DOI: 10.1097/01.jsm.0000157395.20513.e9
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PMID: 15867572
Issn Print: 1050-642X
Publication Date: 2005/05/01
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Excerpt
Objective: To assess the long-term effects of open kinetic chain exercises (OKCE) versus closed kinetic chain exercises (CKCE) for patellofemoral pain.
Design: Patients in a 5-week randomized controlled trial were followed up after 3 months and 5 years.
Setting: Physical therapy department in a university hospital in Belgium.
Participants: 60 patients (mean age, 20; range, 14-33 years; 60% women) with unilateral or bilateral (n = 27) patellofemoral pain for ≥6 weeks (mean duration, 15 months; range, 6 weeks to 28 months) were included. Eligibility criteria included pain on 2 of direct compression of the patella, palpation of the posterior surface of the patella, resisted knee extension, and quadriceps muscle contraction against suprapatellar resistance. Patients with other knee problems or previous knee surgery were excluded.
Intervention: The patients were randomized to a 5-week program of either OKCE or CKCE. Patients trained 3 times per week for 30 to 45 minutes. The OKCE program was maximal static quadriceps muscle contractions with fully extended knees, straight-leg raises, short arc movements from 10° of knee flexion to terminal extension, and leg adduction exercises. The CKCE program was seated leg presses, 1/3 knee bends on 1 and both legs, stationary bicycling, rowing-machine exercises, step up and down, and jumping exercises.
Main outcome measures: The main outcome measures were pain during rest and activities (measured by the Kujala scale and on 100-mm visual analogue scales), functional outcome (criteria were a pain-free full knee bend, step up and down 45 cm, and 1-leg jumps), and strength of the quadriceps and hamstring muscles (measured on the Cybex 350 dynamometer). Only the more painful knee was evaluated in bilateral cases. Of 51 patients (85%) who attended the 5-year follow-up examination, 1 from each group was excluded because of surgical interventions.
Main results: Although both groups improved significantly on all measures during the trial and initial 3-month follow-up period, the groups did not differ on any measure. After 5 years, 9 patients in the OKCE group compared with 10 in the CKCE group reported no patellofemoral pain (39% overall). More patients in the OKCE group than the CKCE were participating actively in sport (92% versus 60%; P < 0.05). Only 35% of the OKCE group did any home exercises, and only 13% did their prescribed exercises, which is significantly lower participation than the CKCE group, of whom 65% did regular home exercises and 41% continued their prescribed exercises. Among multiple comparisons, the OKCE group complained less of swelling of the knee joint (P = 0.04), of pain when descending stairs (P = 0.01), and of pain at night (P = 0.04) than the CKCE group. The groups did not differ on the Kujala scale or on the functional and strength tests. Both groups experienced more pain on some scales than they had at the 3-month follow-up.
Conclusions: The 5-year results for patients with patellofemoral pain randomized to OKCE or CKCE were similar, and the improvements that were shown after 3 months were generally maintained.
