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, 11, 201

Anterior Knee Pain in Younger Adults as a Precursor to Subsequent Patellofemoral Osteoarthritis: A Systematic Review


Anterior Knee Pain in Younger Adults as a Precursor to Subsequent Patellofemoral Osteoarthritis: A Systematic Review

Martin J Thomas et al. BMC Musculoskelet Disord.


Background: Patellofemoral osteoarthritis (PFOA) is a common form of knee OA in middle and older age, but its relation to PF disorders and symptoms earlier in life is unclear. Our aim was to conduct a systematic review to investigate the strength of evidence for an association between anterior knee pain (AKP) in younger adults and subsequent PFOA.

Methods: The search strategy included electronic databases (Pubmed, EMBASE, AMED, CINAHL, Cochrane, PEDro, SportDiscus: inception to December 2009), reference lists of potentially eligible studies and selected reviews. Full text articles in any language, - identified via English titles and abstracts, were included if they were retrospective or prospective in design and contained quantitative data regarding structural changes indicative of PFOA, incident to original idiopathic AKP. Eligibility criteria were applied to titles, abstracts and full-texts by two independent reviewers. Data extraction included study location, design, date, sampling procedure, sample characteristics, AKP/PFOA definitions, follow-up duration and rate, and main findings. Foreign language articles were translated into English prior to examination.

Results: Seven articles satisfied eligibility (5 English, 2 German). Only one case-control study directly investigated a link between PFOA and prior AKP, providing level 3b evidence in favour of an association (OR 4.4; 95%CI 1.8, 10.6). Rough estimates of the annual risk of PFOA from the remaining six small, uncontrolled, observational studies (mean follow-up range: 5.7 to 23 years) ranged from 0% to 3.4%. This was not the primary aim of these studies, and limitations in design and methodology mean this data should be interpreted with caution.

Conclusions: There is a paucity of high-quality evidence reporting a link between AKP and PFOA. Further, well-designed cohort studies may be able to fill this evidence gap.


Figure 1
Figure 1
Flow diagram summarising systematic search and process for selection of studies.

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    1. Duncan RC, Hay EM, Saklatvala J, Croft PR. Prevalence of radiographic osteoarthritis--it all depends on your point of view. Rheumatology (Oxford) 2006;45:757–760. doi: 10.1093/rheumatology/kei270. - DOI - PubMed
    1. Grelsamer R, Moss G, Ee G, Donell S. The patellofemoral syndrome; the same problem as the loch ness monster? Knee. 2009;16:301–302. doi: 10.1016/j.knee.2009.05.005. - DOI - PubMed
    1. Vahasarja V. Prevalence of chronic knee pain in children and adolescents in northern Finland. Acta Paediatr. 1995;84:803–805. doi: 10.1111/j.1651-2227.1995.tb13760.x. - DOI - PubMed
    1. Callaghan MJ, Selfe J. Has the incidence or prevalence of patellofemoral pain in the general population in the United Kingdom been properly evaluated? Phys Ther Sport. 2007;8:37–43. doi: 10.1016/j.ptsp.2006.07.001. - DOI
    1. Sandow MJ, Goodfellow JW. The natural history of anterior knee pain in adolescents. J Bone Joint Surg Br. 1985;67:36–38. - PubMed

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