SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Am J Sports Med. 2019 Jun;47(7):1629-1637. doi: 10.1177/0363546519843915. Epub 2019 May 16.
Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.
To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management.
Cohort study; Level of evidence, 2.
Adolescents aged 10 to 14 years with PFP were included (N = 151). The 12-week intervention included 4 supervised sessions with a physical therapist, which adolescents and parents were required to attend. The intervention included activity modification (weeks 1-4) to reduce loading of the patellofemoral joint via an activity ladder and pain monitoring, home-based exercises (weeks 5-8), and return-to-sport guidance (weeks 9-12). Primary outcome was a 7-point global rating of change, ranging from "much improved" to "much worse." Adolescents were considered to have a successful outcome if they reported "much improved" or "improved." The primary endpoint was at 12 weeks, with additional follow-up at 4, 24, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), hip and knee torque, sports participation, satisfaction with treatment, and use of painkillers.
At 12 weeks, 87% completed the full questionnaire, of which 86% reported a successful outcome, as compared with 77% (95% CI, 68%-83%) at 6 months and 81% (95% CI, 73%-88%) at 12 months. There were large clinically relevant improvements in 3 KOOS subscales: Pain, Sport/Recreation, and Quality of Life (13-24 points). Hip and knee torque increased by 20% to 33%. In total, 68% were back playing sport after 3 months, which increased to 79% at 6 months and 81% at 12 months. The majority were satisfied with the treatment (90%) and would recommend it to a friend (95%). No specific patient characteristics were associated with prognosis.
A treatment strategy focusing on activity modification and load management was associated with high rates of successful outcome among adolescents with PFP at 12 and 52 weeks. These short- and longer-term outcomes were supported by improvements in symptoms and objective measures of hip and knee torque.
NCT02402673 (ClinicalTrials.gov identifier).
髌股疼痛（PFP）影响 7%的青少年，尤其是那些高度活跃的青少年。以运动为重点的治疗方法效果有限，且忽视了活动的改变和负荷管理。由于许多青少年尽管有疼痛仍继续高强度运动，因此需要一种新的策略来解决这个问题。
研究一种以活动改变和负荷管理为重点的青少年治疗策略的效果。
队列研究；证据水平，2 级。
纳入 10 至 14 岁患有 PFP 的青少年（N=151）。为期 12 周的干预包括 4 次与物理治疗师一起进行的监督治疗，青少年及其父母都需要参加。干预措施包括活动改变（第 1-4 周），通过活动梯和疼痛监测减少髌股关节的负荷，家庭锻炼（第 5-8 周），以及重返运动指导（第 9-12 周）。主要结局是 7 分制的整体变化评分，范围从“明显改善”到“明显恶化”。如果青少年报告“明显改善”或“改善”，则认为他们有成功的治疗效果。主要终点是在 12 周时，额外的随访时间分别为 4、24 和 52 周。次要结局包括膝关节损伤和骨关节炎结果评分（KOOS）、髋关节和膝关节扭矩、运动参与度、对治疗的满意度和止痛药的使用情况。
在 12 周时，87%的青少年完成了完整的问卷，其中 86%报告了成功的治疗效果，而在 6 个月时为 77%（95%可信区间，68%-83%），在 12 个月时为 81%（95%可信区间，73%-88%）。3 个 KOOS 子量表（疼痛、运动/娱乐和生活质量）有较大的临床相关改善（13-24 分）。髋关节和膝关节扭矩增加了 20%-33%。总共，68%的青少年在 3 个月后重返运动，6 个月时增加到 79%，12 个月时增加到 81%。大多数青少年对治疗满意（90%），并会向朋友推荐（95%）。没有特定的患者特征与预后相关。
在 12 和 52 周时，一种以活动改变和负荷管理为重点的治疗策略与 PFP 青少年的高成功率相关。这些短期和长期的结果得到了症状和髋关节及膝关节扭矩的客观测量的改善的支持。
NCT02402673（ClinicalTrials.gov 标识符）。
