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The reliability and validity of assessing medio-lateral patellar position: a systematic review

PainSci » bibliography » Smith et al 2009
Tags: diagnosis, etiology, patellar pain, knee, biomechanics, pro, arthritis, aging, pain problems, leg, limbs, overuse injury, injury, running, exercise, self-treatment, treatment

Three articles on PainSci cite Smith 2009: 1. The Complete Guide to IT Band Syndrome2. The Complete Guide to Patellofemoral Pain Syndrome3. Patellofemoral Tracking Syndrome

PainSci commentary on Smith 2009: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Considering kneecap alignment is a reflex for most manual therapists — a staple of knee pain diagnosis. But is assessment of patellar alignment actually reliable? Probably not. This paper reviews nine reliability studies of 306 knees. (The authors note that this is not much evidence, and more is needed.) What evidence there is showed that assessment of patellar position was “variable” from one therapist to the next — in other words, the same patient is likely to get different diagnoses from different professionals. Patients and professionals should reconsider therapy based on assessments of patellar alignment.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Medio-lateral patellar position is regarded as a sign of patellofemoral pain syndrome and patellar instability. Its assessment is important in accurately performing patellofemoral therapeutic taping techniques. The purpose of this paper is to systematically review the literature to determine the reliability and validity of evaluating medio-lateral patellar position. An electronic database search was performed accessing AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Zetoc to July 2008. Conference proceedings and grey literature were also scrutinised for future publications. All human subject, clinical trials, assessing the inter- or intra-tester reliability, or the criterion validity, were included. A CASP tool was employed to evaluate methodological quality. Nine papers including 237 patients (306 knees) were reviewed. The findings of this review suggest that the intra-tester reliability of assessing medio-lateral patellar position is good, but that inter-tester reliability is variable. The criterion validity of this test is at worse moderate. These are based on a limited evidence-base. Further study is recommended to compare the McConnell (1986) and Herrington (2002) methods of assessing medio-lateral patellar position in patients with well-defined patellofemoral disorders.

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