Stratification of patellofemoral pain using clinical, biomechanical and imaging features

Patellofemoral pain (PFP) is a common musculoskeletal complaint and the efficacy of current therapies aimed at PFP is limited. The aetiology of PFP is widely considered to be multifactorial and as a result the clinical presentation is often heterogeneous. In an attempt to address this issue, an international PFP consensus statement, published in 2013, highlighted the need to sub-group patients with PFP to enable more stratified interventions.

A multi-methodological approach was used in this thesis. A systematic review of the existing imaging literature in PFP demonstrated that PFP is associated with a number of imaging features in particular MRI bisect offset and CT congruence angle and that some of these features should be modifiable with conservative treatment. A retrospective analysis investigating the overall 3D shape and 3D equivalents of commonly used PFJ imaging features demonstrated no differences between a group with and without PFP, challenging the current perceptions on the structural associations to PFP. A cross-sectional cluster analysis using modifiable clinical, biomechanical and imaging features identified four subgroups that are present in PFP cohort with a Weak group showing the worst prognosis at 12 months. Lastly, a pragmatic randomised controlled feasibility study comparing matched treatment to usual care management showed that matching treatment to a specific subgroup is feasible in terms of adherence, retention and conversion to consent.

In summary, the findings of this thesis improves our understanding of the structural associations to PFP; the subgroups that exist within the PFP population; the natural prognosis of these PFP subgroups; and the feasibility of targeting treatment at PFP subgroups within a clinical trial.