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Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Study protocol

The Patella Pro study — effect of a knee brace on patellofemoral pain syndrome: design of a randomized clinical trial (DRKS-ID:DRKS00003291)

Authors: Wolf Petersen, Andree Ellermann, Ingo Volker Rembitzki, Sven Scheffler, Mirco Herbort, Frederike Sophie Sprenker, Andrea Achtnich, Gert Peter Brüggemann, Raymond Best, Frank Hoffmann, Andreas Gösele Koppenburg, Christian Liebau

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

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Abstract

Background

Patellofemoral pain syndrome (PFPS) is a frequent cause of anterior knee pain predominantly affecting young female patients who do not have significant chondral damage. Development of PFPS is probably multifactorial, involving various knee, hip, and foot kinematic factors. Biomechanical studies have described patellar maltracking and dynamic valgus (functional malalignment) in patients with patellofemoral pain syndrome. The literature provides evidence for short-term use of nonsteroidal anti-inflammatory drugs; short-term medially directed taping; and exercise programs focusing on the lower extremity, hip, and trunk muscles. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this article is to publish the design of a prospective randomized trial that examines the outcomes of patients with PFPS after treatment with a new patellar brace (Patella Pro) that applies medially directed force on the patella.

Methods/Design

For this multicenter trial, 156 patients (adolescents and young adults) with PFPS were recruited from orthopedic practices and orthopedic hospitals and randomly allocated to 3 months of supervised physiotherapy in combination with the Patella Pro brace or supervised physiotherapy alone. The primary outcome measures are pain (numerical analog scale); knee function (Kujala score and Knee Injury and Osteoarthritis Outcome Score); and self-reported perception of recovery at baseline, 6 weeks, 3 months, and 1 year.

Discussion

Only limited evidence for the use of a patellar brace for the treatment of PFPS exists in the literature. Disputable evidence for the use of orthoses for PFPS patients has been presented in one meta-analysis, in which only one of three studies found the effect of a medially directed patellar brace to be significant. Because of these low-quality studies, the authors concluded that this evidence should be regarded as limited, and we feel there is a need for further well-designed studies to evaluate the effect of patellar bracing on PFPS-related pain. The Patella Pro study is a prospective randomized trial in which supervised physiotherapy in combination with a patellar brace is compared with supervised physiotherapy alone. This trial started in April 2012 and finished in October 2013.

Trial registration

DRKS-ID:​DRKS00003291, January 3rd, 2012
Appendix
Available only for authorised users
Literature
1.
go back to reference 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 (1): 37-43.CrossRef 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 (1): 37-43.CrossRef
2.
go back to reference Blond L, Hansen L: Patellofemoral pain syndrome in athletes: a 5.7-year retrospective follow-up study of 250 athletes. Acta Orthop Belg. 1998, 64: 393-400.PubMed Blond L, Hansen L: Patellofemoral pain syndrome in athletes: a 5.7-year retrospective follow-up study of 250 athletes. Acta Orthop Belg. 1998, 64: 393-400.PubMed
3.
go back to reference Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A: Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010, 20 (5): 725-730.CrossRefPubMedPubMedCentral Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A: Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010, 20 (5): 725-730.CrossRefPubMedPubMedCentral
4.
5.
6.
go back to reference Petersen W, Ellermann A, Liebau C, Brüggemann GP, Best R, Gösele-Koppenburg A, Semsch H, Albasini A, Rembitzki I: Das patellofemorale Schmerzsyndrom. Orthop Praxis. 2010, 46 (8): 34-42. Petersen W, Ellermann A, Liebau C, Brüggemann GP, Best R, Gösele-Koppenburg A, Semsch H, Albasini A, Rembitzki I: Das patellofemorale Schmerzsyndrom. Orthop Praxis. 2010, 46 (8): 34-42.
7.
go back to reference Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, Liebau C: Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2013, Nov 13. [Epub ahead of print] PMID:24221245 Petersen W, Ellermann A, Gösele-Koppenburg A, Best R, Rembitzki IV, Brüggemann GP, Liebau C: Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2013, Nov 13. [Epub ahead of print] PMID:24221245
8.
go back to reference Petersen W, Rembitzki IV, Brüggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C: Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop. 2013, 22: [Epub ahead of print] PMID: 24057656 Petersen W, Rembitzki IV, Brüggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C: Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop. 2013, 22: [Epub ahead of print] PMID: 24057656
9.
go back to reference Van Linschoten R, Van Middelkoop M, Berger MY, Heintjes EM, Koopmanschap MA, Verhaar JA, Koes BW, Bierma-Zeinstra SM: The PEX study - Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749]. BMC Musculoskelet Disord. 2006, 17 (7): 31-45.CrossRef Van Linschoten R, Van Middelkoop M, Berger MY, Heintjes EM, Koopmanschap MA, Verhaar JA, Koes BW, Bierma-Zeinstra SM: The PEX study - Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749]. BMC Musculoskelet Disord. 2006, 17 (7): 31-45.CrossRef
10.
go back to reference Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Vanden Berghe L, Cerulli G: Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc. 2005, 13 (2): 122-130.CrossRefPubMed Witvrouw E, Werner S, Mikkelsen C, Van Tiggelen D, Vanden Berghe L, Cerulli G: Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc. 2005, 13 (2): 122-130.CrossRefPubMed
11.
go back to reference Thomas MJ, Wood L, Selfe J, Peat G: Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskelet Disord. 2010, 11: 201-208.CrossRefPubMedPubMedCentral Thomas MJ, Wood L, Selfe J, Peat G: Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskelet Disord. 2010, 11: 201-208.CrossRefPubMedPubMedCentral
12.
go back to reference Utting MR, Davies G, Newman JH: Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?. Knee. 2005, 12: 362-365.CrossRefPubMed Utting MR, Davies G, Newman JH: Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?. Knee. 2005, 12: 362-365.CrossRefPubMed
13.
go back to reference Draper CE, Besier TF, Santos JM, Jennings F, Fredericson M, Gold GE, Beaupre GS, Delp SL: Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res. 2009, 27 (5): 571-577.CrossRefPubMedPubMedCentral Draper CE, Besier TF, Santos JM, Jennings F, Fredericson M, Gold GE, Beaupre GS, Delp SL: Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res. 2009, 27 (5): 571-577.CrossRefPubMedPubMedCentral
14.
go back to reference MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR: Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am. 2006, 88 (12): 2596-2600.CrossRefPubMed MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR: Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am. 2006, 88 (12): 2596-2600.CrossRefPubMed
15.
go back to reference Wilson NA, Press JM, Koh JL, Hendrix RW, Zhang LQ: In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 2009, 1;91 (3): 558-566.CrossRef Wilson NA, Press JM, Koh JL, Hendrix RW, Zhang LQ: In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 2009, 1;91 (3): 558-566.CrossRef
16.
go back to reference Baldon Rde M, Nakagawa TH, Muniz TB, Amorim CF, Maciel CD, Serrão FV: Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train. 2009, 44 (5): 490-496.CrossRefPubMed Baldon Rde M, Nakagawa TH, Muniz TB, Amorim CF, Maciel CD, Serrão FV: Eccentric hip muscle function in females with and without patellofemoral pain syndrome. J Athl Train. 2009, 44 (5): 490-496.CrossRefPubMed
17.
go back to reference Bolgla LA, Malone TR, Umberger BR, Uhl TL: Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2008, 38 (1): 12-16.CrossRefPubMed Bolgla LA, Malone TR, Umberger BR, Uhl TL: Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2008, 38 (1): 12-16.CrossRefPubMed
18.
go back to reference Brent JL, Myer GD, Ford KR, Hewett TE: A longitudinal examination of hip abduction strength in adolescent males and females. Med Sci Sports Exerc. 2008, 39: 34-45.CrossRef Brent JL, Myer GD, Ford KR, Hewett TE: A longitudinal examination of hip abduction strength in adolescent males and females. Med Sci Sports Exerc. 2008, 39: 34-45.CrossRef
19.
go back to reference Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM: Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011, 39: 866-873.CrossRefPubMed Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM: Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011, 39: 866-873.CrossRefPubMed
20.
go back to reference Cavazzuti L, Merlo A, Orlandi F, Campanini I: Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Gait Posture. 2010, 32 (3): 290-295.CrossRefPubMed Cavazzuti L, Merlo A, Orlandi F, Campanini I: Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Gait Posture. 2010, 32 (3): 290-295.CrossRefPubMed
21.
go back to reference Chen HY, Chien CC, Wu SK, Liau JJ, Jan MH: Electromechanical delay of the vastus medialis obliquus and vastus lateralis in individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2012, 42 (9): 791-796.CrossRefPubMed Chen HY, Chien CC, Wu SK, Liau JJ, Jan MH: Electromechanical delay of the vastus medialis obliquus and vastus lateralis in individuals with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2012, 42 (9): 791-796.CrossRefPubMed
22.
go back to reference Patil S, Dixon J, White LC, Jones AP, Hui AC: An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain. Knee. 2011, 18 (5): 329-332.CrossRefPubMed Patil S, Dixon J, White LC, Jones AP, Hui AC: An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain. Knee. 2011, 18 (5): 329-332.CrossRefPubMed
23.
go back to reference Harvie D, O'Leary T, Kumar S: A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works?. J Multidiscip Healthc. 2011, 4: 383-392.PubMedPubMedCentral Harvie D, O'Leary T, Kumar S: A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works?. J Multidiscip Healthc. 2011, 4: 383-392.PubMedPubMedCentral
24.
go back to reference Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW: Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003, 4: CD00347 Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW: Exercise therapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2003, 4: CD00347
25.
go back to reference Powers CM, Ward SR, Chen YJ, Chan LD, Terk MR: Effect of bracing on patellofemoral joint stress while ascending and descending stairs. Clin J Sport Med. 2004, 14 (4): 206-214.CrossRefPubMed Powers CM, Ward SR, Chen YJ, Chan LD, Terk MR: Effect of bracing on patellofemoral joint stress while ascending and descending stairs. Clin J Sport Med. 2004, 14 (4): 206-214.CrossRefPubMed
26.
go back to reference Selfe J, Richards J, Thewlis D, Kilmurray S: The biomechanics of step descent under different treatment modalities used in patellofemoral pain. Gait Posture. 2008, 27 (2): 258-263.CrossRefPubMed Selfe J, Richards J, Thewlis D, Kilmurray S: The biomechanics of step descent under different treatment modalities used in patellofemoral pain. Gait Posture. 2008, 27 (2): 258-263.CrossRefPubMed
27.
go back to reference Selfe J, Thewlis D, Hill S, Whitaker J, Sutton C, Richards J: A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain. Gait Posture. 2011, 34 (1): 92-96.CrossRefPubMed Selfe J, Thewlis D, Hill S, Whitaker J, Sutton C, Richards J: A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain. Gait Posture. 2011, 34 (1): 92-96.CrossRefPubMed
28.
go back to reference Brüggemann GP, Heinrich K, Liebau C, Ellermann A, Potthast W, Rembitzki I: Patella-Re-Zentrierungs-Orthese Patella Pro Biomechanische Evaluation: ex vivo und in vivo. 2010, Leipzig: Proceedings of the ISPO World Congress, 234- Brüggemann GP, Heinrich K, Liebau C, Ellermann A, Potthast W, Rembitzki I: Patella-Re-Zentrierungs-Orthese Patella Pro Biomechanische Evaluation: ex vivo und in vivo. 2010, Leipzig: Proceedings of the ISPO World Congress, 234-
29.
go back to reference Van Linschoten R, Van Middelkoop M, Berger MY, Heintjes EM, Verhaar JA, Willemsen SP, Koes BW, Bierma-Zeinstra SM: Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. BMJ. 2009, 20: 339-346. Van Linschoten R, Van Middelkoop M, Berger MY, Heintjes EM, Verhaar JA, Willemsen SP, Koes BW, Bierma-Zeinstra SM: Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. BMJ. 2009, 20: 339-346.
30.
go back to reference Thijs Y, Vingerhoets G, Pattyn E, Rombaut L, Witvrouw E: Does bracing influence brain activity during knee movement: an fMRI study. Knee Surg Sports Traumatol Arthrosc. 2010, 18 (8): 1145-1149.CrossRefPubMed Thijs Y, Vingerhoets G, Pattyn E, Rombaut L, Witvrouw E: Does bracing influence brain activity during knee movement: an fMRI study. Knee Surg Sports Traumatol Arthrosc. 2010, 18 (8): 1145-1149.CrossRefPubMed
31.
go back to reference Callaghan MJ, McKie S, Richardson P, Oldham JA: Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging. Phys Ther. 2012, 92 (6): 821-830.CrossRefPubMedPubMedCentral Callaghan MJ, McKie S, Richardson P, Oldham JA: Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging. Phys Ther. 2012, 92 (6): 821-830.CrossRefPubMedPubMedCentral
32.
go back to reference D'hondt NE, Struijs PA, Kerkhoffs GM, Verheul C, Lysens R, Aufdemkampe G, Van Dijk CN: Orthotic devices for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2002, 1: CD002267 D'hondt NE, Struijs PA, Kerkhoffs GM, Verheul C, Lysens R, Aufdemkampe G, Van Dijk CN: Orthotic devices for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2002, 1: CD002267
33.
go back to reference Warden SJ, Hinman RS, Watson MA, Avin KG, Bialocerkowski AE, Crossley KM: Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Rheum. 2008, 15; 59 (1): 73-83.CrossRef Warden SJ, Hinman RS, Watson MA, Avin KG, Bialocerkowski AE, Crossley KM: Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Rheum. 2008, 15; 59 (1): 73-83.CrossRef
36.
go back to reference Gluckert K, Kladny B, Blank-Schal A, Hofmann G: MRI of the knee joint with a 3-D gradient echo sequence. Equivalent to diagnostic arthroscopy?. Arch Orthop Trauma Surg. 1992, 112 (1): 5-12.CrossRefPubMed Gluckert K, Kladny B, Blank-Schal A, Hofmann G: MRI of the knee joint with a 3-D gradient echo sequence. Equivalent to diagnostic arthroscopy?. Arch Orthop Trauma Surg. 1992, 112 (1): 5-12.CrossRefPubMed
37.
go back to reference Clark DI, Downing N, Mitchell J, Coulson L, Syzpryt EP, Doherty M: Physiotherapy for anterior knee pain: a randomised controlled trial. Ann Rheum Dis. 2000, 59: 700-704.CrossRefPubMedPubMedCentral Clark DI, Downing N, Mitchell J, Coulson L, Syzpryt EP, Doherty M: Physiotherapy for anterior knee pain: a randomised controlled trial. Ann Rheum Dis. 2000, 59: 700-704.CrossRefPubMedPubMedCentral
39.
go back to reference Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O: Scoring of patellofemoral disorders. Arthroscopy. 1993, 9: 159-163.CrossRefPubMed Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O: Scoring of patellofemoral disorders. Arthroscopy. 1993, 9: 159-163.CrossRefPubMed
41.
go back to reference Kessler S, Lang S, Puhl W, Stöve J: [Knee Injury and Osteoarthritis Outcome Score–a multifunctional questionnaire to measure outcome in knee arthroplasty]. Z Orthop Ihre Grenzgeb. 2003, 141 (3): 277-282.CrossRefPubMed Kessler S, Lang S, Puhl W, Stöve J: [Knee Injury and Osteoarthritis Outcome Score–a multifunctional questionnaire to measure outcome in knee arthroplasty]. Z Orthop Ihre Grenzgeb. 2003, 141 (3): 277-282.CrossRefPubMed
42.
go back to reference Mason M, Keays SL, Newcombe PA: The effect of taping, quadriceps strengthening and stretching prescribed separately or combined on patellofemoral pain. Physiother Res Int. 2011, 16 (2): 109-119.CrossRefPubMed Mason M, Keays SL, Newcombe PA: The effect of taping, quadriceps strengthening and stretching prescribed separately or combined on patellofemoral pain. Physiother Res Int. 2011, 16 (2): 109-119.CrossRefPubMed
43.
go back to reference Swart NM, Van Linschoten R, Bierma-Zeinstra SM, Van Middelkoop M: The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2012, 46 (8): 570-577.CrossRefPubMed Swart NM, Van Linschoten R, Bierma-Zeinstra SM, Van Middelkoop M: The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2012, 46 (8): 570-577.CrossRefPubMed
Metadata
Title
The Patella Pro study — effect of a knee brace on patellofemoral pain syndrome: design of a randomized clinical trial (DRKS-ID:DRKS00003291)
Authors
Wolf Petersen
Andree Ellermann
Ingo Volker Rembitzki
Sven Scheffler
Mirco Herbort
Frederike Sophie Sprenker
Andrea Achtnich
Gert Peter Brüggemann
Raymond Best
Frank Hoffmann
Andreas Gösele Koppenburg
Christian Liebau
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-200

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