Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. 
Nunes GS, Stapait EL, Kirsten MH, de Noronha M. and Santos GM. Physical Therapy in Sport. 2012:1-6.

Patellofemoral pain syndrome (PFPS) affects between 15 and 25% of the general population, and is more predominant in physically-active individuals. Although PFPS is prevalent in the active population, there is no “gold-standard” set of procedures for diagnosing PFPS. Therefore, Nunes and colleagues performed a systematic review to investigate the accuracy of clinical and functional tests used in diagnosing PFPS. The authors performed an electronic literature search in March 2012 using the search filters developed by the Scottish Intercollegiate Guidelines Network. A total of 16,169 articles were identified through the search process. Two independent reviewers screened the titles and abstracts, obtained full text of 26 articles, and assessed for eligibility. Studies were excluded if (a) the patients had a history of surgery in lower limbs affected by PFPS, (b) they evaluated the accuracy of diagnostic imaging tests, (c) diagnosis was determined using questionnaires, (d) the participants had other associated disease (e.g. osteoarthritis), and (e) the authors evaluated the accuracy of testing among individuals with chondromalacia patellae. Five articles were deemed eligible for inclusion of the systematic review. The authors evaluated the methodological quality of the 5 studies with the Quality Assessment of Diagnostic Accuracy Studies scale and reported that 1 presented high, 2 presented intermediate, and 2 presented low methodological quality. The 5 studies evaluated 24 tests for diagnosing PFPS. The 3 most sensitive tests (correctly identifies PFPS) were pain with squatting (91%), pain with kneeling (84%) and compression test (83%). The 3 tests with the greatest specificity (correctly identify absence of PFPS) were the active instability test (100%), vastus medialis coordination test (93%), and the patellar tilt test (92%). The patellar tilt test was also found to have the highest positive likelihood ratio (5.4).

Overall this study presents sensitivity and specificity data of clinical and functional tests used to diagnose PFPS. This study identified two tests, which may be highly beneficial in the diagnosis of PFPS. The squatting and active instability tests were identified as the most beneficial; however, it would be advisable for clinicians to use multiple tests in their diagnosis as the evidence available in this systematic review was inconsistent. Furthermore, this systematic review included a small number of studies with relatively low (4 of 5 with either intermediate or low) methodological quality. With such a low number of studies with sufficient quality, this calls for more high quality research evaluating the efficacy of various clinical and functional diagnostic tests for PFPS. Without high methodological quality, a true “gold standard” for the diagnosis of PFPS cannot be determined. Tell us what you have seen in your practice. Have you used the patellar tilt test or pain with squatting to diagnose PFPS? Have you found these tests helpful? What test(s) have you found to be especially helpful in making a diagnosis of PFPS?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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Factors Associated with Patellofemoral Pain Syndrome 

Nunes GS, Stapait EL, Kirsten MH, de Noronha M, & Santos GM (2012). Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical Therapy in Sport PMID: 23232069