From the Research
The best clinical screening tool for sports medicine physicians evaluating patellofemoral issues is a comprehensive approach combining a thorough history, Functional Movement Screen (FMS), and specific patellofemoral assessment tests such as the Clarke's test, J-sign observation, and patellar apprehension test, as supported by the most recent and highest quality study 1. When evaluating patients with potential patellofemoral pain syndrome or instability, begin with a comprehensive history followed by these targeted physical examination techniques. The FMS provides valuable information about movement patterns that may contribute to patellofemoral dysfunction, while the specific tests help identify patellar tracking abnormalities, maltracking, and instability. Some key points to consider in the evaluation process include:
- Assessment of quadriceps strength, hip abductor and external rotator strength, and Q-angle measurement as these factors often contribute to patellofemoral problems 1
- Dynamic assessment during squatting and single-leg activities is essential to observe functional limitations
- The use of musculoskeletal ultrasound (US) as a diagnostic tool for PFPS, which has shown value in diagnosing those with PFPS, particularly in evaluating decreased vastus medialis obliquus (VMO) volume, asymmetry in gluteus medius thickness, intra-articular effusions, and quadriceps and patellar tendon thicknesses 1 This comprehensive approach is recommended because patellofemoral issues typically result from a combination of biomechanical factors including muscle imbalances, alignment issues, and movement pattern dysfunctions rather than a single anatomical problem. Early identification of these factors through proper screening allows for targeted interventions including physical therapy, activity modification, and appropriate bracing when indicated. It's worth noting that while other studies have investigated the diagnostic accuracy of clinical tests for PFPS, such as the patellar tilt and squatting tests 2, and the use of clinical findings for screening and diagnosis of PFPS 3, the most recent and highest quality study 1 provides the strongest evidence for the recommended approach. Additionally, other studies have discussed the importance of a thorough physical examination and radiographic imaging in evaluating patellofemoral patients 4, 5, but the comprehensive approach recommended here is supported by the most recent and highest quality evidence.