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. 2023 Nov 23;40(4):589-595.
doi: 10.1093/fampra/cmad087.

Patellofemoral pain in general practice: the incidence and management

Guido J van Leeuwen  1 , Evelien I T de Schepper  1 , Patrick J E Bindels  1 , Sita M A Bierma-Zeinstra  1   2 , Marienke van Middelkoop  1
Affiliations

Patellofemoral pain in general practice: the incidence and management

Guido J van Leeuwen et al. Fam Pract. .

Abstract

Background: Patellofemoral pain (PFP) is a nontraumatic knee problem primarily observed in physically active adolescents. The objective of this study was to determine the incidence and management of PFP in children and adolescents in general practice.

Methods: A retrospective cohort study was conducted using a regional primary care database containing full electronic health records of over 300,000 patients. Patients with a new PFP diagnosis between the years 2013 and 2019 were extracted using a search algorithm based on International Classification of Primary Health Care coding and search terms in free text. Data on the management of PFP were manually checked and analysed. In addition, a sub-analysis for chronic and nonchronic PFP patients was performed.

Results: The mean incidence of PFP over the study period was 3.4 (95% CI 3.2-3.6) per 1,000 person years in the age group of 7-24 years. Girls had a higher incidence rate (4.6 [95% CI 4.3-5.0]) compared to boys (2.3 [95% CI 2.1-2.5]). Peak incidence was at age 13 years for both sexes. The most commonly applied management strategy was advice (55.1%), followed by referral to physiotherapy (28.2%), analgesics prescription (10.4%), and referral to the orthopaedic surgeon (8.9%). No differences were found in age, sex, and treatment between chronic and nonchronic PFP patients.

Conclusions: The average Dutch general practitioner sees approximately 1.4 new child or adolescent with PFP per year. Overall management strategies were in concordance with current Dutch general practice guideline on nontraumatic knee problems. More insight should be gained in the population with chronic complaints.

Keywords: adolescents; cohort studies; epidemiology; general practice; incidence; knee; management; patellofemoral pain; primary health care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Incidence of patellofemoral pain per age group during the years 2013–2019. The incidence of patellofemoral pain per age group (7–24 years).
Fig. 2.
Fig. 2.
Overview of applied management strategies during all consultations. Overview of the different applied management strategies in all consultations and in the total amount of consultations (range 1–9). Because of a low number of patients consultation 5–9 were combined. A detailed overview with exact percentages can be found in Supplementary Table 1. *Patients could receive more than one intervention per consultation, therefore the total of patients in these cells does not add up to 100%.).
Fig. 3.
Fig. 3.
Hierarchical visualization of the management of patellofemoral pain per consultation (2013–2019). The inner circle represents the policy in the first consultation (N = 1,030 patients). The second circle represents the policy in the second consultation (N = 306) and the third circle represents the policy in the third consultation (N = 116). Percentages are based on the management in the first consultation. Patients could be treated according to more than one policy; consequently, the total percentage may exceed 100%.
See this image and copyright information in PMC

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