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Abstract
Patients with patellofemoral pain (PFP) experience pain during or after physical activities. Recent evidence suggests PFP is not only a painful symptom which hinders daily activity but also a potential marker for future development of patellofemoral osteoarthritis (PFOA). Ultimately, PFP may also lead to tibiofemoral osteoarthritis (TFOA), which is recognized as a knee osteoarthritis. Traditionally, lower extremity strengthening exercises successfully alleviate pain for patients with PFP. However, strengthening exercises are not effective in modifying certain movement patterns associated with PFP development and progression. Researchers found feedback motion retraining to be an effective mode of intervention to alter movement patterns. However, there is no research synthesizing the efficacy of feedback motion retraining for patients with PFP. Therefore, in Chapter 2, we assessed the efficacy of feedback motion retraining by summarizing relevant scientific evidence. Diagnostic ultrasound (US) is a cost-effective imaging tool to assess morphology of soft tissue, but it is rarely used for evaluating cartilage health in individuals with PFP. But, diagnostic US may be a useful clinical tool for understanding the progression from PFP to PFOA. Therefore, our aims were to evaluate femoral cartilage health in patients with PFP. In Chapter 3, we compared the deformative characteristics of femoral cartilage following varied forms of loading conditions between individuals with and without PFP by assessing US image cross-sectional area and echo intensity. In Chapter 4, we compared the image quality gradebetween individuals with and without PFP to understand whether individuals with PFP are demonstrating worse cartilage health that may not be captured using traditional evaluation methods. We identified significant correlations between patient-reported outcomes and echo intensity following loading conditions. We also identified statistically significant differences of femoral cartilage image quality between individuals with and without PFP which indicates increased risk of osteoarthritis in individuals with PFP.