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Patellofemoral pain (PFP) remains one of the most common conditions encountered in sports medicine. Characterised by anterior knee pain that is aggravated by activities such as running, squatting and stair ambulation; PFP generally reduces or restricts physical activity. While PFP may subside with activity reduction, the natural history of this common condition is not one of spontaneous recovery. Indeed, PFP is often recalcitrant and can persist for many years. In a prospective study of people with PFP, symptoms persisted in 25% of people up to 20 years.1 Despite considerable evidence for the efficacy of conservative interventions for PFP, such as multimodal physiotherapy,2 these interventions do not appear to have long-lasting effects.2 Compounding the management of PFP is that surgery for PFP is widely considered to have poor outcomes.
Are PFP and osteoarthritis on a disease continuum?
As mentioned in the 2014 consensus statement from the International Patellofemoral Pain Research Retreat3 there is speculation that PFP may be a prelude to degenerative joint changes and ultimately the development of patellofemoral osteoarthritis (PFOA).4 ,5 While no current studies have prospectively studied people with PFP through to the development of PFOA (and thus verify this relationship), a recent systematic review4 observed that individuals undergoing arthroplasty for PFOA were more than twice as likely (OR=2.31, 95% CI 1.37 to 3.88) to report having had PFP as an adolescent than patients undergoing an arthroplasty for isolated tibiofemoral OA.
In the absence of rigorous …
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