Nielsen Torsten Grønbech, Miller Lene Lindberg, Mygind-Klavsen Bjarne, Lind Martin
Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
J Exp Orthop. 2020 Feb 7;7(1):5. doi: 10.1186/s40634-020-00223-z.
The purpose of the present study was to investigate the effects of a 3-month multimodal intervention including patient education, a simple hip exercise program, footwear adjustment, and foot orthoses to reduce symptoms in patients with patellafemoral pain (PFP).
Patients were diagnosed based on a physical examination, patient symptoms and ruled out intra-articular knee pathologies by MRI. Patients were educated on PFP and participated in a 3-month exercise program; shoes with solid heel-caps were recommended, and custom made orthoses with arch support were recommended to patients with foot pronation. The Anterior Knee Pain Scale (AKPS) and the pain numeric rating scale (NRS) were used to evaluate the outcomes of the intervention and collected at baseline, 3 and 12-months follow-ups.
Sixty-five patients (age 18 years (9-32)) were included in a consecutive prospective cohort. The AKPS score improved from 71 ± 24 to 89 ± 9 (p < 0.01) at 12 months follow up. The NRS-rest and NRS-activity improved from 3 to 0 (p < 0.01) and 7 to 3 (p < 0.01) respectively. 78% of the patients clinically improved (i.e., demonstrated a > 10-point improvement (minimal clinically important difference (MCID))) considering the AKPS; and 76% and 73% clinically improved (i.e., demonstrated (MCID) a ≥ 2-point improvement) in their NRS-rest and NRS-activity, respectively. No patients experienced a decrease in their AKPS score or an increase in their NRS-rest and NRS-activity scores at 12-months.
A 3-month PFP multimodal treatment strategy focusing on patient education, footwear adjustment, orthoses, and simple hip muscle exercises significantly improved functional outcomes and reduced pain at a 12 month follow-up.
本研究旨在探讨为期3个月的多模式干预措施，包括患者教育、简单的髋关节锻炼计划、鞋类调整和足部矫形器，对减轻髌股关节疼痛（PFP）患者症状的效果。
根据体格检查、患者症状对患者进行诊断，并通过磁共振成像排除膝关节内病变。对患者进行PFP相关教育，并让其参与为期3个月的锻炼计划；建议穿着带有坚固鞋跟帽的鞋子，对于有足内翻的患者，建议定制带有足弓支撑的矫形器。使用前膝疼痛量表（AKPS）和疼痛数字评定量表（NRS）评估干预效果，并在基线、3个月和12个月随访时收集数据。
连续纳入65例患者（年龄18岁（9 - 32岁））组成前瞻性队列。在12个月随访时，AKPS评分从71±24提高到89±9（p < 0.01）。NRS静息评分和NRS活动评分分别从3分提高到0分（p < 0.01）和从7分提高到3分（p < 0.01）。考虑AKPS时，78%的患者临床症状改善（即改善超过10分（最小临床重要差异（MCID）））；NRS静息评分和NRS活动评分分别有76%和73%的患者临床症状改善（即改善≥2分（MCID））。在12个月时，没有患者的AKPS评分降低，或NRS静息评分和NRS活动评分升高。
为期3个月的PFP多模式治疗策略，重点关注患者教育、鞋类调整、矫形器和简单的髋关节肌肉锻炼，在12个月随访时显著改善了功能结局并减轻了疼痛。
