Additional File 1: Review of Potential Patellofemoral Pain Syndrome Risk Factors

Test Source Comments Significance

Electromyography Cowan et al (2001) 33 PFPS and 33 Significant in PFPS population for EMG
(EMG) Measured asymptomatic controls onset of VL prior to VMO in both step up
Neuro-Motor [43] and step down phases of stair-stepping
Dysfunction Case-Control activity (P0.05).

There was no difference in the onset of

VMO and VL activity in the
asymptomatic controls (P0.05).

Cowan et al (2002) 37 PFPS and 37 Significant difference in PFPS compared

asymptomatic controls to asymptomatic controls in EMG VL-
[42] VMO onset timing difference in rock
Rise task is standing on (P0.001) and rise (P0.01).
toes.
Significant difference in PFPS group for
Rock task is standing on
EMG VL onset compared to VMO onset
heels.
in rock (P0.005) and rise (P0.005).
Case-Control
There was no difference in the VMO and
VL activity in asymptomatic controls in
rock ( P=0.31) and rise (P=0.33)

Crossley et al (2004) 48 PFPS and 18 controls Significant stance-phase knee flexion

angle is lower in individuals with PFPS
[44] Case-Control compared to controls (P0.05).

Significant mean onset of VMO EEG

activity was delayed relative to that of the
VL (P0.05).

Thomee et al (1996) 11 PFPS and 9 control Significant (P0.05) difference between

subjects PFPS and controls in vastus medialis
[45] EMG activity during standing. PFPS has
Case-Control less activity.

No difference in EMG activity for sitting

or standing rectus femoris or sitting
vastus medialis (P0.05).

Average pain during sitting and standing

was significantly higher (P0.0001) using
the visual analogue scale (VAS) pain
 scores.

Witvrouw et al (2000) 24 PFPS and 258 control Significant for faster response in VMO
subjects. (P=0.02) and VL (P=0.006) in the PFPS
[39] group compared to controls.
Prospective Cohort
Not significant for difference between
response of the VMO-VL (P=0.26) when
compared to controls.

Foot Abnormalities Duffey et al (2000) 99 anterior knee pain and Significant (P=0.05) for lower arch index
70 controls subjects. (cavus/ higher arches) for combined
[63] discriminant analysis only.
Case-Control

Haim et al (2006) 61 PFPS and 25 control Not significant for :

subjects. Genu varum,
[48] genu valgum, pes cavus, Genu varum (P=0.12)
and pes planus Genu valgum (P=0.21)
investigated.
Pes cavus (P=1.00)
Case-Control
Pes planus (P=0.15)

Thomee et al (1995) 40 PFPS and 20 control Not significant for lower leg anatomical
subjects. Leg-heel differences (no P value reported).
[47] alignment measurements
taken.

Case-Control

Witvrouw et al (2000) 24 PFPS and 258 control Not significant for genu varum/valgum
subjects. (P=0.96).
[39]
Prospective Cohort

Functional Testing Loudon et al (2002) 29 subjects with PFPS and PFPS subjects demonstrated decreased
11 controls. The 5 performance in anteromedial lunge, step-
[49] functional tests were down, single-leg press, balance and reach
anteromedial lunge, step- when compared to healthy controls
down, single-leg press, (P0.05). Intrarater interclass correlation
bilateral squat, balance coefficient: 0.79-0.94.
and reach.

Case-Control

Thomee et al (1995) 40 PFPS and 20 control Significant for decreased unilateral

subjects. counter movement drop vertical jump in
 [46] Case-Control
Witvrouw et al (2000) 24 PFPS and 258 control
subjects. Tested Flamingo
[39] balance, vertical jump,
standing broad jump, bent
arm hang, shuttle run,
plate tapping, arm pull, leg
lifts, sit and reach, sit ups,
and maximal O2 uptake.
Prospective Cohort
Gastrocnemius Duffey et al (2000) 99 anterior knee pain and
Tightness 70 control subjects.
[63]
Case-Control
Piva et al (2005) 30 PFPS and 30 control
subjects.
[50]
Case-Control
Witvrouw et al (2000) 24 PFPS and 258 control
subjects.
[39]
Prospective Cohort
Generalized al-Rawi et al (1997) 115 chondromalacia
Ligamentous/Joint patellas and 110 control
Laxity [64] subjects.
Case-Control
Fairbank et al (1984) 136 knee pain and 310
control subjects.
[51]
Case-Control
Witvrouw et al (2000) 24 PFPS and 258 control
subjects.
[39]
Prospective Cohort
PFPS subjects (P0.05)
Significant for a decreased vertical jump
(P=0.01) in PFPS subjects.
Not significant for a difference between
PFPS and control subjects for Flamingo
balance (P=0.021), standing broad jump
(P=0.41), bent arm hang (P=0.6), shuttle
run (P=0.8), plate tapping (P=0.79), arm
pull (P= 0.17), leg lifts (P=0.49), sit and
reach (P=0.25), sit ups (P=0.41), and
maximal oxygen uptake (P=0.96).
Not significant (P0.05) for a difference
in anterior knee pain subjects compared
to control subjects.
Significant (P0.001) for both increased
gastrocnemius and soleus tightness in
PFPS subjects.
Significant (P=0.038) for increased
gastrocnemius tightness.
Significant (P0.001) for increased joint
laxity in knees with chondromalacia
compared to controls.
Not significant (no P value reported) for
increased joint laxity in knee pain
subjects.
Significant for increased thumb-forearm
mobility in PFPS subjects compared to
controls (P=0.01).
Not significant for increased extension of
the little forefinger (P=0.058), shoulder
mobility (P=0.06), elbow extension
(P=0.41), and knee extension (P=0.37) in

Hamstring Strength Kibler (1987) 76 running athletes with
syndrome complex. had an absolute strength deficiency at
[59]
Case series
Hamstring Tightness Kibler (1987) 76 running athletes with
syndrome complex. had tightness (no P value reported).
[59]
Case series
Piva et al (2005) 30 PFPS and 30 control
subjects.
[50]
Case-Control
Smith et al (1991) 14 anterior knee pain and
32 control subjects.
[40]
Prospective Cohort
Witvrouw et al (2000) 24 PFPS and 258 control
subjects.
[39]
Prospective Cohort
Hip Musculature Cichanowski et al (2007) 13 PFPS and 13 matched
Weakness control subjects. PFPS
[52] subjects were only
included if unilateral pain.
Injured leg was compared
to non-injured leg in PFPS
group.
Case-Control
Ireland et al (2003) 15 PFPS and 15 control
subjects.
[53]
Case-Control
Piva et al (2005) 30 PFPS and 30 control
subjects.
PFPS subjects compared to controls.
81% of syndrome complex subjects
60deg per second and 73% had a
deficiency at 240 degrees per second (No
P value reported)
23 % of syndrome complex subjects
Significant for hamstring tightness in the
PFPS subjects (P0.001).
Significant for hamstring tightness in the
anterior knee pain subjects (P0.01).
Not significant for hamstring tightness in
the PFPS subjects (P=0.442).
Significant for hip abduction (P=0.003)
and external rotation weakness (P=0.049)
when comparing injured to uninjured
knee. Not significant for hip flexion
(P=0.466), extension (P=0.563),
adduction (P=0.650), and internal
rotation (P=0.111).
Significant for hip flexion (P=0.033),
extension (P=0.029), abduction (P=0.01),
internal rotation (P=0.049), and external
rotation (P=0.033) weakness. Not
significant for hip adduction (P=0.087)
Significant for 26% less strength in hip
abductor in the PFPS subjects (P0.001).
Not significant for hip external rotation
strength weakness (% of body mass)
 [50] Case-Control (P=0.218) or hip abduction strength
weakness (% of body mass) (P=0.016).

Iliotibial Band Kibler (1987) 76 running athletes with 67% of syndrome complex subjects
Tightness syndrome complex. had IT band tightness (No P value
[59] reported).
Case series

Piva et al (2005) 30 PFPS and 30 control Not significant for iliotibial band/ tensor
subjects. fascia lata complex length (P=0.102)
[50] difference.
Case-Control

Puniello (1993) 17 PFPS subjects. 12 of 17 PFPS patients exhibited IT band

tightness (P0.005).
[60] Case series

Winslow et al (1995) 14 PFPS and 34 control Significant for IT band tightness in PFPS
subjects. subjects(P0.01)
[54]
Case-Control

Quadriceps-Angle Aglietti et al (1983) 150 healthy knees and 90 Significant for increased Q angle in
chondromalacia patella chondromalacia patella knees (P0.001).
(Q-Angle) [55] knees.

Case-Control

Caylor et al (1993) 50 Anterior Knee Pain Not significant for difference in Q angle
subjects and 20 healthy in anterior knee pain compared to healthy
[56] subjects. control subjects (P=0.07).

Case-Control

Duffey et al (2000) 99 anterior knee pain and Not significant for difference in Q angle
70 controls. in anterior knee pain compared to healthy
[63] control subjects (P0.05).
Case-Control

Haim et al (2006) 61 PFPS and 25 control Significant for PFPS if the Q angle is
subjects. 32 PFPS had Q greater than 20 degrees (P0.001).
[48] angle greater than 20
degrees. No controls had
Q angle greater than 20
degrees.

Case-Control

Messier et al (1991) 16 PFPS and 20 controls. Significant for increased Q angle in PFPS
subjects between PFPS and control
 [57] Case-Control subjects (P0.01).

Thomee et al (1995) 40 PFPS and 20 control Not significant for Q angle difference (P
subjects. not reported).
[47]
Case-Control

Witvrouw et al (2000) 24 PFPS and 258 control Not significant for Q angle difference
subjects. between PFPS and control subjects
[39] (P=0.394).
Prospective Cohort

Quadriceps Tightness Duffey et al (2000) 99 anterior knee pain and Significant for increased quadriceps
70 controls. tightness in anterior knee pain subjects
[63] (P=0.022).
Case-Control

Kibler (1987) 76 running athletes with 61% of syndrome complex subjects

syndrome complex. have tightness in the rectus femoris (No P
[59] value reported).
Case series

Piva et al (2005) 30 PFPS and 30 control Significant for quadriceps tightness in the
subjects. PFPS subjects (P0.001).
[50]
Case-Control

Smith et al (1991) 14 anterior knee pain and Significant for quadriceps tightness in the
32 control subjects. PFPS subjects (P0.01).
[40]
Case-Control

Witvrouw et al (2000) 24 PFPS and 258 control Significant for quadriceps tightness in
subjects. PFPS subjects (P=0.028).
[39]
Prospective- Cohort

Quadriceps Weakness Bennett et al (1986) 130 anterior knee pain 41/130 subjects demonstrated decreased
subjects. torque production during eccentric
[62] exercise between 30-60 degrees of knee
Case series flexion (P0.05).

Callaghan et al (2004) 57 PFPS and 10 control Significant for quadriceps weakness in

patients. PFPS subjects (P=0.002).
[58]
Case-Control

Kibler (1987) 76 running athletes with 39% of syndrome complex subjects

syndrome complex. have quadriceps weakness (No P value
[59] reported).
 Case series

Messier et al (1991) 16 PFPS and 20 control Not significant for quadriceps weakness
subjects. in PFPS (P0.05).
[57]
Case-Control

Milgrom et al (1991) 77 PFPS knees of 390 Not significant for quadriceps weakness
military recruits. in PFPS (P0.05). Increased isometric
[41] strength of the quadriceps tested at 85
Prospective Cohort degrees of knee flexion was increased in
patellofemoral pain caused by
overactivity (P=0.05).

Thomee et al (1995) 40 PFPS and 20 control Significant (P0.01) for eccentric

subjects. quadriceps weakness in PFPS.
[46]
Case-Control Not significant (P0.05)) for concentric
and isometric quadriceps weakness in
PFPS.

Patellar Niskanen et al (2001) 85 anterior knee pain Patellar Tracking test:

Compression/Crepitus knees. Data confirmed by
[61] arthroscopy confirmation. Sensitivity 56%, Specificity 55% for
detecting chondromalacia in anterior
Case series knee pain.

Haim et al (2006) 61 PFPS and 25 control Significant crepitations for PFPS subjects
subjects. 43 PFPS and 2 (P0.001).
[48] control subjects with PF
crepitations.

Case-Control

Patellar Mediolateral Haim et al (2006) 61 PFPS and 25 control Significant (P=0.018) reduced mobility in
Glide/Mobility subjects. Patellar glide PFPS patients.
[48] measured as a percentage
of patellar width.

Case-Control

Puniello (1993) 17 PFPS subjects. 14 or 17 PFPS patients exhibited

hypomobility of the medial glide
[60] Case series (P0.005).

Witvrouw et al (2000) 24 PFPS and 258 control Not significant (P=0.06), but medial,
subjects. lateral, and total patellar mobility was
[39] greater in PFPS group.
 Prospective Cohort

Patellar Tilting Haim et al (2006) 61 PFPS and 25 control Significant (P=0.002) for lateral tilting.
subjects. Specificity 92% Sensitivity 43%
[48]
Case-Control