Predictors and effects of patellofemoral pain following hamstring-tendon ACL reconstruction

Adam G Culvenor; Natalie J Collins; Bill Vicenzino; Jill L Cook; Timothy S Whitehead; Hayden G Morris; Kay M Crossley

doi:10.1016/j.jsams.2015.07.008

Predictors and effects of patellofemoral pain following hamstring-tendon ACL reconstruction

J Sci Med Sport. 2016 Jul;19(7):518-23. doi: 10.1016/j.jsams.2015.07.008. Epub 2015 Jul 10.

Authors

Adam G Culvenor¹, Natalie J Collins², Bill Vicenzino³, Jill L Cook⁴, Timothy S Whitehead⁵, Hayden G Morris⁶, Kay M Crossley⁷

Affiliations

¹ The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Australia; La Trobe University, Department of Physiotherapy, School of Allied Health, College of Science, Health and Engineering, Australia.
² The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Australia; The University of Melbourne, Department of Mechanical Engineering, Australia.
³ The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Australia.
⁴ Monash University, Department of Physiotherapy, School of Primary Health Care, Australia.
⁵ Epworth Healthcare, Australia.
⁶ The University of Melbourne, Department of Physiotherapy, Melbourne School of Health Sciences, Australia.
⁷ The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Australia; La Trobe University, Department of Physiotherapy, School of Allied Health, College of Science, Health and Engineering, Australia. Electronic address: k.crossley@latrobe.edu.au.

PMID: 26205774
DOI: 10.1016/j.jsams.2015.07.008

Abstract

Objectives: Patellofemoral pain is a frequent and troublesome complication following anterior cruciate ligament reconstruction (ACLR), irrespective of graft source. Yet, little is known about the factors associated with patellofemoral pain following hamstring-tendon ACLR.

Design: Retrospective analysis of potential patellofemoral pain predictors, and cross-sectional analysis of possible patellofemoral pain consequences.

Methods: Potential predictors (pre-injury patellofemoral pain and activity level, concomitant patellofemoral cartilage damage and meniscectomy, age, sex, and surgical delay) and consequences (hopping performance, quality of life, kinesiophobia, and return to sport rates and attitudes) of patellofemoral pain 12 months following hamstring-tendon ACLR were assessed in 110 participants using univariate and multivariate analyses.

Results: Thirty-three participants (30%) had patellofemoral pain at 12 months post-ACLR. Older age at the time of ACLR was the only predictor of post-operative patellofemoral pain. Following ACLR, those with patellofemoral pain had a higher body mass index, and worse physical performance, quality of life, kinesiophobia and return to sport attitudes. Patellofemoral pain has a significant burden on individuals 12 months following hamstring-tendon ACLR.

Conclusions: Clinicians need to be cognisant of patellofemoral pain, particularly in older individuals and those with a higher body mass index. The importance of considering psychological factors that are not typically addressed during ACLR rehabilitation, such as kinesiophobia, quality of life and return to sport attitudes is emphasised.

Keywords: Anterior knee pain; Kinesiophobia; Quality of life; Rehabilitation; Return to sport.

MeSH terms

Adolescent
Adult
Age Factors
Analysis of Variance
Anterior Cruciate Ligament Reconstruction / adverse effects*
Female
Hamstring Tendons / transplantation*
Humans
Male
Middle Aged
Patellofemoral Joint / physiopathology
Patellofemoral Pain Syndrome / etiology*
Patellofemoral Pain Syndrome / physiopathology
Postoperative Complications* / physiopathology
Quality of Life
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Young Adult