Condition Of The Lumbopelvic Region Or Lower Extremity: Anterior Knee Pain - Essay Example

Condition of the Lumbopelvic Region or Lower Extremity: Anterior Knee Pain Student name: Unit name: Course name Submission date: Introduction Anterior knee pain is a musculoskeletal pain that occurs at front part and centre of the knee. The anterior knee pains are mainly due to the irritation of the patellafemoral (Biedert & Sanchis 2007, p. 337). There are different problems associated with the anterior knee pain. Examples of the problems include:chondromalacia which occurs by softening and subsequent breakdown of cartilage on the underside of the patella. The anterior knee pain can also be due to the problem of tendinitis commonly referred to as runner’s knee. According to Baker et al (2002, p.210\)Anterior knee pain will be will be felt when the patella cannot move properly which results to itcausing friction with the lower side of the thigh bone. This happens when the kneecap is either abnormally positioned or there happens to be muscle weakness or tightness on the back or front of the thigh. The pain also occurs when there is a lot of stress placed on the kneecap, for example when one is jumpingor running. A high frequency of occurrence of knee pain at the anterior has been recorded in the following groups of people: Teenage girls Sports people (soccer players, athletes, jumpers among other sports people). Overweight people People who have had fractures or related injuries to the kneecap. The frequency of occurrence is due to different factors. The aim of this paper is carry out a systematic literature review that focuses on the frequency of occurrence of the anterior knee pain. Systematic Literature Review There are myriad of researches that relate to the anterior knee pain. Clinicians have and other medical researchers have conducted many studies that point to the frequency of occurrence of knee pain. Foss et al (2012, pp. 519-525) stated that female athletes are likely to experience anterior knee pain. Foss et al carried a study to determine the occurrence of patellofemoral problems in female athletes. The research used variance diagnosis of anterior knee pain among the women athletes in their adolescence. This study was carried out during pre-participation screening of athletic activities. The research design applied in the study was descriptive epidemiology. The sample size for the study was 419 high school girls (adolescents). The 419 participants were evaluated by the specialists for over three baseball seasons. The results of the evaluations showed that over 26.8% of the evaluated cases experienced anterior knee pain. There was a substantial difference of anterior knee pain depending on the school level with high school girls presenting 34.4% compared to 23.5% in the girls from the middle level. Out of the 1376 cases that were evaluated, the common occurrence diagnosis was that of patellofemoral dysfunction with a preference of 7.3%.The study concluded that anterior knee pain occurred frequently in adolescent female girls who were screened for the three seasons, 26.6%. The comparison of this study had no much variation which could affect the validity of the inferences. The middle school girls and high school girls do not have many differences in biological, physiological and activity factors. It could have compared the girls with other athletes who much older. Anterior knee pain frequently occurs during the reconstruction of anterior cruciate ligament. Physicians attribute this pain to the repair of auto graft. Page (2001, pp. 5-13) carried a retrospective multi case analysis study. Included in the analysis werepatients with mean age of 25 years (10 men and 6 females). The analysis was performed on the patients who were undergoing anterior cruciate ligament reconstruction and carried out by the same physician (surgeon). The results of the analysis showed that of these patients had suffered from anterior knee pain in the rehabilitation course. This wasin the first six months after the reconstruction. The 50% patients confirmed to have experienced the pain were further evaluated for abductor weakness in the hip. The results found that 87.5% of the study participantswho had experienced the problem of the anterior knee pain (50%) experienced abductor weakness. The analysis of the results pointed to possibility that the abductor weakness could have led to the increased occurrence of anterior knee pain (Page 2001, pp.5-13). This study demonstrates that occurrence frequency ofanterior knee pain relates closely toother proximal structures that are linked to it. Thereforeclinicians should do assessment of muscle imbalances when assessing the cause of the pain as this could help in strategizing on how to avoid the frequency of occurrence. Selfe (2009, pp. 53-57) carried out an exploratory study to determine the evidence for the frequency of occurrence and extent of anterior knee pain. The study used different databases to carry out the literature search related to the frequencyof occurrence of the anterior knee pain. Some of the databases searched were AMED, EMASE, Ovid Medline and Ovid SP. The articles collected were then filtered in order to determine their suitability in the study. Ten studies from the articles were included for the exploratory review, these articles spanned over a duration of 22 years and focused on the incidence over the prevalence (Selfe 2009, pp.56-67). The participating groups in the study were recruits from military, athletes, students and health care patients. The study established that there was no big difference in the occurrence of the anterior knee pain across the different groups reviewed. The homogeneity across the discussed groups could be due to their physical statuses and similarity of thephysical activities across the students, military recruits and athletes. In a study to examine the influence of flexion of knee on commonness and extent of anterior knee pain after nailing, Jankovic et al (2013, pp.33-39)evaluated the rate of anterior knee pain in different patients who were undergoing intramedullary nailing to stabilize tibial fractures. This was a longitudinal study which followed the patients for varied time range. During the study the movement of knee range and its return to the previous position were recorded. The fixation of the fractures was through the medial paratenditious approach. Follow up for the patients ranged from 12 months to 87 months. The patients who were anlysed in this study were 60 and the tibial shaft fractures were 62. The mean age during the last month of follow up was 49.4 years. This was from the range of the patients’ age ranging from 20 to 87 years. The results found that 35.5% of the participants experienced anterior knee pain in the knee that was operated. The pain was categorized as mild in 19.4% and moderate in 16.1% of the patients. A significant note of the study was that between 6-12 months after the injury and the return to the recreational activities, 73% of patientsreported the anterior knee pain in the first months (6-12), the trend kept on reducing as the years proceeded (Jankovic et al 2009, pp. 33-39). Thisstudyindicates that the frequency of occurrence frequency of anterior knee pain reduces with time after intramedullary fixation of tibial fractures, i.e. it is high in the first months after fixation. The pronation of the foot has been related to occurrence ofanterior knee pain. Hetsroni et al (2006, pp.905-913) conducted a study to determine the association of frequency of occurrence of anterior knee pain and pronation of foot. This study was a prospective biomechanical study and the participants were recruits in military. The military recruits were to undertake 14 weeks training, 473 recruits were included in the study two weeks prior to the training. The displacements of subtalar joint dimensions were measured when the recruits were walking on a treadmill. Total of 405 military recruits completed the training, 15% complained of knee pain (Hetsroni et al 2006, pp. 905-913). The results showed a strong correlation of anterior knee pain and pronation velocity. However, the frequency of occurrencewas not associated to excessive pronation of foot. This research confirms that among the athletes and people involved in strenuous exercises, the anterior knee pain is likely to occur depending on the speed/activity they apply in the exercises. Tokuhara et al (2011, pp.955-960) carried a study aimed at investigating the frequency of anterior knee pain after total hip arthroplasty (THA). The study investigated the anterior knee pain in 252 patients, thus only the patientswith dysplasia of hip got admitted in the study.Assessment was carried for the anterior knee pain occurrenceafore and afterwards the THA. The study showed that there was strong association between anterior knee pain and THA. The results of the study showed that the patients included in the study 7.3%were positive anterior knee pain. THA was found to affect pattellofemoral joint through lengthening of the leg which consequently leads to anterior knee pain. The frequency of occurrence of anterior knee pain varies between men and women. According to Fulkerson and Arendt (2000, pp. 69-73) the differences in the anatomy are the causes of the difference. For instance, the females have a pelvic that is increased in width compared to men. This causes a lateral thrust that is excess on the kneecap and hence the much occurrence of anterior knee pain in women more than in men. According to Witvrouw (2009, p.483) there are connective tissues affected by estrogen, this aspect has been reported to be the likely cause of higher incidence of anterior knee pain in women than men. However, there are no scientific studies to back the association of estrogen and anterior knee pain. According to Galanty and Hergenroeder (2004, p.177) other factors such as women having their legs abducted while sitting and putting on high heeled schools could be attributing factors. The frequency of occurrence of anterior knee pain is influenced by different conditions and factors. Some of the influences include the kinesiophobia, depression and catastrophizing. Domenech, et al (2013, pp.1562-1569) carried out a research to determine the prevalence and influence of fear and catastrophizing on anterior knee pain. The study design applied was cross-sectional with 97 patients who had chronic anterior knee pain. This study was carried out in a setting of secondary healthcare. Using the Analogue Visual Scalethe anterior knee pain was measured. A questionnaire auto-administered was used to study the psychological factors which included anxiety, depression strategies to cope with the pain (Domenech et al 2013, pp.1565-1569). The results showed that incidence of psychological distress, kinesiophobia and catastrophizing influenced the occurrence of anterior knee pain. This study affirmed that the psychological variables are predictors of disability of anterior knee pain. The study is very crucial as it brings in a new perspective of biopsychosocial perspective which can be applied in management of the anterior knee pain. The frequency of occurrence of anterior knee pain has been found to be high among the sportsmen and women. Kujala et al (1989, 766-769) conducted a study to investigate the effect of volleyball playing on the extensor mechanism of the knee. This study included 32 male players of volleyball who were involved in competitive volleyball (Group V). A control study was carried and consisted of 49 adult young males (Group C). Astructured questionnaire,clinical and radiographic examination were used record the variables.A fact in the study was that the extent of physical activity was high in group V compared to group C. The incidence of knee pain was 31% in group V and 6% in group C a year before the examination. The reason behind high incidence of anterior pain was attributed to activity a situation the researcher termed as jumper knee. However, there was no quantifiable difference between the two groups in the relation to the clinical symptoms. Radiologicaly, 38% of the subjects in the experimental group (group V) had detectable soft tissue calcifications at upper patella; the control group did not show the calcifications. In addition, the experiment group showed a significant trend to alteration of patella compared to the control group. Tibial nailing increases the frequency of occurrence of anterior knee pain (LaBella 2004, p.997). This has been attributed to the possible injury of saphenous nerve. Leliveld and Verhofstad (2012, pp.779-783) conducted a study to examine the long term occurrence of damage of infrapatellar after conducting tibial nailing. The research aimed at finding the effect of tibial nailing on anterior knee pain. The research studied 71 patientsin a retrospective manner. Of these patients, intramedullary nail treatment was applied to 72 cases. The study average time of follow up was 84 months. The concluding results of the study indicated that 38% of the patients reported enduring anterior pain. Thedamage of nerve (infrapatellar) was diagnosed in 43patients who represented 60%. Of the percentagewith anterior knee pain (27 patients) 78% were confirmed to have deficit in distribution of nerves of sensory nerves. During the follow up 33 nails had to be removed, 12 of them being removed due to the reported knee pain this study concluded that injury to infrapatella nerve has a significant association to occurrence of anterior pain that is experienced after tibial nailing (Leliveld& Verhofstad, 2012). Table 1: summary of studies Examining the frequency of Occurrence of Anterior Knee Pain Author Study Design Sample Aim Findings Limitations Foss et al 2012 Descriptive epidemiology N=419 Teenage girls To determine the occurrence of patellofemoral problems in female athletes -26.8% of the evaluated cases were positive for anterior knee pain. - The study focused on the adolescent girls only. Good comparisons could thus not be achieved. Page, P. 2001 Retrospective multi case analysis N=16 (10 men, 6 men) To determine the incidence of anterior knee pain in the reconstruction of anterior cruciate ligament -50% patients had anterior knee pain The study sample was very small, therefore the validity and reliability of the results could be affected. Selfe, 2009 Exploratory study Various medical research databases (Ten studies from the articles) To determine the evidence for the incidence and prevalence of anterior knee pain No significant difference in the occurrence of the anterior knee pain across the groups The groups reviewed were homogenous there was no control study that could to provide comparisons. Jankovic et al 2013 Longitudinal study N=60 patients 62 Tibial shaft fractures -To evaluated the incidence of anterior knee pain in different patients who were undergoing intramedullary nailing to stabilize tibial fractures. -35.5% of the patients experienced anterior knee pain of the knee that was operated -19.4% experienced mild pain. -16.4% experienced moderate pain The follow was for a long time (87 months) and other factors could have led to the changes. Hetsroni et al 2006 Prospective biomechanical study N= 473 recruits in defense forces(405 completed the training) To determine the association of frequency of occurrence of anterior knee pain and foot pronation. -15% developed anterior knee pain. -There was strong correlation of anterior knee pain and pronation velocity. The study was only conducted from one centre hence cannot be termed as representative of other recruits in different centers and experiencing different conditions. Tokuhara et al 2011 Longitudinal 252 patients with dysplasia of hip To investigating the frequency of anterior knee pain after total hip arthroplasty 7.3% of patients reported anterior knee pain The study relied on the patients with dysplasia only other related conditions were excluded. Theis means that the inferences drawn could be biased and limited. Conclusion Anterior knee pain is a common occurrence that affects different people. According to Foss et al (2012, pp.519) the occurrence of anterior pain is common in teenage girls compared to the boys of similar age. A similar study carried out by Fulkerson and Arendt (2000, pp. 69-73) found that the same case applied to adult population with women showing high incidence of anterior knee pain compared to men. Anterior knee pain is also a common occurrence in sportsmen. According to Kujala et al (1989, 766-769) men involved in competitive volleyball were found to have high occurrence of anterior knee pain. There is a body of knowledge that the condition frequency of occurrence varies across age groups and genders. It is true that the frequency of anterior knee pain may vary depending on the group orientation (Biedert and Sanchis 2007,pp.2007) despite of the differences in occurrence of anterior knee pain in, the studies concur that the main cause of the anterior knee pain is usually due to alter in anatomy that could result to exertion of pressure in the patella .This alterations result from physical activities and medical procedures which interfere with the general positioning of the patella and hence anterior knee pain occurs, in addition to the changes in position, injury of nerves that relate to kneecap can lead to the occurrence of the pain (Fulkerson & Arendt 2000, pp. 69-73). Thebiopsychological factors have also been related to the anterior knee pain.From these findings it can be conclusively implied that the frequency of occurrence of anterior knee pain is caused by myriad of factors and conditions that have direct effect or relate to patellofemoral joint and knee extensor mechanisms. Vast knowledge on the frequency of occurrence of the anterior knee pain and associated causal factors can help clinicians in the treatment and management of the anterior knee pain. References Baker, V., Bennell, K., Stillman B, Cowan. S., Crossley. K. (2002). Abnormal knee joint position sense in individuals with patellofemoral pain syndrome. Journal of Orthopaedic Research, 20(2), pp.208-214. Biedert, R.M, Sanchis, A.V. 2007.Sources of anterior knee pain. Clinics in Sports Medicine 21(3), pp.335-347. Domenech, J., Sanchis, A., Vicente, L, and Espejo, B. 2013. Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients. Knee Surgery, Sports Traumatology, Arthroscopy Journal 21(7), pp. 1562-1569. Foss, K, Barber, M., Gregory, D. Chen, S and Hewett, E. 2012. Prevalence of Anterior Knee Pain in Adolescent Girls. Journal of Athletic Training 47(5), pp 519-525. Fulkerson, J.P and Arendt, E.A. 2000. Anterior Knee Pain in Females. Clinical Orthopaedic and Related Research Journal, 372(1), pp. 69-73. Galanty, H.L and Hergenroeder, A.C. 2004. Anterior knee pain in adolescents. Clinical Journal of Sports, 4 (1), pp.176-181. Hetsroni, I., Finestone, A., Milgrom, C., Sira, D., Nyska, M. and Ayalon, M. 2006. Prospective biomechanical study of association between foot pronation and incidence of anterior knee pain among military recruits. Journal of Bone and Joint Surgery, 88(7), pp. 905-913. Jankovic, A., Korac, Z., Bozic, N. and Ivan, S. 2013. Influence of knee flexion and traumatic mobilization of infrapatellar fat pad on incidence of anterior knee pain after tibial nailing. Injury 44 (1), pp.33-39. Kujala, U., Aalto, T., Osterman, K., and Ahlstroms, S. 1989. The effect of volleyball playing on the knee extensor mechanism. The American Journal of Sports Medicine, 17 (6), pp. 766- 769. Leliveld, M and Verhofstad, M, 2012. Injury to the infrapatella branch of saphenous nerve: A possible cause for anterior knee pain after tibial nailing? Injury 43 (6), pp. 779-783. LaBella, C. 2004. Patellofemoral pain syndrome: evaluation and treatment. Primary Care 2004, 31(4):977-1003. Messier, S.P., Davis, S. E., Curl, W .W., Lowery, R. B. and Pack R, J. (2007)Etiologic factors associated with patellofemoral pain in runners. Medicine & Science in Sports & Exercise 23(9):1008-1015 Page, P. 2001. Incidence of anterior knee pain in ACL Reconstruction: A retrospective multi case analysis. Journal of Athletic Training, 36(2), pp. 5-13. Selfe, J. 2009. Exploration of the Current Evidence Base for the Incidence and Prevalence of Anterior Knee Pain. Physical Therapy Reviews, 1 (1), pp., 53-57 Tokuhura, Y., Kadoya. Y., Kim, M., Shoundou, M., Kanno, T. and Masuda, T. 2011. Anterior Knee Pain after total hip arthroplasty in developmental dysplasia. The Journal of Arthroplasty, 26(6), pp. 955-960. Witvrouw, E., Lysens, R., Bellemans, J., Cambier, D. and Vanderstraeten, G. 2009. Intrinsic risk factors for the development of anterior knee painin an athletic population. A two-year prospective study. American Journal of Sports Medicine, 28(4):480-489. Read More