Ön Diz Ağrısı ve Fizyoterapisi
Özet
Ön diz ağrısı, hem sporcularda hem de sedanter bireylerde sık karşılaşılan kas-iskelet yakınmalarındandır ve olguların önemli bir bölümü patellofemoral ağrı sendromu (PFAS) ile ilişkilidir. Vücudun en büyük sesamoid kemiği olan patella, ekstansör mekanizmanın moment kolunu uzatarak kuadriseps verimliliğini artırır; patella ile femoral troklea arasındaki eklemleşme uyumu, diz fleksiyon ve ekstansiyonu boyunca temas alanını ve yük dağılımını belirler. Bu uyumun bozulması eklem kıkırdağında lezyon gelişimine ve ağrıya zemin hazırlar. Tanı, ayrıntılı öykünün çömelme, merdiven inip çıkma ve uzun süreli oturma gibi provokatif yüklenmelerle birlikte değerlendirilmesine dayanır; hastalar ICF temelli dört alt gruba ayrılabilir: aşırı kullanım/aşırı yüklenme, kas performansı eksikliği, hareket koordinasyonu eksikliği ve mobilite bozukluğu. Yönetimin merkezinde egzersiz terapisi yer alır; kalça ve diz kaslarını birlikte kuvvetlendirmeyi hedefleyen 6-12 haftalık yapılandırılmış programlar yalnızca diz odaklı programlardan üstündür. Ayak ortezleri, patellar bantlama, manuel terapi ile yürüyüş ve koşu paterninin yeniden eğitimi klinik bulgulara göre seçilen destekleyici seçeneklerdir; elektrofiziksel ajanların rutin kullanımı önerilmez. Tanıdan ortalama dört yıl sonra hastaların %94'ünde ağrı yeniden semptom olarak bildirilmektedir. Bu nedenle, hasta eğitimini ve izleme dayalı bireyselleştirilmiş uzun dönem rehabilitasyon yönetimi olması gerektiği önerilmektedir.
Anterior knee pain is a common musculoskeletal complaint in both athletes and sedentary individuals, and a significant proportion of cases are associated with patellofemoral pain syndrome (PFPS). The patella, the body's largest sesamoid bone, increases quadriceps efficiency by extending the lever arm of the extensor mechanism; its articulation with the femoral trochlea determines contact area and load distribution throughout knee flexion and extension. Disruption of this alignment leads to articular cartilage lesions and pain. Diagnosis is based on a detailed history assessed together with provocative loading tests such as squatting, stair climbing and prolonged sitting; patients can be categorised into four ICF-based subgroups: overuse/overloading, impaired muscle performance, impaired movement coordination and mobility impairment. Exercise therapy is at the heart of management; structured 6–12 week programmes strengthening both hip and knee muscles are superior to knee-focused programmes. Foot orthoses, patellar taping, manual therapy and re-education of walking and running patterns are supportive options selected according to clinical findings, whereas routine use of electro-physical agents is not recommended. Since 94 per cent of patients still report pain four years after diagnosis, management should consist of patient education and individualised long-term rehabilitation based on regular monitoring.
Referanslar
Wheatley MGA, Rainbow MJ, Clouthier AL. Patellofemoral Mechanics: a Review of Pathomechanics and Research Approaches. Curr Rev Musculoskelet Med. 2020 Jun 1;13(3):326. doi:10.1007/S12178-020-09626-Y PubMed PMID: 32394363.
Esmer AF, Başarır K, Binnet M. Diz ekleminin cerrahi anatomisi. TOTBİD Derleme Dergisi [Internet]. 2011 Jun 2 [cited 2026 Jun 22];10(1):038–44. Available from: https://totbidderlemedergisi.org/abstract.php?lang=en&id=206
KAYA SS, KARAGÖZ A, NACIR B, DUYUR ÇAKIT B. The Association Between Patellofemoral Pain Syndrome and Lower Extremity Biomechanics. Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi. 2018;21(1):22–8. doi:10.31609/JPMRS.2017-58440
Vora M, Curry E, Chipman A, Matzkin E, Li X. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options. Orthop Rev (Pavia). 2018;9(4):7281. doi:10.4081/OR.2017.7281 PubMed PMID: 29564075.
Koçak C, Yıldırım AÖ. Patella kırıklarında tedavi yaklaşımları ve patellektominin tedavideki yeri. TOTBİD Derleme Dergisi. 2018 Jun 7;17(4):381–5. doi:10.14292/TOTBID.DERGISI.2018.49
Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc. 2006 Mar;14(3):235–40. doi:10.1007/S00167-005-0683-0 PubMed PMID: 16254736.
Loudon JK. BIOMECHANICS AND PATHOMECHANICS OF THE PATELLOFEMORAL JOINT. Int J Sports Phys Ther. 2016 Dec;11(6):820. PubMed PMID: 27904787.
Sherman SL, Plackis AC, Nuelle CW. Patellofemoral anatomy and biomechanics. Clin Sports Med. 2014;33(3):389–401. doi:10.1016/j.csm.2014.03.008 PubMed PMID: 24993406.
Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane. A clinical analysis. Am J Sports Med. 1994;22(1):61–6. doi:10.1177/036354659402200111 PubMed PMID: 8129112.
Cleather DJ. The patella: A mechanical determinant of coordination during vertical jumping. J Theor Biol. 2018 Jun 7;446:205–11. doi:10.1016/j.jtbi.2018.03.013 PubMed PMID: 29548734.
Lankhorst NE, Van Middelkoop MM, Crossley KM, Bierma-Zeinstra SMA, Oei EHG, Vicenzino B, et al. Factors that predict a poor outcome 5-8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis. Br J Sports Med. 2016 Jul 1;50(14):881–6. doi:10.1136/BJSPORTS-2015-094664 PubMed PMID: 26463119.
Rathleff MS, Rathleff CR, Olesen JL, Rasmussen S, Roos EM. Is Knee Pain During Adolescence a Self-limiting Condition? Prognosis of Patellofemoral Pain and Other Types of Knee Pain. Am J Sports Med. 2016 May 1;44(5):1165–71. doi:10.1177/0363546515622456 PubMed PMID: 26792702.
Yamada Y, Toritsuka Y, Horibe S, Sugamoto K, Yoshikawa H, Shino K. In vivo movement analysis of the patella using a three-dimensional computer model. J Bone Joint Surg Br. 2007 Jun;89(6):752–60. doi:10.1302/0301-620X.89B6.18515 PubMed PMID: 17613499.
van Kampen A, Huiskes R. The three-dimensional tracking pattern of the human patella. J Orthop Res. 1990;8(3):372–82. doi:10.1002/JOR.1100080309 PubMed PMID: 2324856.
Nagamine R, Otani T, White SE, McCarthy DS, Whiteside LA. Patellar tracking measurement in the normal knee. J Orthop Res. 1995;13(1):115–22. doi:10.1002/JOR.1100130117 PubMed PMID: 7853092.
Nakagawa S, Kadoya Y, Kobayashi A, Tatsumi I, Nishida N, Yamano Y. Kinematics of the patella in deep flexion. Analysis with magnetic resonance imaging. J Bone Joint Surg Am. 2003 Jul 1;85(7):1238–42. doi:10.2106/00004623-200307000-00009 PubMed PMID: 12851348.
Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017 Dec 1;51(24):1713–23. doi:10.1136/BJSPORTS-2017-098717 PubMed PMID: 29109118.
Weiss K, Whatman C. Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports. Sports Med. 2015 Sep 17;45(9):1325–37. doi:10.1007/S40279-015-0353-4 PubMed PMID: 26130304.
Liao TC, Yin L, Powers CM. The influence of isolated femur and tibia rotations on patella cartilage stress: a sensitivity analysis. Clinical Biomechanics. 2018 May 1;54:125–31. doi:10.1016/j.clinbiomech.2018.03.003 PubMed PMID: 29579721.
Ho KY, Hu HH, Colletti PM, Powers CM. Running-induced patellofemoral pain fluctuates with changes in patella water content. Eur J Sport Sci. 2014;14(6):628–34. doi:10.1080/17461391.2013.862872 PubMed PMID: 24283889.
Farrokhi S, Keyak JH, Powers CM. Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: A finite element analysis study. Osteoarthritis Cartilage. 2011 Mar;19(3):287–94. doi:10.1016/j.joca.2010.12.001 PubMed PMID: 21172445.
Fregly BJ, Banks SA, D’Lima DD, Colwell CW. Sensitivity of knee replacement contact calculations to kinematic measurement errors. J Orthop Res. 2008 Sep;26(9):1173–9. doi:10.1002/JOR.20548 PubMed PMID: 18383141.
Baldwin JL, House CK. Anatomic dimensions of the patella measured during total knee arthroplasty. Journal of Arthroplasty. 2005;20(2):250–7. doi:10.1016/j.arth.2004.09.027 PubMed PMID: 15902866.
Wibeeg G. Roentgenographs and Anatomic Studies on the Femoropatellar Joint: With Special Reference to Chondromalacia Patellae. Acta Orthop. 1941 Jan 1;12(1–4):319–410. doi:10.3109/17453674108988818
Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P. Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):663–70. doi:10.1007/S00167-010-1329-4 PubMed PMID: 21153544.
Neyret P, Robinson AHN, Le Coultre B, Lapra C, Chambat P. Patellar tendon length - The factor in patellar instability? Knee. 2002;9(1):3–6. doi:10.1016/S0968-0160(01)00136-3 PubMed PMID: 11830373.
Pal S, Besier TF, Beaupre GS, Fredericson M, Delp SL, Gold GE. Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study. J Orthop Res. 2013 Mar;31(3):448–57. doi:10.1002/JOR.22256 PubMed PMID: 23165335.
Arendt EA, Askenberger M, Agel J, Tompkins MA. Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables. Am J Sports Med. 2018 Dec 1;46(14):3385–90. doi:10.1177/0363546518803936 PubMed PMID: 30398902.
Ambra LF, Hinckel BB, Arendt EA, Farr J, Gomoll AH. Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study. Am J Sports Med. 2019 Aug 1;47(10):2444–53. doi:10.1177/0363546519859320 PubMed PMID: 31287712.
Stefanik JJ, Zhu Y, Zumwalt AC, Gross KD, Clancy M, Lynch JA, et al. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken). 2010;62(9):1258–65. doi:10.1002/ACR.20214 PubMed PMID: 20506169.
van Middelkoop M, Bennell KL, Callaghan MJ, Collins NJ, Conaghan PG, Crossley KM, et al. International patellofemoral osteoarthritis consortium: Consensus statement on the diagnosis, burden, outcome measures, prognosis, risk factors and treatment. Semin Arthritis Rheum. 2018 Apr 1;47(5):666–75. doi:10.1016/j.semarthrit.2017.09.009 PubMed PMID: 29056348.
Lewallen L, McIntosh A, Dahm D. First-Time Patellofemoral Dislocation: Risk Factors for Recurrent Instability. J Knee Surg. 2015 Aug 1;28(4):303–9. doi:10.1055/S-0034-1398373 PubMed PMID: 25633361.
Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc. 2014 Sep 1;22(10):2308–14. doi:10.1007/S00167-013-2650-5 PubMed PMID: 24005331.
Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med. 2015 Apr 4;43(4):921–7. doi:10.1177/0363546514563904 PubMed PMID: 25587185.
Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am. 2007;89(8):1749–55. doi:10.2106/JBJS.F.00508 PubMed PMID: 17671014.
Watson NA, Duchman KR, Grosland NM, Bollier MJ. Finite Element Analysis of Patella Alta: A Patellofemoral Instability Model. Iowa Orthop J. 2017;37:101. PubMed PMID: 28852343.
Ward SR, Powers CM. The influence of patella alta on patellofemoral joint stress during normal and fast walking. Clinical Biomechanics. 2004 Dec;19(10):1040–7. doi:10.1016/j.clinbiomech.2004.07.009 PubMed PMID: 15531054.
Luyckx T, Didden K, Vandenneucker H, Labey L, Innocenti B, Bellemans J. Is there a biomechanical explanation for anterior knee pain in patients with patella alta? Influence of patellar height on patellofemoral contact force, contact area and contact pressure. Journal of Bone and Joint Surgery - Series B. 2009 Mar 1;91(3):344–50. doi:10.1302/0301-620X.91B3.21592/LETTERTOEDITOR PubMed PMID: 19258610.
Lenhart RL, Kaiser J, Smith CR, Thelen DG. Prediction and Validation of Load-Dependent Behavior of the Tibiofemoral and Patellofemoral Joints During Movement. Ann Biomed Eng. 2015 Nov 1;43(11):2675–85. doi:10.1007/S10439-015-1326-3 PubMed PMID: 25917122.
Steiner TM, Torga-Spak R, Teitge RA. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med. 2006 Aug;34(8):1254–61. doi:10.1177/0363546505285584 PubMed PMID: 16567459.
Nha KW, Papannagari R, Gill TJ, Van De Velde SK, Freiberg AA, Rubash HE, et al. In vivo patellar tracking: clinical motions and patellofemoral indices. J Orthop Res. 2008 Aug;26(8):1067–74. doi:10.1002/JOR.20554 PubMed PMID: 18327809.
Sheehan FT, Derasari A, Brindle TJ, Alter KE. Understanding patellofemoral pain with maltracking in the presence of joint laxity: complete 3D in vivo patellofemoral and tibiofemoral kinematics. J Orthop Res. 2009 May;27(5):561–70. doi:10.1002/JOR.20783 PubMed PMID: 19009601.
Lin F, Wilson NA, Makhsous M, Press JM, Koh JL, Nuber GW, et al. In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain. J Biomech. 2010 Jan 19;43(2):235–41. doi:10.1016/J.JBIOMECH.2009.08.043 PubMed PMID: 19878947.
Fulkerson JP. Patellofemoral Pain Disorders: Evaluation and Management. J Am Acad Orthop Surg. 1994 Mar;2(2):124–32. doi:10.5435/00124635-199403000-00006 PubMed PMID: 10709000.
Kujala UM, Osterman K, Kormano M, Nelimarkka O, Hurme M, Taimela S. Patellofemoral relationships in recurrent patellar dislocation. J Bone Joint Surg Br. 1989;71(5):788–92. doi:10.1302/0301-620X.71B5.2584248 PubMed PMID: 2584248.
Hochreiter B, Hess S, Moser L, Hirschmann MT, Amsler F, Behrend H. Healthy knees have a highly variable patellofemoral alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2020 Feb 1;28(2):398–406. doi:10.1007/S00167-019-05587-Z PubMed PMID: 31256215.
Keser S, Savranlar A, Bayar A, Ege A, Turhan E. Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 2008 Oct;16(10):911–5. doi:10.1007/S00167-008-0571-5 PubMed PMID: 18553069.
Biyani R, Elias JJ, Saranathan A, Feng H, Guseila LM, Morscher MA, et al. Anatomical factors influencing patellar tracking in the unstable patellofemoral joint. Knee Surg Sports Traumatol Arthrosc. 2014 Sep 1;22(10):2334–41. doi:10.1007/S00167-014-3195-Y PubMed PMID: 25063490.
Macri EM, Stefanik JJ, Khan KK, Crossley KM. Is Tibiofemoral or Patellofemoral Alignment or Trochlear Morphology Associated With Patellofemoral Osteoarthritis? A Systematic Review. Arthritis Care Res (Hoboken). 2016 Oct 1;68(10):1453–70. doi:10.1002/ACR.22842 PubMed PMID: 26814979.
Mofidi A, Veravalli K, Jinnah RH, Poehling GG. Association and impact of patellofemoral dysplasia on patellofemoral arthropathy and arthroplasty. Knee. 2014;21(2):509–13. doi:10.1016/j.knee.2013.09.009 PubMed PMID: 24417902.
Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One. 2018 Jan 1;13(1):e0190892. doi:10.1371/JOURNAL.PONE.0190892 PubMed PMID: 29324820.
Yılmaz B, Çiçek ED, Şirin E, Özdemir G, Karakuş Ö, Muratlı HH. A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation. Clin Imaging. 2017 Mar 1;42:83–7. doi:10.1016/j.clinimag.2016.11.010 PubMed PMID: 27894010.
Kaiser P, Loth F, Attal R, Kummann M, Schuster P, Riechelmann F, et al. Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle-trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion. Knee Surg Sports Traumatol Arthrosc. 2020 Mar 1;28(3):952–9. doi:10.1007/S00167-019-05588-Y PubMed PMID: 31267191.
Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM. Association Between Measures of Patella Height, Morphologic Features of the Trochlea, and Patellofemoral Joint Alignment: The MOST Study. Clin Orthop Relat Res. 2013;471(8):2641. doi:10.1007/S11999-013-2942-6 PubMed PMID: 23546847.
Van Haver A, De Roo K, De Beule M, Labey L, De Baets P, Dejour D, et al. The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med. 2015 Jun 3;43(6):1354–61. doi:10.1177/0363546515572143 PubMed PMID: 25740833.
Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev. 2007 Mar;15(1):39–46. doi:10.1097/JSA.0B013E31803035AE PubMed PMID: 17301701.
Fitzpatrick CK, Steensen RN, Tumuluri A, Trinh T, Bentley J, Rullkoetter PJ. Computational analysis of factors contributing to patellar dislocation. J Orthop Res. 2016 Mar 1;34(3):444–53. doi:10.1002/JOR.23041 PubMed PMID: 26331373.
Clouthier AL, Smith CR, Vignos MF, Thelen DG, Deluzio KJ, Rainbow MJ. The effect of articular geometry features identified using statistical shape modelling on knee biomechanics. Med Eng Phys. 2019 Apr 1;66:47–55. doi:10.1016/J.MEDENGPHY.2019.02.009 PubMed PMID: 30850334.
Delgado-Martínez AD, Rodríguez-Merchán EC, Ballesteros R, Luna JD. Reproducibility of patellofemoral CT scan measurements. Int Orthop. 2000;24(1):5–8. doi:10.1007/S002640050002 PubMed PMID: 10774853.
Walker C, Cassar-Pullicino VN, Vaisha R, McCall IW. The patello-femoral joint--a critical appraisal of its geometric assessment utilizing conventional axial radiography and computed arthro-tomography. Br J Radiol. 1993;66(789):755–61. doi:10.1259/0007-1285-66-789-755 PubMed PMID: 8220942.
Nomura E, Inoue M, Kobayashi S. Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy. 2006 Aug 1;22(8):861–5. doi:10.1016/J.ARTHRO.2006.04.090 PubMed PMID: 16904584.
Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev. 2007 Jun;15(2):48–56. doi:10.1097/JSA.0B013E318053EB74 PubMed PMID: 17505317.
Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003 Sep;10(3):215–20. doi:10.1016/S0968-0160(03)00006-1 PubMed PMID: 12893142.
Conlan T, Garth WP, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am. 1993;75(5):682–93. doi:10.2106/00004623-199305000-00007 PubMed PMID: 8501083.
Neri T, Parker DA, Beach A, Gensac C, Boyer B, Farizon F, et al. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2019 Mar 14;27(3):805–13. doi:10.1007/S00167-018-5102-4 PubMed PMID: 30167754.
Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop. 1999;23(5):260–3. doi:10.1007/S002640050366 PubMed PMID: 10653289.
Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994 Mar;2(1):19–26. doi:10.1007/BF01552649 PubMed PMID: 7584171.
Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children. Am J Sports Med. 2017 Jan 1;45(1):50–8. doi:10.1177/0363546516663498 PubMed PMID: 27613760.
Elias JJ, Jones KC, Lalonde MK, Gabra JN, Rezvanifar SC, Cosgarea AJ. Allowing one quadrant of patellar lateral translation during medial patellofemoral ligament reconstruction successfully limits maltracking without overconstraining the patella. Knee Surg Sports Traumatol Arthrosc. 2018 Oct 1;26(10):2883–90. doi:10.1007/S00167-017-4799-9 PubMed PMID: 29128875.
Ostermeier S, Stukenborg-Colsman C, Hurschler C, Wirth CJ. In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy. 2006 Mar;22(3):308–19. doi:10.1016/J.ARTHRO.2005.09.024 PubMed PMID: 16517316.
Stephen JM, Lumpaopong P, Dodds AL, Williams A, Amis AA. The effect of tibial tuberosity medialization and lateralization on patellofemoral joint kinematics, contact mechanics, and stability. Am J Sports Med. 2015 Jan 8;43(1):186–94. doi:10.1177/0363546514554553 PubMed PMID: 25367019.
Sakai N, Luo ZP, Rand JA, An KN. The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: An in vitro biomechanical study. Clinical Biomechanics. 2000 Jun;15(5):335–9. doi:10.1016/S0268-0033(99)00089-3 PubMed PMID: 10758294.
Van Tiggelen D, Cowan S, Coorevits P, Duvigneaud N, Witvrouw E. Delayed vastus medialis obliquus to vastus lateralis onset timing contributes to the development of patellofemoral pain in previously healthy men: a prospective study. Am J Sports Med. 2009 Jun;37(6):1099–105. doi:10.1177/0363546508331135 PubMed PMID: 19282508.
Briani RV, De Oliveira Silva D, Pazzinatto MF, De Albuquerque CE, Ferrari D, Aragão FA, et al. Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain. Clinical Biomechanics. 2015 Mar 1;30(3):302–7. doi:10.1016/j.clinbiomech.2014.12.014 PubMed PMID: 25583618.
Rathleff MS, Roos EM, Olesen JL, Rasmussen S, Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013;43(6):414–21. doi:10.2519/JOSPT.2013.4383 PubMed PMID: 23508216.
Liao TC, Keyak JH, Powers CM. Runners With Patellofemoral Pain Exhibit Greater Peak Patella Cartilage Stress Compared With Pain-Free Runners. J Appl Biomech. 2018 Aug 1;34(4):298–305. doi:10.1123/JAB.2017-0229 PubMed PMID: 29485362.
Collins NJ, Barton CJ, Van Middelkoop M, Callaghan MJ, Rathleff MS, Vicenzino BT, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018 Sep 1;52(18):1170–8. doi:10.1136/BJSPORTS-2018-099397 PubMed PMID: 29925502.
Ophey M, Koëter S, van Ooijen L, van Ark M, Boots F, Ilbrink S, et al. Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy. 2025 Feb 1;33(2):457–69. doi:10.1002/KSA.12367;ISSUE:ISSUE:DOI PubMed PMID: 39045713.
Neal BS, Lack SD, Bartholomew C, Morrissey D. Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning. Br J Sports Med. 2024 Dec 18;58(24):1486–95. doi:10.1136/BJSPORTS-2024-108110 PubMed PMID: 39401870.
Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, et al. Patellofemoral Pain. J Orthop Sports Phys Ther. 2019 Sep 1;49(9):CPG1–95. doi:10.2519/JOSPT.2019.0302 PubMed PMID: 31475628.
Eapen C, Nayak CD, Zulfeequer CP. Effect of eccentric isotonic quadriceps muscle exercises on patellofemoral pain syndrome: an exploratory pilot study. Asian J Sports Med. 2011;2(4):227–34. doi:10.5812/ASJSM.34747 PubMed PMID: 22375243.
Raju A, Jayaraman K, Nuhmani S, Sebastian S, Khan M, Alghadir AH. Effects of hip abductor with external rotator strengthening versus proprioceptive training on pain and functions in patients with patellofemoral pain syndrome: A randomized controlled trial. Medicine. 2024 Feb 16;103(7):E37102. doi:10.1097/MD.0000000000037102 PubMed PMID: 38363950.
Halabi MH, Alturkistani BA, Abuhadi RH, Garout AN, Almuqbil FB, Alshehri MS. The Efficacy of Hip and Knee Muscles Strengthening Versus Knee Muscle Strengthening Alone in Managing Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis. Musculoskeletal Care. 2025 Mar 1;23(1). doi:10.1002/MSC.70059 PubMed PMID: 39934098.
Xie P, István B, Liang M. The Relationship between Patellofemoral Pain Syndrome and Hip Biomechanics: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 Jan 1;11(1). doi:10.3390/HEALTHCARE11010099 PubMed PMID: 36611559.
Nascimento LR, Teixeira-Salmela LF, Souza RB, Resende RA. Hip and knee strengthening is more effective than knee strengthening alone for reducing pain and improving activity in individuals with patellofemoral pain: A systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 2018 Jan 1;48(1):19–31. doi:10.2519/JOSPT.2018.7365 PubMed PMID: 29034800.
Collins NJ, Barton CJ, Van Middelkoop M, Callaghan MJ, Rathleff MS, Vicenzino BT, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018 Sep 1;52(18):1170–8. doi:10.1136/BJSPORTS-2018-099397 PubMed PMID: 29925502.
Santos TRT, Oliveira BA, Ocarino JM, Holt KG, da Fonseca ST. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther. 2015 Jul 14;19(3):167–76. doi:10.1590/BJPT-RBF.2014.0089 PubMed PMID: 26039034.
