As clinicians, we are not only in search of optimal treatments for our patients, but also are in search of patient-specific factors that will influence the patient response to treatment. Hott and colleagues published such prognostic factors in patellofemoral pain in their study, “Predictors of pain, function, and change in patellofemoral pain,” published in AJSM in 2019. Psychologic factors have been found to have a profound effect on patient outcomes in diverse fields as arthroplasty, ACL surgery and back pain and thus, it is no surprise to see a similar effect when treating patellofemoral pain.
Pain is the central perception of a peripheral nociceptive signal. While the nociceptive signal may be triggered by similar pathologies in two patients, ultimately their central processing is the key to their perception of pain. Treating these two patients with the same peripheral (patellofemoral) approach is likely to produce differing outcomes. Understanding who will and who won’t respond to treatment may allow a more in-depth discussion at the onset of treatment to assure expectations are realistic.
Most physicians who have practiced more than a few years have developed a “sixth sense” as to which patients will respond to treatment. Studies in arthroplasty and back pain have shown that patients with depression, pain amplification/catastrophic thinking and poor outlook on life in general do worse than those without depression, who have a graded response to nociceptive stimuli and have a positive outlook on life.
Hott and colleagues compared two patellofemoral pain groups treated with an education and exercise-based intervention. They found that the most consistent predictor of pain, function and patient-reported outcome changes at 1 year was the number of pain sites in the patient’s body, as well as longer pain duration and lower self-efficacy. This study further supports a wholistic approach when treating the patellofemoral pain patient as in certain patients, this could even mean enlisting the aid of psychological experts.
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Jack Farr, MD -
Professor of orthopedic surgery, Indiana University School of Medicine
OrthoIndy Center for Joint Preservation, Cartilage Regeneration and OrthoBiologics/Regenerative Medicine
Knee section
Patellofemoral subsection
Indianapolis
Disclosures: Farr reports no relevant financial disclosures.
