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DOI: 10.1055/a-2595-4220
Klinische Untersuchung, psychosoziale Faktoren und Biomechanik bei Kindern und Jugendlichen zwischen 10 und 18 Jahren mit patellofemoralem Schmerzsyndrom
QuerschnittstudieClinical Examination, Psychosocial Factors and Biomechanics in Children and Adolescents between 10 and 18 Years of Age with Patellofemoral Pain SyndromeCross-sectional StudyAuthors

Zusammenfassung
Das patellofemorale Schmerzsyndrom (PFS) ist bei Kindern und Jugendlichen mit einer Prävalenz von 29% häufig, doch das Zusammenspiel von Ursachen und beitragenden Faktoren wird kontrovers diskutiert. Im Rahmen dieser Querschnittstudie werden klinische, psychosoziale und biomechanische Parameter bei Kindern und Jugendlichen mit PFS erfasst und die Fragestellung „Inwiefern hängen Befunde aus der körperlichen Untersuchung mit berichtetem Schmerz, Einschränkungen in Funktion und Lebensqualität und Abweichungen der Beinachse unter Belastung bei Kindern mit PFS zusammen?“ untersucht.
Zwölf Kinder im Alter von 10–18 Jahren mit PFS wurden mittels Fragebögen (Knee Injury and Osteoarthritis Outcome Score Children KOOS-Child, Deutscher Schmerzfragebogen für Kinder und Jugendliche DSF-KJ), klinischer Untersuchungen (Druckschmerzschwelle, Beweglichkeit, Kraft, Muskellängen) sowie funktioneller Belastungstests (Single Leg Squat (SLS), Vertical Drop Jump (VDJ), Single Leg Drop Vertical Jump (SLDVJ)) untersucht. Die Zusammenhänge wurden mittels Pearsons r, Spearman’s Rho (ρ) und Eta-Koeffizient (η) ermittelt.
Die Ergebnisse zeigen statistisch signifikante Zusammenhänge zwischen körperlichen Merkmalen und empfundenen Schmerzen sowie Einschränkungen hinsichtlich Aktivitäten des täglichen Lebens (ADL) und Lebensqualität (LQ). Basierend auf Einflussfaktoren auf PFS wurden 9 Zusammenhangshypothesen gebildet und überprüft.
Die Studie zeigt statistisch signifikante Zusammenhänge zwischen klinischen, biomechanischen und patient*innenberichteten psychosozialen Parametern bei Kindern und Jugendlichen mit PFS auf, die teilweise entgegengesetzt zu bestehenden Studien sind. Die Arbeit liefert Grundlagen für weitere Untersuchungen der Pathogenese und Ätiologie von PFS.
Abstract
Patellofemoral pain syndrome (PFPS) is common in children and adolescents, with a prevalence of 29%, but the interaction of causes and contributing factors remains controversial. In this cross-sectional study, clinical, psychosocial and biomechanical parameters are collected in children and adolescents with PFPS. The research question “To what extent are findings from the clinical examination related to reported pain, limitations in function and quality of life and deviations of the leg axis under stress in children with PFPS?” is investigated.
Twelve children aged 10–18 years with PFS were examined using questionnaires (Knee Injury and Osteoarthritis Outcome Score Children KOOS-Child, German Pain Questionnaire for Children and Adolescents DSF-KJ), clinical examinations (pressure pain threshold, mobility, strength, muscle lengths) and functional exercise tests (Single Leg Squat (SLS), Vertical Drop Jump (VDJ), Single Leg Drop Vertical Jump (SLDVJ)). Correlations were determined using Pearson's r, Spearman's Rho (ρ) and Eta coefficient (η).
The results show statistically significant correlations between physical characteristics and perceived pain as well as limitations in activities of daily living (ADL) and quality of life (QoL). A total of nine correlation hypotheses based on factors influencing PFPS were tested.
The study shows statistically significant correlations between clinical, biomechanical and patient-reported psychosocial parameters in children and adolescents with PFPS, some of which are contrary to existing studies. Our work paves the ground for further research on the pathogenesis and etiology of PFPS.
Schlüsselwörter
Patellofemorales Schmerzsyndrom - Kinder - Jugendliche - klinische Untersuchung - instrumentelle Bewegungsanalyse - MalalignmentKeywords
patellofemoral pain syndrome - children - adolescents - clinical examination - instrumented movement analysis - malalignmentPublication History
Received: 02 July 2024
Accepted: 15 August 2024
Article published online:
19 September 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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Literatur
- 1 Sanchis GJ, Barbosa JVS, Cavalcanti RL. et al. Patellofemoral pain syndrome in children and adolescents: A cross-sectional study. PLoS ONE 2024; 19: e0300683
- 2 Crossley KM, Stefanik JJ, Selfe J. et al. Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med 2016; 50: 839-843
- 3 Neal BS, Lack SD, Lankhorst NE. et al. Risk factors for patellofemoral pain: a systematic review and meta-analysis. Br J Sports Med 2019; 53: 270-281
- 4 Rathleff CR, Baird WN, Olesen JL. et al. Hip and Knee Strength Is Not Affected in 12-16 Year Old Adolescents with Patellofemoral Pain - A Cross-Sectional Population-Based Study. PLoS ONE 2013; 8: e79153
- 5 Rathleff MS. Patellofemoral pain during adolescence: much more prevalent than appreciated. Br J Sports Med 2016; 50: 831-832
- 6 Lankhorst NE, Bierma-Zeinstra SMA, van Middelkoop M. Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review. J Orthop Sports Phys Ther 2012; 42: 81-94
- 7 Maclachlan LR, Collin NJ, Matthews MLG. et al. The psychological features of patellofemoral pain: a systematic review. Br J Sports Med 2017; 51: 732-742
- 8 Witvrouw E, Werner S, Mikkelsen C. et al. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc 2005; 13: 122-130
- 9 Selhorst M, Rice W, Degenhart T. et al. Evaluation of a treatment algorithm for patients with patellofemoral pain syndrome: a pilot study. Int J Sports Phys Ther 2015; 10: 178-188
- 10 Powers CM, Witvrouw E, Davis IS. et al. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med 2017; 51: 1713-1723
- 11 Willy RW, Hoglund LT, Barton CJ. et al. Patellofemoral Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther 2019; 49: CPG1-CPG95
- 12 Rathleff MS, Holden S, Straszek CL. et al. Five-year prognosis and impact of adolescent knee pain: a prospective population-based cohort study of 504 adolescents in Denmark. BMJ Open 2019; 9: e024113
- 13 Rathleff MS, Rathleff CR, Olesen JL. et al. Is Knee Pain During Adolescence a Self-limiting Condition?: Prognosis of Patellofemoral Pain and Other Types of Knee Pain. Am J Sports Med 2016; 44: 1165-1171
- 14 Rathleff MS, Vicenzino B, Middelkoop M. et al. Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different. Sports Med 2015; 45: 1489-1495
- 15 Rathleff MS, Holden S, Krommes K. et al. The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10–14-year-old adolescents with patellofemoral pain. Phys Ther Sport 2022; 53: 28-33
- 16 Neuhaus C, Camathias C, Mumme M. et al. German version of the Knee injury and Osteoarthritis Outcome Score for children (KOOS-Child): cross-cultural adaptation, reliability, internal consistency and validation in children with knee problems. SportRxiv 2021;
- 17 Schroeder S, Hechler Z, Denecke H. et al. Deutscher Schmerzfragebogen für Kinder, Jugendliche und deren Eltern (DSF-KJ). Schmerz 2010; 24: 23-37
- 18 Neuhaus C, Camathias C, Mumme M. et al. The German version of the KOOS-Child questionnaire (Knee injury and Osteoarthritis Outcome Score for children) shows a good to excellent internal consistency and a high test–retest reliability in children with knee problems. Knee Surg Sports Traumatol Arthrosc 2023; 31: 1354-1360
- 19 Castarlenas E, Jensen MP, von Baeyer CL. et al. Psychometric Properties of the Numerical Rating Scale to Assess Self-Reported Pain Intensity in Children and Adolescents: A Systematic Review. Clin J Pain 2017; 33: 376-383
- 20 Kasitinon D, Li W-X, Wang EXS. et al. Physical Examination and Patellofemoral Pain Syndrome: an Updated Review. Curr Rev Musculoskelet Med 2021; 14: 406-412
- 21 Sweeney E, Rodenberg R, MacDonald J. Overuse Knee Pain in the Pediatric and Adolescent Athlete. Curr Sports Med Rep 2020; 19: 479-485
- 22 Arendt-Nielsen L, Morlion B, Perrot S. et al. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018; 22: 216-241
- 23 Holden S, Rathleff MS, Thorborg K. et al. Mechanistic pain profiling in young adolescents with patellofemoral pain before and after treatment: a prospective cohort study. Pain 2020; 5: 1065-1071
- 24 van Wilgen P, van der Noord R, Zwerver J. Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy. J Sci Med Sport 2011; 14: 477-481
- 25 Roach SM, San Juan JG, Suprak DN. et al. Patellofemoral pain subjects exhibit decreased passive hip range of motion compared to controls. Int J Sports Phys Ther 2014; 9: 468-475
- 26 Svensson M, Lind V, Löfgren Harringe M. Measurement of knee joint range of motion with a digital goniometer: A reliability study. Physiother Res Int 2019; 24: e1765
- 27 Carey MA, Laird DE, Murray KA. et al. Reliability, validity, and clinical usability of a digital goniometer. Work 2010; 36: 55-66
- 28 Bennell KL, Talbot RC, Wajswelner H. et al. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother 1998; 44: 175-180
- 29 Wyndow N, De Jong A, Rial K. et al. The relationship of foot and ankle mobility to the frontal plane projection angle in asymptomatic adults. J Foot Ankle Res 2016; 9: 3
- 30 McPoil TG, Vicenzino B, Cornwall MW. et al. Reliability and normative values for the foot mobility magnitude: a composite measure of vertical and medial-lateral mobility of the midfoot. J Foot Ankle Res 2009; 2: 6
- 31 D’Ambrosi R, Meena A, Raj A. et al. Anterior Knee Pain: State of the Art. Sports Med - Open 2022; 8: 98
- 32 Janssen J, Dey P, Celik C. et al. How useful is a single measurement of patellar mobility in the assessment of patients with patellofemoral pain?. PPR 2019; 40: 29-35
- 33 Watson CJ, Leddy HM, Dynjan TD. et al. Reliability of the lateral pull test and tilt test to assess patellar alignment in subjects with symptomatic knees: student raters. J Orthop Sports Phys Ther 2001; 31: 368-374
- 34 Haim A, Yaniv M, Dekel S. et al. Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res 2006; 451: 223-228
- 35 Hébert LJ, Maltais DB, Lepage C. et al. Isometric Muscle Strength in Youth Assessed by Hand-held Dynamometry: A Feasibility, Reliability, and Validity Study: A Feasibility, Reliability, and Validity Study. Pediatr Phys Ther 2011; 23: 289
- 36 Mahaffey R, Le Warne M, Morrison SC. et al. Concurrent Validity of Lower Limb Muscle Strength by Handheld Dynamometry in Children 7 to 11 Years Old. J Sport Rehabil 2022; 31: 1089-1094
- 37 Lunsford BR, Perry J. The Standing Heel-Rise Test for Ankle Plantar Flexion: Criterion for Normal. Phys Ther 1995; 75: 694-698
- 38 Yocum A, McCoy SW, Bjornson KF. et al. Reliability and validity of the standing heel-rise test. Phys Occup Ther Pediatr 2010; 30: 190-204
- 39 Mishra R, Aranha VP, Samuel AJ. Reliability and Reference Norms of Single Heel-Rise Test Among Children: A Cross-sectional Study. J Foot Ankle Surg 2023; 62: 426-431
- 40 Dingenen B, Malfait B, Nijs S. et al. Can two-dimensional video analysis during single-leg drop vertical jumps help identify non-contact knee injury risk? A one-year prospective study. Clin Biomech (Bristol) 2015; 30: 781-787
- 41 Nilstad A, Andersen TE, Kristianslund E. et al. Physiotherapists Can Identify Female Football Players With High Knee Valgus Angles During Vertical Drop Jumps Using Real-Time Observational Screening. J Orthop Sports Phys Ther 2014; 44: 358-365
- 42 Zeller BL, McCrory JL, Ben Kibler W. et al. Differences in Kinematics and Electromyographic Activity between Men and Women during the Single-Legged Squat <sup/>. Am J Sports Med 2003; 31: 449-456
- 43 McCurdy KW, Walker JL, Langford GA. et al. The Relationship Between Kinematic Determinants of Jump and Sprint Performance in Division I Women Soccer Players. J Strength Cond Res 2010; 24: 3200-3208
- 44 Kums T, Ereline J, Gapeyeva H. et al. Vertical jumping performance in young rhytmic gymnasts. Biology of Sport 2005; 22: 237-246
- 45 Hayek R, Gottlieb U, Gutman I. et al. Can Stabilization Analysis Following a Single Leg Drop Jump Be Compared between Young and Middle-Aged Adults. J Biomechl 2022; 143: 111269
- 46 Stensrud S, Myklebust G, Kristianslund E. et al. Correlation between two-dimensional video analysis and subjective assessment in evaluating knee control among elite female team handball players. Br J Sports Med 2011; 45: 589-595
- 47 Myer GD, FOrd KR, Barber Foss KD. et al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol) 2010; 25: 700-707
- 48 Eid M, Gollwitzer M, Schmitt M. Statistik und Forschungsmethoden: mit Online-Materialien. 5. Aufl. Weinheim Basel: Beltz; 2017
- 49 Carter R, Lubinsky J. Rehabilitation Research: Principles and Applications. Elsevier Health Sciences. 2015
- 50 Tachtsoglou S, König J. Zusammenhangsmaße für nominalskalierte Variablen. In: Tachtsoglou S, König J, Hrsg. Statistik für Erziehungswissenschaftlerinnen und Erziehungswissenschaftler. Wiesbaden: Springer Fachmedien Wiesbaden; 2017: 129-163
- 51 Campbell R, Ju A, King MT. et al. Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies“. Qual Life Res 2022; 31: 1597-1620
- 52 Martinez AF, Lessi GC, Carvalho C. et al. Association of Hip and Trunk Strength With Three-Dimensional Trunk, Hip, and Knee Kinematics During a Single-Leg Drop Vertical Jump. J Strength Cond Res 2018; 32: 1902-1908
- 53 Arnold A, Thigpen CA, Beattie PF. et al. Overuse Physeal Injuries in Youth Athletes: Risk Factors, Prevention, and Treatment Strategies. Sports Health 2017; 9: 139-147
- 54 Luhmann SJ, Schoenecker PL, Dobbs MB. et al. Adolescent patellofemoral pain: implicating the medial patellofemoral ligament as the main pain generator. J Child Orthop 2008; 2: 269-277
- 55 Boling M, Padua D. Relationship between hip strength and trunk, hip, and knee kinematics during a jump landing task in individuals with patellofemoral pain. Int J Sports Phys Ther 2013; 8: 661-669
- 56 Ugalde V, Brockman C, Bailowitz Z. et al. Single Leg Squat Test and Its Relationship to Dynamic Knee Valgus and Injury Risk Screening. PM&R 2015; 7: 229-235
- 57 Holden S, Boreham C, Doherty C. et al. Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females. Scandinavian Med Sci Sports 2017; 27: 188-194
- 58 Rathleff MS, Winiarski L, Krommes K. et al. Pain, sports participation, and physical function in 10-14 years olds with Patellofemoral Pain and Osgood Schlatter: A matched cross-sectional study of 252 adolescents. J Orthop Sports Phys Ther 2020; 50: 149-157
- 59 Djurtoft C, Yona T, Roos EM. et al. Quality of life in adolescents with longstanding non-traumatic knee pain: An analysis of 316 adolescents with Patellofemoral Pain and Osgood-Schlatter Disease. Phys Ther Sport 2023; 61: 156-164
- 60 Stief F, Böhm H, Michel K. et al. Reliability and Accuracy in Three-Dimensional Gait Analysis: A Comparison of Two Lower Body Protocols. J Appl Biomech 2013; 29: 105-111
- 61 Hartmann M, Merker J, Haas J-P. et al. Pilot study of a three-dimensional method to detect the tibial torsion in healthy adolescents and its impact on the knee kinematic in walking. Gait & Posture 2016; 49: 183
- 62 Hartmann M, Kreuzpointner F, Schwirtz A. et al. Improved accuracy with an optimized plug-in-gait protocol. Gait & Posture 39: 109
- 63 Glaviano NR, Holden S, Bazett-Jones DM. et al. Living well (or not) with patellofemoral pain: A qualitative study. Phys Ther Sport 2022; 56: 1-7
- 64 Rathleff MS, Graven-Nielsen T, Hölmich P. et al. Activity Modification and Load Management of Adolescents With Patellofemoral Pain: A Prospective Intervention Study Including 151 Adolescents. Am J Sports Med 2019; 47: 1629-1637