 24 months after unilateral ACLR. We hypothesized that peak knee flexion angle, knee extension moment, and PFJ contact force during stance would be lower in the ACLR limb compared with the uninjured limb. Controlled laboratory study. A total of 55 participants (mean ± SD age, 28 ± 7 years), 12 to 24 months after ACLR, ran at a self-selected speed (2.9 ± 0.3 m/s). Measured kinematics and ground-reaction forces were input into musculoskeletal models to calculate joint moments and muscle forces. These values were subsequently input into a PFJ model to calculate contact force peak and impulse. Outcome measures were compared between the ACLR and uninjured limbs. In the ACLR limb, compared with the uninjured limb, the PFJ contact force displayed a lower peak (ACLR, 6.1 ± 1.3 body weight [BW] uninjured, 6.7 ± 1.4 BW P .001) and impulse (ACLR, 0.72 ± 0.17 BW*seconds [BWs] uninjured, 0.81 ± 0.17 BWs P .001). At the time of the peak PFJ contact force, the knee extension moment was lower in the ACLR limb (ACLR, 14.0 ± 2.4 %BW*height [%BW*HT] uninjured, 15.5 ± 2.5 %BW*HT P .001). The opposite was true for the ankle plantarflexion moment (ACLR, 12.1 ± 2.6 %BW*HT uninjured, 11.5 ± 2.7 %BW*HT P = .019) and the hip extension moment (ACLR, 2.3 ± 2.5 %BW*HT uninjured, 1.6 ± 2.3 %BW*HT P = .013). The foot-ground center of pressure was located more anteriorly with respect to the ankle joint center (ACLR, 5.8 ± 0.9 %height [%HT] uninjured, 5.4 ± 1.0 %HT P = .001). No differences were found for the sagittal plane hip, knee, and ankle angles. The ACLR limb experienced lower peak PFJ loads during running, explained by a small anterior shift in the foot-ground center of pressure during stance that offloaded the torque demand away from the ACLR knee. Lower net PFJ loading during running in the ACLR limb more than 12 months after ACLR suggests that underloading might play a role in the onset of PFJ osteoarthritis after ACLR.

Publication

Quadriceps volumes are reduced in people with patellofemoral joint osteoarthritis

Publisher: Elsevier BV

Date: 08-2012

DOI: 10.1016/J.JOCA.2012.04.009

Abstract: This study aimed to (1) compare the volumes of vastus medialis (VM), vastus lateralis (VL), vastus intermedius and rectus femoris and the ratio of VM/VL volumes between asymptomatic controls and patellofemoral joint osteoarthritis (PFJ OA) participants and (2) assess the relationships between cross-sectional area (CSA) and volumes of the VM and VL in in iduals with and without PFJ OA. Twenty-two participants with PFJ OA and 11 controls aged ≥ 40 years were recruited from the community and practitioner referrals. Muscle volumes of in idual quadriceps components were measured from thigh magnetic resonance (MR) images. The CSA of the VM and lateralis were measured at 10 equally distributed levels (femoral condyles to lesser femoral trochanter). PFJ OA in iduals had smaller normalized VM (mean difference 0.90 cm(3) · kg(-1), α = 0.011), VL (1.50 cm(3) · kg(-1), α = 0.012) and rectus femoris (0.71 cm(3) · kg(-1), α = 0.009) volumes than controls. No differences in the VM/VL ratio were observed. The CSA at the third level (controls) and fourth level (PFJ OA) above the femoral condyles best predicted VM volume, whereas the VL volume was best predicted by the CSA at the seventh level (controls) and sixth level (PFJ OA) above the femoral condyles. Reduced quadriceps muscle volume was a feature of PFJ OA. Muscle volume could be predicted from CSA measurements at specific levels in PFJ OA patients and controls.

Publication

Navicular stress fractures: outcomes of surgical and conservative management * Commentary

Publisher: BMJ

Date: 12-04-2006

DOI: 10.1136/BJSM.2005.022079

Publication

Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis

Publisher: Oxford University Press (OUP)

Date: 16-05-2003

DOI: 10.1093/RHEUMATOLOGY/KEG233

Publication

Health-Related Quality of Life After Anterior Cruciate Ligament Reconstruction

Publisher: SAGE Publications

Date: 06-12-2013

DOI: 10.1177/0363546513512774

Abstract: Anterior cruciate ligament reconstructions (ACLRs) are frequently performed on young, active patients and can result in persistent knee symptoms and activity limitations that may affect health-related quality of life (HRQoL). To date, there has been no systematic review of HRQoL outcomes after ACLR. The objectives of this study were to report HRQoL ≥5 years after ACLR, compare HRQoL outcomes with available population norms, and describe factors that may affect HRQoL in this population. Systematic review. All studies reporting HRQoL ≥5 years after ACLR with hamstring or patellar tendon autografts were eligible for review. Common HRQoL outcomes were pooled using a random-effects meta-analysis and compared with published population norms. The Spearman rank correlation coefficient (ρ) was used to identify variables associated with HRQoL outcomes. Where insufficient data were available, outcomes were reported descriptively. Fourteen studies were eligible for review, and HRQoL was reported for 2493 patients at a mean of 9 years (range, 5-16 years) after ACLR. Pooling of knee-related quality of life outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS]–QOL) found impairments after ACLR when compared with population norms. In comparison, studies using the Short Form–36 (SF-36) reported similar or better HRQoL compared with normative data. The KOOS-QOL subscores correlated strongly with KOOS-sport/recreation (ρ = .70, P = .04) and KOOS-pain (ρ = .85, P = .003) subscores. Severe radiographic osteoarthritis, meniscal injuries sustained after surgery, and revision ACLR were associated with poorer HRQoL outcomes at a minimum 5-year follow-up. The negative influence of concomitant meniscal surgery on HRQoL became apparent more than 10 years after ACLR. This review found that patients assessed using a knee-specific measure (KOOS-QOL) were more likely to report poorer HRQoL values, compared with population norms, than those assessed using a generic HRQoL measure (SF-36). Revision surgeries, meniscal injuries, and severe radiographic osteoarthritis were associated with poorer HRQoL outcomes after ACLR. However, these relationships should be interpreted with caution, as they were only investigated in a small number of studies. These results can be used by clinicians to educate patients about potential long-term outcomes after ACLR and to develop strategies for optimizing postoperative HRQoL.

Publication

Publisher: Wiley

Date: 28-01-2011

DOI: 10.1002/ACR.20341

Publication

Publisher: SAGE Publications

Date: 2014

DOI: 10.1177/0363546513514718

Publication

Patellofemoral osteoarthritis is prevalent and associated with worse symptoms and function after hamstring tendon autograft ACL reconstruction

Publisher: BMJ

Date: 27-11-2013

DOI: 10.1136/BJSPORTS-2013-092975

Abstract: To evaluate the compartmental distribution of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR), to determine if patellofemoral or tibiofemoral OA is more strongly associated with knee symptoms and function, and to evaluate the contribution of associated injuries and surgical delay to the development of OA. This cross-sectional study recruited 70 participants who underwent hamstring tendon (HT) ACLR 5-10 years previously. Radiographic OA was assessed according to the Osteoarthritis Research Society International (OARSI) criteria. Knee symptoms were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Anterior Knee Pain Scale (AKPS), while function was assessed with three lower limb tasks (hop-for-distance, one-leg rise and side-hop). Multivariate and binary logistic regression analyses were performed to assess the relationship between OA and symptomatic/functional outcomes and associated injuries/surgical delay, respectively. Radiographic OA was observed in the patellofemoral (47%) and tibiofemoral joints (31%). Pain, symptoms and quality of life on the KOOS and the AKPS were associated with severity of patellofemoral OA (standardised regression coefficient (β)=-0.3 to -0.5, p=0.001-0.042), whereas only the KOOS-pain subscale was associated with tibiofemoral OA (β=-0.3, p=0.037). For each functional task, greater patellofemoral OA severity was associated with worse performance, independent of tibiofemoral OA severity (β=-0.3 to -0.4, p=0.001-0.026). Medial meniscal and patellofemoral chondral lesions at surgery were associated with tibiofemoral and patellofemoral OA development at follow-up, respectively, while a longer surgery delay was associated with patellofemoral OA. Patellofemoral OA is common following HT ACLR and is associated with worse knee-related symptoms, including anterior knee pain, and decreased functional performance.

Publication

Fractures associated with ACL injury need to be taken seriously

Publisher: BMJ

Date: 24-03-2017

DOI: 10.1136/BJSPORTS-2017-097736

Publication

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Publisher: Elsevier BV

Date: 10-2017

DOI: 10.1016/J.JOCA.2017.06.005

Publication

Computer‐Aided Detection AI Reduces Interreader Variability in Grading Hip Abnormalities With MRI

Publisher: Wiley

Date: 15-04-2020

DOI: 10.1002/JMRI.27164

Publication

Publisher: Human Kinetics

Date: 2023

DOI: 10.1123/JSR.2022-0450

Publication

Publisher: BMJ

Date: 06-2018

DOI: 10.1136/BJSPORTS-2017-098695

Publication

Sagittal plane bending moments acting on the lower leg during running

Publisher: Elsevier BV

Date: 02-2010

DOI: 10.1016/J.GAITPOST.2009.10.009

Abstract: Sagittal bending moments acting on the lower leg during running may play a role in tibial stress fracture development. The purpose of this study was to evaluate these moments at nine equidistant points along the length of the lower leg (10% point-90% point) during running. Kinematic and ground reaction force data were collected for 20 male runners, who each performed 10 running trials. Inverse dynamics and musculoskeletal modelling techniques were used to estimate sagittal bending moments due to reaction forces and muscle contraction. The muscle moment was typically positive during stance, except at the most proximal location (10% point) on the lower leg. The reaction moment was predominantly negative throughout stance and greater in magnitude than the muscle moment. Hence, the net sagittal bending moment acting on the lower leg was principally negative (indicating tensile loads on the posterior tibia). Peak moments typically occurred around mid-stance, and were greater in magnitude at the distal, compared with proximal, lower leg. For ex le, the peak reaction moment at the most distal point was -9.61+ or - 2.07%Bw.Ht., and -2.73 + or - 1.18%Bw.Ht. at the most proximal point. These data suggest that tensile loads on the posterior tibia are likely to be higher toward the distal end of the bone. This finding may explain the higher incidence of stress fracture in the distal aspect of the tibia, observed by some authors. Stress fracture susceptibility will also be influenced by bone strength and this should also be accounted for in future studies.

Publication

Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis?

Publisher: Wiley

Date: 30-11-2009

DOI: 10.1002/ART.24872

Abstract: Patellar taping is a conservative treatment that may reduce patellar malalignment and pain in people with patellofemoral joint osteoarthritis (OA). This study aimed to compare patellar alignment in people with and without patellofemoral joint OA and to evaluate immediate effects of patellar taping on patellar alignment and pain in people with patellofemoral joint OA. Patellar malalignment was measured from magnetic resonance imaging (MRI 15 degrees knee flexion) in 28 in iduals (14 with patellofemoral joint OA and 14 asymptomatic, age-matched controls). In the patellofemoral joint OA group, MRI data were collected in 2 randomly allocated conditions (tape and no tape). Patellar alignment indices were measured from deidentified axial scans by 1 examiner. Pain during squatting was recorded in the 2 conditions (tape and no tape). People with patellofemoral joint OA exhibited greater lateral displacement and bisect offset compared with controls (P < 0.001). Lateral patellar tilt angle did not differ between groups. In the patellofemoral joint OA group, patellar tape resulted in a significant lessening of lateral alignment, with reduced lateral displacement (P = 0.028) and increased lateral patellar tilt angle (P < 0.001). Mean pain during squatting decreased with patellar tape by 15 mm on a 100-mm scale (P = 0.045). Patellar tape may reduce malalignment and pain associated with patellofemoral joint OA.

Publication

The effect of gait modification on the external knee adduction moment is reference frame dependent

Publisher: Elsevier BV

Date: 06-2008

DOI: 10.1016/J.CLINBIOMECH.2007.12.008

Abstract: This study investigated the extent to which reference frame convention affects the interpretation of how gait modification alters the external knee adduction moment. Data were collected from a single male able-bodied subject performing three gait tasks: normal, toe out and medial thrust. The net external moment vector at the knee was expressed in five alternative reference frames: the femur anatomical frame, the proximal tibia anatomical frame, the distal tibia anatomical frame, the laboratory frame and a non-orthogonal knee joint coordinate system. For each reference frame, the knee adduction moment was taken as the component about the frame's anteroposterior axis. Gait modification and selected reference frame both influenced the calculated knee adduction moment. Furthermore, these two effects were interactive, with the magnitude of the changes in the knee adduction moment produced by toe out and medial thrust gait being highly dependent on selected reference frame. Choice of reference frame for calculating the external knee adduction moment is therefore an important consideration for studies investigating the relative effectiveness of interventions such as gait modification.

Publication

Publisher: Wiley

Date: 30-06-2020

DOI: 10.1002/MSC.1490

Publication

Immediate effects of foot orthoses on lower limb biomechanics, pain, and confidence in individuals with patellofemoral osteoarthritis

Publisher: Elsevier BV

Date: 02-2020

DOI: 10.1016/J.GAITPOST.2019.10.019

Abstract: Foot orthoses are a recommended treatment for patellofemoral (PF) pain and a number of lower limb osteoarthritic (OA) conditions. However, their mechanism of effect is poorly understood. To compare the immediate effects of foot orthoses and flat inserts on lower limb biomechanics, knee pain and confidence in in iduals with PFOA. Twenty-one participants (14 females mean ± SD age 58 ± 8 years) with PFOA underwent three-dimensional motion analysis during level-walking, stair ascent, and stair descent under three footwear conditions: (i) their own shoes (ii) prefabricated foot orthoses and (iii) flat shoe inserts. Participants reported their average levels of knee pain and confidence after each task. Data were analysed with repeated-measures analysis of variance (ANOVA), effect sizes (partial eta squared), and Bonferroni post-hoc tests. During level-walking, there was a significant main effect of foot orthoses on peak ankle dorsiflexion angle (F Prefabricated foot orthoses altered sagittal plane biomechanics of the ankle during level-walking and stair descent in in iduals with PFOA. Further research is required to determine whether these changes are clinically beneficial.

Publication

Risk factors for knee osteoarthritis after knee trauma: A systematic review of randomized controlled trials and cohort studies

Publisher: Center for Open Science

Date: 19-01-2023

DOI: 10.31219/OSF.IO/2ZEAS

Abstract: Objective To identify and quantify potential risk factors for osteoarthritis (OA) following traumatic knee injury.Design Systematic review and meta-analyses that estimated the odds of OA for in idual risk factors assessed in more than four studies using random-effects models. Remaining risk factors underwent semiquantitative synthesis. The modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for prognostic factors guided the assessment.Data sources MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to 2009–2021.Eligibility Randomised controlled trials and cohort studies assessing risk factors for symptomatic or structural OA in persons with a traumatic knee injury, mean injury age ≤30 years and minimum 2-year follow-up.Results Across 66 included studies, 81 unique potential risk factors were identified. High risk of bias due to attrition or confounding was present in 64% and 49% of studies, respectively. Ten risk factors for structural OA underwent meta-analysis (sex, rehabilitation for anterior cruciate ligament (ACL) tear, ACL reconstruction (ACLR), ACLR age, ACLR body mass index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low certainty evidence suggests increased odds of structural OA related to ACLR+cartilage injury (OR=2.31 95% CI 1.35 to 3.94), ACLR+partial meniscectomy (OR=1.87 1.45 to 2.42) and ACLR+total medial meniscectomy (OR=3.14 2.20 to 4.48). Semiquantitative syntheses identified moderate-certainty evidence that cruciate ligament, collateral ligament, meniscal, chondral, patellar/tibiofemoral dislocation, fracture and multistructure injuries increase the odds of symptomatic OA.Conclusion Moderate-certainty evidence suggests that various single and multistructure knee injuries (beyond ACL tears) increase the odds of symptomatic OA. Risk factor heterogeneity, high risk of bias, and inconsistency in risk factors and OA definition make identifying treatment targets for preventing post-traumatic knee OA challenging.

Publication

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pa

Publisher: BMJ

Date: 20-06-2018

DOI: 10.1136/BJSPORTS-2018-099397

Abstract: Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network ( www.ipfrn.org ) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.

Publication

Sport and exercise medicine/physiotherapy publishing has a gender/sex equity problem: we need action now!

Publisher: BMJ

Publisher: Wiley

Date: 03-2019

DOI: 10.1002/JOR.24237

Publication

Publisher: Elsevier BV

Date: 2018

DOI: 10.1016/J.JPHYS.2017.10.004

Publication

The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome

Publisher: BMJ

Date: 20-07-2010

DOI: 10.1136/BJSM.2009.069203

Abstract: Patellofemoral pain syndrome (PFPS) often results in reduced functional performance. There is growing evidence for the use of foot orthoses to treat this multifactorial condition. In this study, the immediate effects of foot orthoses on functional performance and the association of foot posture and footwear with improvements in function were evaluated. Fifty-two in iduals with PFPS (18-35 years) were prescribed prefabricated foot orthoses (Vasyli Pro Vasyli International, Labrador, Australia). Functional outcome measures evaluated included the change in (1) pain and (2) ease of a single-leg squat on a five-point Likert scale, and change in the number of (3) pain-free step downs and (4) single-leg rises from sitting. The association of foot posture using the Foot Posture Index, navicular drop and calcaneal angle relative to subtalar joint neutral and the footwear motion control properties scale score with improved function were evaluated using Spearman's ρ statistics. Prefabricated foot orthoses produced significant improvements (p<0.05) for all functional outcome measures. A more pronated foot type and poorer footwear motion control properties were found to be associated with reduced pain during the single-leg squat and improvements in the number of pain-free single-leg rises from sitting when wearing foot orthoses. In addition, a more pronated foot type was also found to be associated with improved ease of completing a single-leg squat when wearing foot orthoses. Prefabricated foot orthoses provide immediate improvements in functional performance, and these improvements are associated with a more pronated foot type and poorer footwear motion control properties.

Publication

Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence

Publisher: BMJ

Date: 13-01-2015

DOI: 10.1136/BJSPORTS-2014-094224

Abstract: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults. A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO. Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were identified. Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 were the most thoroughly investigated PROs and studies including these PROs reported key aspects of the COSMIN checklist. HAGOS and IHOT-12 were based on studies with the least ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present. HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip arthroscopy. At present, HAGOS is the only PRO also aimed for young-aged to middle-aged adults presenting with groin pain and is recommended for use in this population. CRD42014009995.

Publication

Sharing decision-making between patient and clinician: the next step in evidence-based practice for patellofemoral pain?: Table 1

Publisher: BMJ

Date: 11-03-2016

DOI: 10.1136/BJSPORTS-2015-095607

Publication

Publisher: Wiley

Date: 30-12-2009

DOI: 10.1002/ART.24089

Abstract: Musculoskeletal conditions of the knee involve changes in sensorimotor function, but it is unclear whether these changes are a cause or result of pain. Induction of experimental pain may help solve this issue. Although this is commonly achieved by injection of hypertonic saline into muscle, muscle is commonly not the source of pain. This study investigated whether pain induced by injection of saline into the infrapatellar fat pad changes motor control of the quadriceps muscles of the knee. Ten participants performed a standardized task involving ascending and descending a series of steps. Electromyographic activity (EMG) of vastus medialis obliquus (VMO) and vastus lateralis (VL) was recorded with surface electrodes. Trials were conducted without pain, with anterior knee pain induced by injection (0.25 ml) of hypertonic saline (5%) into the infrapatellar fat pad, with anticipation of pain associated with unpredictable electrical shocks to the knee, and 20 minutes after pain cessation. EMG onset and litude were analyzed. When participants ascended the steps with pain, the onset of VMO EMG was delayed relative to that of VL, in contrast to simultaneous or earlier activation of VMO EMG in the pre- and postpain trials. VL EMG litude was decreased significantly from the control condition. These data show that alterations in coordination of knee muscle activity can be caused by pain, even when it is of nonmuscle origin. Treatment of pain is therefore important to facilitate performance of the quadriceps muscles, which are essential for locomotor and functional tasks as well as for knee stability.

Publication

Are Knee Biomechanics Different in Those With and Without Patellofemoral Osteoarthritis After Anterior Cruciate Ligament Reconstruction?

Publisher: Wiley

Date: 25-09-2014

DOI: 10.1002/ACR.22313

Abstract: Patellofemoral (PF) osteoarthritis (OA) is prevalent following anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate differences in transverse plane rotation between knees with varus and valgus alignment during gait in people with and without PFOA after ACLR. Thirty-six in iduals who were mean ± SD 9 ± 2 years post-ACLR (18 radiographic PFOA and 18 no knee OA) participated in this cross-sectional study. Knee internal-external rotation angles were measured using a 3-dimensional motion analysis system during walking and running. Weight-bearing frontal plane knee alignment, measured with an inclinometer, was used to classify participants as having varus or valgus alignment. Two-way analysis of covariance was used to assess the effect of both PFOA and frontal plane knee alignment on dynamic knee internal-external rotation. Significant interactions were found between PFOA status and frontal plane alignment on knee internal-external rotation angles during walking (P = 0.019) and running (P = 0.002). Tests of simple effects revealed that during walking, in iduals with valgus alignment and PFOA demonstrated a mean 3.9° (95% confidence interval [95% CI] 0.7, 7.1) less knee internal rotation than those with valgus alignment and no OA. During running this difference increased to 6.1° (95% CI 1.8, 10.4). For in iduals with varus alignment, no significant effects were observed. Less knee internal rotation during gait was found in in iduals with PFOA and valgus alignment. A rotational shift of this magnitude may be sufficient to initiate or accelerate patellofemoral cartilage degeneration. Prospective studies are required to determine if these altered kinematic patterns result from, or contribute to, PFOA development after reconstruction.

Publication

Outcome measures in patellofemoral pain syndrome: test retest reliability and inter-relationships

Publisher: Elsevier BV

Date: 05-2000

DOI: 10.1054/PTSP.2000.0009

Publication

A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation

Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)

Date: 11-2015

DOI: 10.2519/JOSPT.2015.5885

Abstract: Synopsis Achilles tendinopathy is a common overuse injury in athletes involved in running and jumping activities and sports. The intervention with the highest level of evidence is exercise therapy, and it is recommended that all patients initially be treated with exercise for at least 3 months prior to considering other treatment options. Recovery from Achilles tendinopathy can take up to a year, and there is a high propensity for recurrence, especially during the return-to-sport phase. The extent of the tendon injury, the age and sex of the athlete, the magnitude of pain/symptoms, the extent of impairments, and the demands of the sport all need to be considered when planning for return to sport. This clinical commentary describes an approach to return to sport for patients with midportion Achilles tendinopathy. The aim of the return-to-sport program is to facilitate the decision-making process in returning an athlete with midportion Achilles tendinopathy back to full sport participation and to minimize the chances for recurrence of the injury. J Orthop Sports Phys Ther 2015 (11):876-886. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5885.

Publication

Date: 07-2010

DOI: 10.1177/0363546510370197

Abstract: Hamstring strains remain one of the most prevalent injuries in Australian Rules football. The authors prospectively examined the relationship between musculotendinous stiffness of the hamstring and leg stiffness with hamstring injury in professional Australian Rules footballers during the 2006 season. Higher hamstring stiffness and leg stiffness are related to noncontact, soft tissue hamstring injury risk in professional Australian Rules footballers. Case-control study Level of evidence, 3. Unilateral hamstring stiffness and leg stiffness were assessed in 136 professional footballers in the month before the commencement of the competitive season. This information was then investigated relative to players who suffered noncontact, soft tissue hamstring injuries during either matches or training throughout the season to identify whether preseason stiffness was related to injury occurrence. Fourteen tested players recorded acute, noncontact hamstring injuries, resulting in 3.3 ± 2.8 weeks of missed match play per injury. At preseason testing, the players who ended up sustaining a hamstring injury during the season recorded significantly higher mean hamstring stiffness (11%, P = .04) and leg stiffness (5%, P = .03). When considering the injured players, the leg stiffness of the involved limb was significantly higher than the noninjured players (P = .02), whereas hamstring stiffness was significantly higher on the noninvolved limb (P = .01). Further, those players who suffered a hamstring injury were significantly older than the noninjured players (P = .01). It appears that a high bilateral hamstring stiffness and leg stiffness may be a determinant in the risk of sustaining a hamstring injury. Further, relatively lower hamstring stiffness in the involved limb of injured players appears to be associated with increased injury and may be related to a lack of strength. The information from stiffness assessment may allow medical staff to determine the hamstring risk status for in idual players in team sports.

Publication

Adults with patellofemoral pain do not exhibit manifestations of peripheral and central sensitization when compared to healthy pain-free age and sex matched controls – An assessor blinded cross-sectional study

Publisher: Public Library of Science (PLoS)

Date: 08-12-2017

DOI: 10.1371/JOURNAL.PONE.0188930

Publication

Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis

Publisher: BMJ

Date: 26-11-2015

DOI: 10.1136/BJSPORTS-2015-095255

Abstract: To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA). A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term 4-12 months=medium term and >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores. 19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control. Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger high-quality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term.

Publication

Publisher: Elsevier BV

Date: 03-2021

DOI: 10.1016/J.JOCA.2020.12.013

Publication

Is there an alternative to the full‐leg radiograph for determining knee joint alignment in osteoarthritis?

Publisher: Wiley

Date: 31-03-2006

DOI: 10.1002/ART.21836

Abstract: To assess the concurrent validity of alternative measures of frontal plane knee alignment, namely the radiographic anatomic axis and 5 clinical measures, in medial compartment knee osteoarthritis (OA) as compared with the mechanical axis on radiograph. Forty in iduals (mean +/- SD age 64.7 +/- 9.4 years) with symptomatic medial knee OA participated. Knee alignment was measured according to the following methods: lower-limb mechanical axis on radiograph, lower-limb anatomic axis on radiograph, visual observation, distance between medial knee joint lines or medial malleoli using a caliper, distance between a plumb line and medial knee joint line or malleolus using a caliper, tibial alignment using a gravity inclinometer, and lower-limb alignment using a goniometer. Data were analyzed using Pearson's correlation coefficient or Spearman's rho correlation coefficient and simple linear regression. The anatomic axis best correlated with the mechanical axis (r = 0.88), followed closely by the inclinometer method (r = 0.80). Other clinical measures of alignment that were significantly associated with the mechanical axis were the caliper method, the plumb-line method, and visual observation (r = 0.76, 0.71, and -0.52, respectively). However, the goniometer method failed to correlate. The anatomic axis on radiograph and the inclinometer method appear to be valid alternatives to the mechanical axis on full-leg radiograph for determining frontal plane knee alignment in medial knee OA. These alternative methods of measuring knee alignment may increase the assessment of this parameter by clinicians and researchers alike, given that malalignment is an important indicator of disease progression and treatment outcome.

Publication

Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment

Publisher: Elsevier BV

Date: 08-2010

DOI: 10.1016/J.JBIOMECH.2010.03.040

Publication

Psychometric Properties of Patient-Reported Outcome Measures for Hip Arthroscopic Surgery

Publisher: SAGE Publications

Date: 08-07-2013

DOI: 10.1177/0363546513494173

Abstract: Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown. To evaluate the reliability, validity, responsiveness, and interpretability of 5 PROs (Copenhagen Hip and Groin Outcome Score [HAGOS], Hip Disability and Osteoarthritis Outcome Score [HOOS], Hip Outcome Score [HOS], International Hip Outcome Tool [iHOT-33], and Modified Harris Hip Score [MHHS]) in a population undergoing hip arthroscopic surgery and also to provide a recommendation of the best PROs in patients undergoing hip arthroscopic surgery. Cohort study (diagnosis) Level of evidence, 2. Study participants were adults (mean age, 37 ± 11 years) who had undergone hip arthroscopic surgery 12 to 24 months previously and pain-free, healthy age-matched controls (mean age, 35 ± 11 years). Baseline characteristics including age, height, weight, waist girth, physical activity, and occupation were collected for both groups. The hip arthroscopic surgery group completed the 5 PRO questionnaires on 3 occasions, while the healthy control group completed the PRO questionnaires on 1 occasion. The reliability (test-retest reliability [intraclass correlation coefficient, or ICC] and minimal detectable change [MDC]), validity (construct validity, ability to detect a difference between groups, acceptability including floor and ceiling effects), responsiveness, and interpretability (minimal important change [MIC]) of each measure were calculated. The test-retest reliability of PROs was excellent (ICC, 0.91-0.97), with an MDC of %. The HOOS, HAGOS, and iHOT-33 had acceptable content validity. All PROs demonstrated construct validity and were able to detect a difference between the hip arthroscopic surgery and control groups. No measures demonstrated a floor effect however, the MHHS and subscales relating to activities of daily living of the HOOS, HOS, and HAGOS demonstrated a ceiling effect. The HOOS, iHOT-33, and MHHS demonstrated adequate responsiveness, and the MIC for all measures was points of a possible 100 points. The PROs of the HOOS and iHOT-33 demonstrate psychometric properties that may enable researchers and clinicians to use them with confidence in a population undergoing hip arthroscopic surgery. The psychometric properties of the MHHS, HOS, and some subscales of the HAGOS are reduced, and these PROs may be less valuable in this group.

Publication

Publisher: BMJ

Date: 08-2007

DOI: 10.1136/BJSM.2007.037804

Publication

What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis

Publisher: Springer Science and Business Media LLC

Date: 10-04-2019

DOI: 10.1007/S40279-019-01092-Y

Abstract: In athletes, hip and groin pain is considered to be associated with hip intra-articular pathologies and hip osteoarthritis (OA). A greater understanding of the relationship between hip and groin pain and imaging findings is required. Our objective was to undertake a systematic review and meta-analysis to determine the prevalence of hip intra-articular pathologies and hip OA in athletes with and without hip and groin pain. Seven electronic databases were searched on 29 January 2018 for studies investigating the prevalence of hip intra-articular pathologies and hip OA using X-ray, magnetic resonance imaging, magnetic resonance arthrography or computed tomography. The search, study selection, quality appraisal and data extraction were performed by two independent reviewers. When studies were considered homogenous, meta-analysis was undertaken. A strength of evidence was given to pooled results. Twenty studies reporting on the prevalence of hip intra-articular pathologies and hip OA in athletes were identified. Included studies were considered moderate to high risk of bias, with only three studies adjudged as low risk of bias. In asymptomatic athletes, limited evidence identified a labral tear prevalence of 54% per person and moderate evidence of 33% per hip. In symptomatic athletes, moderate evidence of a labral tear prevalence of 20% per hip was found. Moderate evidence of a cartilage defect prevalence of 10% per person was reported in asymptomatic athletes. In symptomatic athletes, cartilage defect prevalence was 7-40%. In asymptomatic athletes, the prevalence of hip OA was 0-17%, compared with 2% in symptomatic athletes. The prevalence of hip intra-articular pathologies and hip OA in symptomatic and asymptomatic athletes is variable. Labral tears and cartilage defects appear to be seen often in athletes with and without pain. Hip OA is rarely seen in athletes either with or without hip and groin pain. PROSPERO registration CRD42017082457.

Publication

Publisher: BMJ

Date: 25-02-2014

DOI: 10.1136/BJSPORTS-2014-093450

Publication

Lower-limb joint mechanics during maximum acceleration sprinting

Publisher: The Company of Biologists

Date: 2019

DOI: 10.1242/JEB.209460

Abstract: We explored how humans adjust the stance phase mechanical function of their major lower-limb joints (hip, knee, ankle) during maximum acceleration sprinting. Experimental data (motion capture and ground reaction force (GRF)) were recorded from eight participants as they performed overground sprinting trials. Six alternative starting locations were used to obtain a dataset that incorporated the majority of the acceleration phase. Experimental data were combined with an inverse-dynamics-based analysis to calculate lower-limb joint mechanical variables. As forward acceleration magnitude decreased, the vertical GRF impulse remained nearly unchanged whereas the net horizontal GRF impulse became smaller due to less propulsion and more braking. Mechanical function was adjusted at all three joints, although more dramatic changes were observed at the hip and ankle. The impulse from the ankle plantar-flexor moment was almost always larger than those from the hip and knee extensor moments. Forward acceleration magnitude was linearly related to the impulses from the hip extensor moment (R2=0.45) and the ankle plantar-flexor moment (R2=0.47). Forward acceleration magnitude was also linearly related to the net work done at all three joints, with the ankle displaying the strongest relationship (R2=0.64). The ankle produced the largest amount of positive work (1.55±0.17 J/kg) of all the joints, and provided a significantly greater proportion of the summed amount of lower-limb positive work as running speed increased and forward acceleration magnitude decreased. We conclude that the hip and especially the ankle represent key sources of positive work during the stance phase of maximum acceleration sprinting.

Publication

Hip flexibility and strength measures

Publisher: BMJ

Date: 11-03-2009

DOI: 10.1136/BJSM.2008.055749

Abstract: Groin pain commonly affects football players and can be associated with prolonged recovery periods. Understanding the relationship between groin pain and reliable measures of hip flexibility and strength may facilitate the development of optimal rehabilitation and prevention strategies. In this study, the reliability and association with athletic groin pain of hip flexibility and strength measures were investigated. A cohort of 29 football players (15-21 years) participating in junior elite competitions (Australian Rules football and soccer) were recruited. The intra-rater reliability (n=13) and inter-rater reliability (n=12) of various hip flexibility (bent knee fall out test, hip internal rotation, hip external rotation) and strength (hip abduction, hip internal rotation, hip external rotation, hip adduction (squeeze test)) measures were investigated using intraclass correlation coefficients (ICC). Reliable hip flexibility and strength measures were compared between football players with (n=10) and without (n=19) groin pain. The bent knee fall out test, hip internal rotation flexibility and the squeeze test demonstrated acceptable (ICC>0.75) intra-rater and inter-rater reliability, while hip external rotation flexibility and hip abduction strength demonstrated acceptable intra-rater but not inter-rater reliability. Hip internal and external rotation strength tests were not found to be reliable. Football players with groin pain had significantly reduced force production on the squeeze test (p>0.05). Several hip flexibility and strength measures were found to be reliable. Only the squeeze test discriminated between football players with and without groin pain.

Publication

Priorities for the effective implementation of osteoarthritis management programs: an OARSI international consensus exercise

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.JOCA.2019.05.015

Abstract: The Joint Effort Initiative was endorsed by Osteoarthritis Research Society International (OARSI) in 2018 as a collaboration between international researchers and clinicians with an interest in the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify and prioritise activities for future work of the Joint Effort Initiative. A survey was emailed to delegates of the 2018 OARSI World Congress attending a pre-conference workshop or with a known interest in OAMPs (n = 115). Delegates were asked about the most important issues regarding OAMP implementation. The top 20 issues were synthesised into 17 action statements, and respondents were invited to participate in a priority ranking exercise to determine the order of importance of the statements. Survey respondents (n = 51, 44%) were most commonly female (71%), with an allied health background (57%), affiliated with universities (73%) from Oceania (37%), and Europe/UK (45%). The five highest ranked action statements were: CONCLUSION: Prioritising statements will bring focus to the future work of the Joint Effort Initiative in the future and provide a basis for longer-term actions.

Publication

It is time for consensus on ‘consensus statements’

Publisher: BMJ

Date: 23-09-2021

DOI: 10.1136/BJSPORTS-2021-104578

Publication

A single-blinded, randomized, parallel group superiority trial investigating the effects of footwear and custom foot orthoses versus footwear alone in individuals with patellofemoral joint osteoarthri

Publisher: Springer Science and Business Media LLC

Date: 26-04-2017

DOI: 10.1186/S13047-017-0200-Y

Publication

Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

Publisher: BMJ

Date: 28-09-2022

DOI: 10.1136/BJSPORTS-2022-105626

Abstract: Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2–14 years post-ACL injury. Pooled PCS scores were worse years (50.8 (48.7 to 52.9)) compared with 2–5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (−1.5 (−2.9 to –0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some in iduals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.

Publication

Publisher: BMJ

Date: 07-10-2021

DOI: 10.1136/BJSPORTS-2020-103081

Publication

Altered hip muscle forces during gait in people with patellofemoral osteoarthritis

Publisher: Elsevier BV

Date: 11-2012

DOI: 10.1016/J.JOCA.2012.07.011

Abstract: The study aimed to (1) assess whether higher vasti (VASTI), gluteus medius (GMED), gluteus maximus (GMAX) and gluteus minimus (GMIN) forces are associated with participant characteristics (lower age, male gender) and clinical characteristics (lower radiographic disease severity, lower symptom severity and higher walking speed) and (2) determine whether hip and knee muscle forces are lower in people with patellofemoral joint (PFJ) osteoarthritis (OA) compared to those without PFJ OA. Sixty participants with PFJ OA and 18 (asymptomatic, no radiographic OA) controls ≥40 years were recruited from the community or via referrals. A three-dimensional musculoskeletal model was used in conjunction with optimisation theory to calculate lower-limb muscle forces during walking. Associations of peak muscle forces with participant and clinical characteristics were conducted using Pearson's r or independent t-tests and between-group comparisons of mean peak muscle forces performed with walking speed as a covariate. Peak muscle forces were not significantly associated with participant, symptomatic or radiographic-specific characteristics. Faster walking speed was associated with higher VASTI muscle force in the PFJ OA (r = 0.495 P < 0.001) and control groups (r = 0.727 P = 0.001) and higher GMAX muscle force (r = 0.593 P = 0.009) in the control group only. In iduals with PFJ OA (N = 60) walked with lower GMED and GMIN muscle forces than controls (N = 18): GMED, mean difference 0.15 [95% confidence interval (CI): 0.01 to 0.29] body weight (BW) GMIN, 0.03 [0.01 to 0.06] BW. No between-group differences were observed in VASTI or GMAX muscle force: VASTI, 0.10 [-0.11 to 0.31] BW GMAX, 0.01 [-0.11 to 0.09] BW. In iduals with PFJ OA ambulate with lower peak hip abductor muscle forces than their healthy counterparts.

Publication

Exercise-therapy and education for individuals one year after anterior cruciate ligament reconstruction: a pilot randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 11-01-2021

DOI: 10.1186/S12891-020-03919-6

Abstract: Guided rehabilitation beyond 6-months is rare following anterior cruciate ligament reconstruction (ACLR), despite high prevalence of unacceptable symptoms and quality of life (QoL). Our primary aim was to determine the feasibility of a randomised controlled trial (RCT) evaluating a physiotherapist-guided intervention for in iduals 1-year post-ACLR with persistent symptoms. Our secondary aim was to determine if a worthwhile treatment effect could be observed for the lower-limb focussed intervention (compared to the trunk-focussed intervention), for improvement in knee-related QoL, symptoms, and function. Participant- and assessor-blinded, pilot feasibility RCT. Participant eligibility criteria: i) 12–15 months post-ACLR ii) 87.5/100 on the Knee injury and Osteoarthritis Outcome Score (KOOS) QoL subscale and either a one-leg rise test 22 repetitions, single-hop 90% limb symmetry or Anterior Knee Pain Scale 87/100. Participants were randomised to lower-limb or trunk-focussed focussed exercise and education. Both interventions involved 8 face-to-face physiotherapy sessions over 16-weeks. Feasibility was assessed by eligibility rate ( 1 in 3 screened), recruitment rate ( 4 participants/month), retention ( 20% drop-out), physiotherapy attendance and unsupervised exercise adherence ( 80%). Between-group differences for knee-related QoL (KOOS-QoL, ACL-QoL), symptoms (KOOS-Pain, KOOS-Symptoms), and function (KOOS-Sport, functional performance tests) were used to verify that the worthwhile effect (greater than the minimal detectable change for each measure) was contained within the 95% confidence interval. 47% of those screened were eligible, and 27 participants (3 participants/month 48% men, 34±12 years) were randomised. Two did not commence treatment, and two were lost to follow-up (16% drop-out). Physiotherapy attendance was 80% for both groups but reported adherence to unsupervised exercise was low ( 55%). Both interventions had potentially worthwhile effects for KOOS-QoL and ACL-QoL, while the lower-limb focussed intervention had potentially greater effects for KOOS-Sport, KOOS-Pain, and functional performance. A larger-scale RCT is warranted. All feasibility criteria were met, or reasonable recommendations could be made to achieve the criteria in future trials. Strategies to increase recruitment rate and exercise adherence are required. The potential worthwhile effects for knee-related QoL, symptoms, and function indicates a fully-powered RCT may detect a clinically meaningful effect. Prospectively registered ( ACTRN12616000564459 ).

Publication

See, hear and empower women: it is time to ‘walk the walk’ to eliminate manels in sport and exercise medicine/physiotherapy

Publisher: BMJ

Date: 14-12-2022

DOI: 10.1136/BJSPORTS-2022-106030

Publication

Poor knee function after ACL reconstruction is associated with attenuated landing force and knee flexion moment during running

Publisher: Springer Science and Business Media LLC

Date: 28-02-2023

DOI: 10.1007/S00167-017-4810-5

Abstract: Poor knee function after anterior cruciate ligament reconstruction (ACLR) may increase the risk of future knee symptoms and knee osteoarthritis via abnormal knee joint loading patterns, particularly during high-impact activity. This study aimed to assess the relationship between poor self-reported or clinically measured knee function and knee moments/vertical ground reaction force (vGRF) in in iduals following ACLR. 61 participants (mean 16.5 ± 3 months following ACLR, 23 women) completed a patient-reported knee function questionnaire and three hop tests (% of uninvolved limb). Participants were ided into satisfactory and poor knee function groups (poor < 85% patient-reported knee function and/or < 85% hop test symmetry). The knee biomechanics of both groups were assessed with three-dimensional motion analysis during the stance phase of overland running at self-selected speeds, and the association between knee function and knee moments was assessed using analysis of covariance with running speed as a covariate. Participants with poor knee function (n = 30) ran with significantly smaller peak knee flexion moments (moderate effect size 0.7, p = 0.03) and significantly smaller peak vGRFs (large effect size 1.0, p = 0.002) compared to those with satisfactory knee function (n = 31). No significant differences were observed for knee adduction and knee external rotation moments or knee kinematics. In iduals following ACLR with poor self-reported knee function and/or hop test performance demonstrate knee moments during running that may be associated with lower knee joint contact forces. These findings provide greater understanding of the relationship between knee biomechanics during running and clinical assessments of knee function. III. Cross-sectional study.

Publication

Publisher: BMJ

Date: 06-2005

DOI: 10.1136/ARD.2004.026526

Publication

People with patellofemoral pain have impaired functional performance, that is correlated to hip muscle capacity

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/J.PTSP.2019.08.010

Abstract: To (i) compare objective function in a range of tasks between people with and without patellofemoral pain (PFP) and (ii) evaluate the relationship of objective function with hip muscle capacity and self-reported function in people with PFP. Cross-sectional. Laboratory. Thirty-two physically active people (16 with PFP and 16 controls). Functional assessments included stair climbing (time), single-legged chair stand (repetitions), step down (repetitions), forward hop for distance and side hop (repetitions). Hip abductor and extensor capacity assessments included power, endurance, isometric and dynamic strength. Self-reported function included the Kujala scale and Patellofemoral sub-scale of the Knee injury and Osteoarthritis Outcome Score (KOOS-PF). The PFP group was 15% slower climbing stairs (effect size [ES] = 0.90), performed 12% fewer chair stands (ES = 0.62) and forward hopped 20% shorter (ES = 0.79) compared to controls. Lower hip muscle strength and power correlated with lower objective function (r = 0.52-0.78). Lower Kujala scores correlated with longer stair climbing time (r = -0.53). People with PFP have objective functional impairments, that are associated with reduced hip muscle capacity, indicating progressive resistance training may be beneficial. Absence of a strong correlation between self-reported, and objective, function indicates assessment of both when treating people with PFP is warranted.

Publication

HAPPi Kneecaps! Protocol for a participant- And assessor-blinded, randomised, parallel group feasibility trial of foot orthoses for adolescents with patellofemoral pain

Publisher: Springer Science and Business Media LLC

Date: 02-08-2020

DOI: 10.1186/S13047-020-00417-9

Abstract: Patellofemoral pain (PFP) is a common cause of knee pain in adolescents, but there are limited evidence-based treatment options for this population. Foot orthoses can improve pain and function in adults with PFP, and may be effective for adolescents. The primary aim of this study is to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating the effects of contoured foot orthoses on knee pain severity and patient-perceived global change, compared to flat shoe insoles, in adolescents with PFP. The secondary aim is to provide an estimate of treatment effects for foot orthoses, compared to flat insoles, in adolescents with PFP. This randomised, controlled, participant- and assessor-blinded, feasibility trial has two parallel groups. Forty adolescents (aged 12–18 years) with clinical symptoms of PFP will be recruited from Queensland, Australia. Participants will be randomised to receive either prefabricated contoured foot orthoses or flat shoe insoles. Both interventions will be fit by a physiotherapist, and worn for 3 months. Feasibility will be evaluated through assessing willingness of volunteers to enrol, number of eligible participants, recruitment rate, adherence with the study protocol, adverse effects, success of blinding, and drop-out rate. Secondary outcomes will evaluate knee-related pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions, at 6 weeks and 3 months. Primary outcomes will be reported descriptively, while estimates of standard deviation and between-group differences (with 95% confidence intervals) will be reported for secondary outcomes. Findings of this study will inform the feasibility of a full-scale RCT investigating the efficacy of contoured foot orthoses in adolescents with PFP. This full-scale study is necessary to improve the evidence base for management of adolescent PFP, and enhance outcomes for this population. ACTRN12619000957190 .

Publication

Single‐Leg Squat Performance is Impaired 1 to 2 Years After Hip Arthroscopy

Publisher: Wiley

Date: 27-07-2015

DOI: 10.1016/J.PMRJ.2015.07.004

Abstract: To evaluate single-leg squat performance 1-2 years after arthroscopy for intra-articular hip pathology compared with control subjects and the nonsurgical limb, and to investigate whether single-leg squat performance on the operated limb was associated with hip muscle strength. Cross-sectional study. Private physiotherapy clinic and university laboratory. Thirty-four participants (17 women, 36.7 ± 12.6 years) 1-2 years after hip arthroscopy and 34 gender-matched control subjects (17 women, 33.1 ± 11.9 years). Participants performed single-leg squats using a standardized testing procedure. Squat performance was captured using video. Video footage was uploaded and reformatted for analyses. Hip muscle strength was measured with handheld dynamometry using reliable methods. Frontal plane pelvic obliquity, hip adduction, and knee valgus were measured. Repeated measures analysis of variance evaluated between-group differences, with limb as a within-subjects factor (surgical versus nonsurgical) and gender as a between-subjects factor (P .05). One to 2 years after hip arthroscopy, deficits in single-leg squat performance exist that have the potential to increase hip joint impingement and perpetuate postoperative symptoms. Rehabilitation after hip arthroscopy should target retraining in functional single-leg positions.

Publication

Foot Orthoses and Footwear for the Management of Patellofemoral Osteoarthritis: A Pilot Randomized Trial

Publisher: Wiley

Date: 02-2021

DOI: 10.1002/ACR.24098

Abstract: To determine the feasibility of a full-scale randomized controlled trial (RCT) comparing foot orthoses and footwear to footwear alone in in iduals with patellofemoral (PF) osteoarthritis (OA). This 4-month, parallel, 2-arm pilot trial took place in Brisbane, Queensland and Hobart, Tasmania (August 2014 to October 2016). Forty-six in iduals with PF OA were randomized by concealed allocation to foot orthoses plus prescribed footwear (n = 24) or prescribed footwear alone (n = 22). Study feasibility was the primary outcome (e.g., recruitment rate, adherence, adverse events, dropout rate). Secondary outcomes included patient-reported outcome measures of pain, function, and quality of life. Effect sizes with 95% confidence intervals were calculated at the 4-month primary end point (standardized mean differences for between-group effects standardized response mean for within-group effects). From 782 volunteers, 47 were eligible (6%), and 46 participated. One participant withdrew (2%), and 1 (2%) was lost to follow-up. Intervention adherence was high for both groups (9-10 hours of wear per day). No serious adverse events were reported. More than 80% of questionnaires were completed at 4 months. Between-group effect sizes for patient-reported outcome measures were typically small, while moderate-to-large within-group response effects were observed in both groups. A full-scale RCT for PF OA is feasible with modifications to eligibility criteria. However, our observed small between-group effect sizes, combined with moderate-to-large within-group responses for both interventions, indicate that a full-scale trial is unlikely to find clinically meaningful differences. Secondary outcomes suggest that both interventions can be recommended for in iduals with PF OA.

Publication

Publisher: Elsevier BV

Date: 2021

DOI: 10.1016/J.KNEE.2020.10.009

Publication

Clinically measured hip muscle capacity deficits in people with patellofemoral pain

Publisher: Elsevier BV

Date: 2019

DOI: 10.1016/J.PTSP.2018.11.003

Abstract: To evaluate differences in clinical measures of hip abductor and extensor capacity (strength, endurance and power) in people with patellofemoral pain (PFP) compared to asymptomatic controls. Cross-sectional. Laboratory. Thirty-two physically active people (16 with PFP and 16 controls). Strength was evaluated isometrically using a hand-held dynamometer and dynamically using 10 repetitions maximum (10RM) tests. Power was assessed using a linear position transducer. Endurance was assessed using maximum number of repetitions. The PFP group had significant deficits compared to the control group in isometric strength (21-25%) for hip abduction (ES = 0.98) and extension (ES = 0.85) in 10RM (15-18%) for hip abduction (ES = 0.72) and extension (ES = 0.85) and in power (24-31%) for hip abduction (ES = 0.80), and extension (ES = 0.94). No difference was identified for hip abduction and extension in endurance tests. Clinical assessments can identify deficits in isometric and dynamic hip strength, as well as power in people with PFP. Hip muscle capacity deficits in people with PFP including strength and power highlight a potential need for more progressive resistance training in this population.

Publication

A phase II trial for the efficacy of physiotherapy intervention for early-onset hip osteoarthritis: study protocol for a randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 27-01-2015

DOI: 10.1186/S13063-014-0543-7

Publication

Neuromotor Control of Gluteal Muscles in Runners with Achilles Tendinopathy

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2014

DOI: 10.1249/MSS.0000000000000133

Publication

Vastus medialis obliquus (VMO) retraining or graduated loading programme for patellofemoral pain: different paradigm with similar results?

Publisher: BMJ

Date: 21-05-2019

DOI: 10.1136/BJSPORTS-2017-098736

Publication

Publisher: Springer Science and Business Media LLC

Date: 08-05-2007

DOI: 10.1038/NCPRHEUM0503

Publication

Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial

Publisher: BMJ

Date: 03-2009

DOI: 10.1136/BMJ.A1735

Abstract: To compare the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome with flat inserts or physiotherapy, and to investigate the effectiveness of foot orthoses plus physiotherapy. Prospective, single blind, randomised clinical trial. Single centre trial within a community setting in Brisbane, Australia. 179 participants (100 women) aged 18 to 40 years, with a clinical diagnosis of patellofemoral pain syndrome of greater than six weeks' duration, who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months. Six weeks of physiotherapist intervention with off the shelf foot orthoses, flat inserts, multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy. Global improvement, severity of usual and worst pain over the preceding week, anterior knee pain scale, and functional index questionnaire measured at 6, 12, and 52 weeks. Foot orthoses produced improvement beyond that of flat inserts in the short term, notably at six weeks (relative risk reduction 0.66, 99% confidence interval 0.05 to 1.17 NNT 4 (99% confidence interval 2 to 51). No significant differences were found between foot orthoses and physiotherapy, or between physiotherapy and physiotherapy plus orthoses. All groups showed clinically meaningful improvements in primary outcomes over 52 weeks. While foot orthoses are superior to flat inserts according to participants' overall perception, they are similar to physiotherapy and do not improve outcomes when added to physiotherapy in the short term management of patellofemoral pain. Given the long term improvement observed in all treatment groups, general practitioners may seek to hasten recovery by prescribing prefabricated orthoses. Australian Clinical Trials Registry ACTRN012605000463673 and ClinicalTrials.gov NCT00118521.

Publication

Clinical Significance of Medial Versus Lateral Compartment Patellofemoral Osteoarthritis: Cross‐Sectional Analyses in an Adult Population With Knee Pain

Publisher: Wiley

Date: 27-06-2017

DOI: 10.1002/ACR.23110

Abstract: To determine the comparative prevalence, associations with selected patient characteristics, and clinical outcomes of medial and lateral compartment patellofemoral (PF) joint osteoarthritis (OA). Information was collected by questionnaires, clinical assessment, and radiographs from 745 eligible community‐dwelling symptomatic adults age ≥50 years. PF joint space narrowing (JSN) and osteophytes were scored from skyline radiographs using the Osteoarthritis Research Society International atlas. Multilevel models were used to assess associations of compartmental PF joint OA with age, sex, body mass index (BMI) and varus–valgus malalignment, while median regression was used to examine associations with clinical outcomes (current pain intensity on a numeric rating scale [0–10] and the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index [0–68]). Isolated lateral PF joint OA was more common than isolated medial PF joint OA, particularly at higher severity thresholds. Irrespective of severity threshold, age (≥2 odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.12, 1.26]), BMI (≥2 OR 1.15 [95% CI 1.07, 1.24]), and valgus malalignment (≥2 OR 2.58 [95% CI 1.09, 6.07]) were associated with increased odds of isolated lateral JSN, but isolated medial JSN was only associated with age (≥2 OR 1.20 [95% CI 1.14, 1.27]). The pattern of association was less clear for PF joint osteophytes. Isolated lateral PF joint OA, defined by JSN or osteophytes, was associated with higher pain scores than isolated medial PF joint OA, but these differences were modest and were not significant. A similar pattern of association was seen for functional limitation but only when PF joint OA was defined by JSN. Isolated lateral PF joint OA is more common than isolated medial PF joint OA, and it is more consistently associated with established OA risk factors. It is also associated with higher, but clinically nonsignificant, pain and function scores than isolated medial PF joint OA, particularly when PF joint OA is defined using JSN.

Publication

Estrogen-induced effects on the neuro-mechanics of hopping in humans

Publisher: Springer Science and Business Media LLC

Date: 21-09-2010

DOI: 10.1007/S00421-010-1647-8

Abstract: Estrogen receptors in skeletal muscle suggest a tissue-based mechanism for influencing neuromuscular control. This has important physiological implications for both eumenorrheic women with fluctuating estrogen levels and those with constant and attenuated estrogen levels, i.e., women using the monophasic oral contraceptive pill (MOCP). This study examined the effects of endogenous plasma estrogen levels on leg stiffness (K (LEG)) and foot center of pressure (COP) during hopping. Nineteen females (Age = 28.0 ± 4.2 years, Ht = 1.67 ± 0.07 m, Mass = 61.6 ± 6.8 kg) who had been using the MOCP for at least 12 months together with 19 matched, female, non-MOCP users (Age = 31.9 ± 7.3 years, Ht = 1.63 ± 0.05 m, Mass = 62.5 ± 5.9 kg) participated. Non-MOCP users were tested at the time of lowest (menstruation) and highest (≈ ovulation) estrogen whilst MOCP users were tested at Day 1 and Day 14 of their cycle. At each test session, K (LEG) (N m(-1) kg(-1)) and foot COP path length (mm) and path velocity (mm s(-1)) were determined from ground reaction force data as participants hopped at 2.2 Hz on a force plate. Statistical analysis revealed no significant (p < 0.05) differences for K (LEG). In contrast, significantly higher COP path length (30%) and COP path velocity (25%) were identified at ≈ ovulation compared to menstruation in the non-MOCP users. Whilst there was no evidence of an estrogen-induced effect on K (LEG) significantly elevated estrogen at ≈ ovulation presumably increased extensibility of connective tissue and/or diminished neuromuscular control. Consistent lower limb dynamics of MOCP users demands less reliance on acutely modified neuromuscular control strategies during dynamic tasks and may explain the lower rate of lower limb musculoskeletal injuries in this population compared to non-MOCP users.

Publication

Reply

Publisher: Wiley

Date: 26-08-2015

DOI: 10.1002/ART.39168

Publication

Infographic. Roadmap to managing a person with musculoskeletal pain irrespective of body region

Publisher: BMJ

Date: 20-01-2020

DOI: 10.1136/BJSPORTS-2019-101681

Publication

Publisher: BMJ

Date: 09-01-2018

DOI: 10.1136/BJSPORTS-2018-100173

Publication

Acupuncture for Chronic Knee Pain

Publisher: American Medical Association (AMA)

Date: 10-2014

DOI: 10.1001/JAMA.2014.12660

Abstract: There is debate about benefits of acupuncture for knee pain. To determine the efficacy of laser and needle acupuncture for chronic knee pain. Zelen-design clinical trial (randomization occurred before informed consent), in Victoria, Australia (February 2010-December 2012). Community volunteers (282 patients aged ≥50 years with chronic knee pain) were treated by family physician acupuncturists. No acupuncture (control group, n = 71) and needle (n = 70), laser (n = 71), and sham laser (n = 70) acupuncture. Treatments were delivered for 12 weeks. Participants and acupuncturists were blinded to laser and sham laser acupuncture. Control participants were unaware of the trial. Primary outcomes were average knee pain (numeric rating scale, 0 [no pain] to 10 [worst pain possible] minimal clinically important difference [MCID], 1.8 units) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0 [no difficulty] to 68 [extreme difficulty] MCID, 6 units) at 12 weeks. Secondary outcomes included other pain and function measures, quality of life, global change, and 1-year follow-up. Analyses were by intention-to-treat using multiple imputation for missing outcome data. At 12 weeks and 1 year, 26 (9%) and 50 (18%) participants were lost to follow-up, respectively. Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference -0.4 units 95% CI, -1.2 to 0.4, and -0.1 95% CI, -0.9 to 0.7, respectively) or function (-1.7 95% CI, -6.1 to 2.6, and 0.5 95% CI, -3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (-1.1 95% CI, -1.8 to -0.4, and -0.8 95% CI, -1.5 to -0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (-3.9 95% CI, -7.7 to -0.2) but was not significantly different from sham (-1.7 95% CI, -6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events. In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients. anzctr.org.au Identifier: ACTRN12609001001280.

Publication

Is Running Better than Walking for Reducing Hip Joint Loads?

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2018

DOI: 10.1249/MSS.0000000000001689

Abstract: Knowledge of hip biomechanics during locomotion is necessary for designing optimal rehabilitation programs for hip-related conditions. The purpose of this study was to: 1) determine how lower-limb muscle contributions to the hip contact force (HCF) differed between walking and running and 2) compare both absolute and per-unit-distance (PUD) loads at the hip during walking and running. Kinematic and ground reaction force data were captured from eight healthy participants during overground walking and running at various steady-state speeds (walking: 1.50 ± 0.11 m·s −1 and 1.98 ± 0.03 m·s −1 running: 2.15 ± 0.18 m·s −1 and 3.47 ± 0.11 m·s −1 ). A three-dimensional musculoskeletal model was used to calculate the HCF as well as lower-limb muscular contributions to the HCF in each direction (posterior–anterior inferior–superior lateral–medial). The impulse of the resultant HCF was calculated as well as the PUD impulse (BW·s·m −1 ) and PUD force (BW·m −1 ). For both walking and running, HCF magnitude was greater during stance than swing and was largest in the inferior–superior direction and smallest in the posterior–anterior direction. Gluteus medius, iliopsoas, and gluteus maximus generated the largest contributions to the HCF during stance, whereas iliopsoas and hamstrings generated the largest contributions during swing. When comparing all locomotion conditions, the impulse of the resultant HCF was smallest for running at 2.15 m·s −1 with an average magnitude of 2.14 ± 0.31 BW·s, whereas the PUD impulse and force were smallest for running at 3.47 m·s −1 with average magnitudes of 0.95 ± 0.18 BW·s·m −1 and 1.25 ± 0.24 BW·m −1 , respectively. Hip PUD loads were lower for running at 3.47 m·s −1 compared with all other locomotion conditions because of a greater distance travelled per stride (PUD impulse) or a shorter stride duration combined with a greater distance travelled per stride (PUD force).

Publication

Publisher: Springer Science and Business Media LLC

Date: 07-07-2017

DOI: 10.1186/S40814-017-0157-4

Publication

Measurement Properties of a Test Battery to Assess Postural Orientation During Functional Tasks in Patients Undergoing ACL Injury Rehabilitation

Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)

Date: 15-10-2017

DOI: 10.2519/JOSPT.2017.7270

Abstract: Study Design Cross-sectional study. Background Visual rating of postural orientation during functional tasks may be a valuable tool to track rehabilitation progress following anterior cruciate ligament (ACL) injury. A valid test battery assessing postural orientation as a separate construct is lacking. Objectives To evaluate measurement properties of a test battery to assess postural orientation in patients with ACL injury. Methods The content validity of functional tasks was assessed by expert focus group discussions. Fifty-one patients (45% women) with ACL injury performed 9 functional tasks of varying difficulty. Interpretability, internal consistency, interrater reliability, and measurement error were assessed for segment-specific postural orientation errors (POEs), within-task POEs, and total POE score. Postural orientation errors were scored on video on an ordinal scale from 0 (no POEs) to 3 (major POEs). Results Stair ascent, deep squat, and crossover hop for distance were excluded in focus group discussions. Postural orientation errors in some tasks were excluded due to floor effects. The mini-squat and drop jump were excluded due to poor internal consistency (α≤.184). Interrater reliability values for segment-specific POEs and within-task POEs yielded fair to almost perfect agreement (κ = 0.429-0.875) and almost perfect agreement for total POE score (intraclass correlation coefficient = 0.842), without systematic differences between raters. The smallest detectable changes were 0.7 and 5 points for groups and in iduals, respectively. Conclusion The final test battery (single-leg mini-squat, stair descent, forward lunge, single-leg hop for distance) of 4 POEs (foot pronation, medial knee-to-foot position, hip joint POEs, and trunk segment POEs) demonstrated good measurement properties in people with ACL injury. J Orthop Sports Phys Ther 2017 (11):863-873. doi:10.2519/jospt.2017.7270.

Publication

Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome

Publisher: BMJ

Date: 16-11-2010

DOI: 10.1136/BJSM.2010.077644

Abstract: There is growing evidence for the provision of foot orthoses when treating in iduals with patellofemoral pain syndrome (PFPS), and prescription is frequently based on the assessment of foot posture/function. However, evaluation of the link between abnormal foot posture/function and foot orthoses outcomes has previously been limited to static alignment measures and has produced inconsistent findings. In this study, the ability of baseline foot kinematics associated with pronation to predict marked improvement 12 weeks following foot orthoses prescription in in iduals with PFPS was evaluated. 26 in iduals with PFPS were issued with prefabricated foot orthoses, and patient-reported level of improvement was documented at 12 weeks. Potential predictors of marked improvement at 12 weeks were measured during walking at baseline and included forefoot dorsiflexion and abduction, and rearfoot eversion. Of the 25 participants who completed the study, seven (28%) reported marked improvement with the foot orthoses after 12 weeks. Discriminant function analysis revealed a greater peak rearfoot eversion to be the only significant independent predictor of marked improvement. These findings provide preliminary evidence that greater peak rearfoot eversion is predictive of marked improvement 12 weeks following prefabricated foot orthoses prescription in in iduals with PFPS. Therefore, foot orthoses may be most effective in the subgroup of people with PFPS and increased dynamic foot pronation.

Publication

Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain

Publisher: BMJ

Date: 06-05-2020

DOI: 10.1136/BJSPORTS-2019-101690

Abstract: To report the effectiveness of physiotherapist-led interventions in improving pain and function in young and middle-aged adults with hip-related pain. Systematic review and meta-analysis. A comprehensive, reproducible search strategy was performed on five databases in May 2019. Reference lists and grey literature were also searched. Population: people aged ≥18 years with hip-related pain (with or without a diagnosis of femoroacetabular impingement syndrome). Intervention(s): physiotherapist-led interventions for hip pain. Comparators: sham treatment, no treatment or other treatment (eg, hip arthroscopic surgery). Outcomes: primary outcomes included patient-reported hip pain and function. Secondary outcomes included physical function measures. 1722 papers were identified. After exclusion criteria were applied, 14 studies were included for analysis. They had varied risk of bias. There were no full-scale placebo-controlled randomised controlled trials (RCTs) of physiotherapist-led treatment. Pooled effects ranged from moderate effects (0.67 (95% CI 0.07 to 1.26)) favouring physiotherapist-led intervention over no treatment post-arthroscopy, to weak effects (−0.32 (95% CI 0.57 to 0.07)) favouring hip arthroscopy over physiotherapist-led treatment. Physiotherapist-led interventions might improve pain and function in young and middle-aged adults with hip-related pain, however full-scale high-quality RCT studies are required. CRD42018089088.

Publication

Publisher: BMJ

Date: 31-05-2016

DOI: 10.1136/BJSPORTS-2016-096268

Publication

Publisher: Springer Science and Business Media LLC

Date: 08-11-2019

DOI: 10.1007/S00296-019-04472-9

Abstract: To determine the longitudinal association of baseline body mass index and change in body mass index over 8 years to incident of patellofemoral osteoarthritis at the 8-year follow-up. A s le of 528 women and men, aged 45-65 years, with knee complaints and without radiographic evidence of patellofemoral and tibiofemoral osteoarthritis at baseline, were selected from the Cohort Hip and Cohort Knee cohort. Incidence of patellofemoral osteoarthritis was defined as presence of radiographic patellofemoral osteoarthritis (with or without tibiofemoral osteoarthritis) at the 8-year follow-up. Baseline body mass index data were categorized into normal, overweight, and obese weight-categories. Logistic regression analyses, adjusted for age and sex, were conducted to determine the association of baseline body mass index and change in body mass index to patellofemoral osteoarthritis incidence 8 years later. Obesity was associated with greater odds of radiographic patellofemoral osteoarthritis incident (odds ratio: 1.8 [95% CI 1.1, 3.1]) 8 years later. There were no significant associations observed between body mass index change over 8 years and incidence of radiographic patellofemoral osteoarthritis in overweight and obese in iduals. Obesity is associated with increased odds of developing radiographic patellofemoral osteoarthritis 8 years later.

Kay Crossley

Researcher

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Publications

Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis

Patellofemoral pain

Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk

Worse knee confidence, fear of movement, psychological readiness to return-to-sport and pain are associated with worse function after ACL reconstruction

Effects of an unloader knee brace on knee-related symptoms and function in people with post-traumatic knee osteoarthritis after anterior cruciate ligament reconstruction

Risk of hip fracture with hip or knee osteoarthritis: a systematic review

Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy

Accelerated return to sport after anterior cruciate ligament injury: a risk factor for early knee osteoarthritis?

Prognostic factors for patellofemoral pain: a multicentre observational analysis

Targeted physiotherapy for patellofemoral joint osteoarthritis: A protocol for a randomised, single-blind controlled trial

Ground reaction forces, bone characteristics, and tibial stress fracture in male runners

The association of quadriceps strength with the knee adduction moment in medial knee osteoarthritis

Co-creation of a sport-specific anterior cruciate ligament injury risk reduction program for women: A concept mapping approach

Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis

Foot and ankle characteristics and dynamic knee valgus in individuals with patellofemoral osteoarthritis

Systematic review of the measurement properties of functional performance tests and muscle strength tests in persons with anterior cruciate ligament or meniscal injury

Is patellofemoral pain preventable? A systematic review and meta-analysis of randomised controlled trials

Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression

Effectiveness of rehabilitation interventions to improve knee joint structural and biological outcomes after knee injury: A systematic review of randomized controlled trials

REPORT-PFP: A consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies

The FOOTPATH study: protocol for a multicentre, participant- and assessor-blind, parallel group randomised clinical trial of foot orthoses for patellofemoral osteoarthritis

Pelvic and Hip Kinematics During Walking in People With Patellofemoral Joint Osteoarthritis Compared to Healthy Age‐Matched Controls

Let’s talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes

Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the Multicenter Osteoarthritis Study

Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis

Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis

Lower limb biomechanics during low- and high-impact functional tasks differ between men and women with hip-related groin pain

Should return to pivoting sport be avoided for the secondary prevention of osteoarthritis after anterior cruciate ligament reconstruction? A prospective cohort study with MRI, radiographic and symptomatic outcomes

Are cam morphology size and location associated with self‐reported burden in football players with FAI syndrome?

Lower limb biomechanics in femoroacetabular impingement syndrome: A systematic review and meta-analysis

It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice

Determining meaningful thresholds for patient-reported outcomes following interventions for anterior cruciate ligament or meniscus injury: A systematic review

Mismatch between expectations and physical activity outcomes at six months following hip-arthroscopy: A qualitative study

Clinical features of patellar tendinopathy and their implications for rehabilitation

Predicting ratings of perceived exertion in Australian football players: methods for live estimation

Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, U

Lower-limb biomechanics in football players with and without hip-related pain

Between-Limb Differences in Patellofemoral Joint Forces During Running at 12 to 24 Months After Unilateral Anterior Cruciate Ligament Reconstruction

Quadriceps volumes are reduced in people with patellofemoral joint osteoarthritis

Navicular stress fractures: outcomes of surgical and conservative management * Commentary

Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis

Health-Related Quality of Life After Anterior Cruciate Ligament Reconstruction

Patient‐Reported Outcomes One to Five Years After Anterior Cruciate Ligament Reconstruction: The Effect of Combined Injury and Associations With Osteoarthritis Features Defined on Magnetic Resonance I

Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis

Knee kinematics and kinetics are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction

Early Patellofemoral Osteoarthritis Features One Year After Anterior Cruciate Ligament Reconstruction: Symptoms and Quality of Life at Three Years

Varus thrust in medial knee osteoarthritis: Quantification and effects of different gait‐related interventions using a single case study

Therapeutic knee taping improved pain and disability in osteoarthritis of the knee

The effect of altered stride length on iliocapsularis and pericapsular muscles of the anterior hip: An electromyography investigation during asymptomatic gait

What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis

Efficacy of Nonsurgical Interventions for Anterior Knee Pain

Impairment of Dynamic Single‐Leg Balance Performance in Individuals With Hip Chondropathy

Rethinking patellofemoral pain: Prevention, management and long-term consequences

Measurement Qualities of Hip and Groin Outcome Scores: Letter to the Editor

Patellofemoral osteoarthritis is prevalent and associated with worse symptoms and function after hamstring tendon autograft ACL reconstruction

Fractures associated with ACL injury need to be taken seriously

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Computer‐Aided Detection AI Reduces Interreader Variability in Grading Hip Abnormalities With MRI

Associations between type and severity of hip pathology with pre-operative patient reported outcome measures

Prevalence of Radiographic and Magnetic Resonance Imaging Features of Patellofemoral Osteoarthritis in Young and Middle‐Aged Adults With Persistent Patellofemoral Pain

Effects of experimentally‐induced anterior knee pain on knee joint position sense in healthy individuals

Gait patterns, symptoms, and function in patients with isolated tibiofemoral osteoarthritis and combined tibiofemoral and patellofemoral osteoarthritis

Hip Muscle Strength, Range of Motion, and Functional Performance in Young Elite Male Australian Football Players

Quality of Life After Anterior Cruciate Ligament Reconstruction

Knowledge, confidence and learning needs of physiotherapists treating persistent knee pain in Australia and Canada: a mixed-methods study

Anterior knee pain following anterior cruciate ligament reconstruction does not increase the risk of patellofemoral osteoarthritis at 15- and 20-year follow-ups

Optimizing Preseason Training Loads in Australian Football

Should we consider changing traditional physiotherapy treatment of patellofemoral pain based on recent insights from the literature?

Sagittal plane bending moments acting on the lower leg during running

Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis?

The effect of gait modification on the external knee adduction moment is reference frame dependent

What fooled us in the knee may trip us up in the hip: lessons from arthroscopy