The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q‐angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear‐foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non‐operative therapy concept with short‐term use of NSAIDs, short‐term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non‐operative and should address the functional causes.Level of evidence V.

Background Lateral ankle sprains are common musculoskeletal injuries. Objectives The objective of this study was to perform a systematic literature review of the last 10 years regarding evidence for the treatment and prevention of lateral ankle sprains. Data source Pubmed central, Google scholar. Study eligibility criteria Meta-analysis, prospective randomized trials, English language articles. Interventions Surgical and non-surgical treatment, immobilization versus functional treatment, different external supports, balance training for rehabilitation, balance training for prevention, braces for prevention. Methods A systematic search for articles about the treatment of lateral ankle sprains that were published between January 2002 and December 2012. Results Three meta-analysis and 19 articles reporting 16 prospective randomized trials could be identified. The main advantage of surgical ankle ligament repair is that objective instability and recurrence rate is less common when compared with non-operative treatment. Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. For non-surgical treatment, long-term immobilization should be avoided. For grade III injuries, however, a short period of immobilization (max. 10 days) in a below knee cast was shown to be advantageous. After this phase, the ankle is most effectively protected against inversion by a semi-rigid ankle brace. Even grades I and II injuries are most effectively treated with a semi-rigid ankle brace. There is evidence that treatment of acute ankle sprains should be supported by a neuromuscular training. Balance training is also effective for the prevention of ankle sprains in athletes with the previous sprains. There is good evidence from high level randomized trials in the literature that the use of a brace is effective for the prevention of ankle sprains. Conclusion Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. The indication for surgical repair should be always made on an individual basis. This systematic review supports a phase adapted non-surgical treatment of acute ankle sprains with a short-term immobilization for grade III injuries followed by a semi-rigid brace. More prospective randomized studies with a longer follow-up are needed to find out what type of non-surgical treatment has the lowest re-sprain rate.

Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

Background: This research was undertaken to determine whether there is a need for a second tibial tunnel in anatomic anterior cruciate ligament reconstruction. Hypothesis: Anatomic two-bundle reconstruction with two tibial tunnels restores knee anterior tibial translation in response to 134 N and to 5-N·m internal tibial torque combined with 10-N·m valgus torque more closely to normal than does double-bundle reconstruction with one tibial tunnel. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were subjected to a 134-N anterior tibial load at 0°, 30°, 60°, and 90° and to 5-N·m internal tibial torque and 10-N·m valgus torque at 15° and 30°. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for (1) intact, (2) anterior cruciate ligament–deficient, (3) double-bundle/one tibial tunnel, and (4) double-bundle/two tibial tunnels. Results: Anterior tibial translation for the reconstruction with two tibial tunnels was significantly closer to that of the intact knee than was the reconstruction with one tibial tunnel at 0° and 30° of flexion (0° = 3.82 vs 6.0 mm, P < .05; 30° = 7.99 vs 11 mm, P < .05). The in situ force normalized to the intact anterior cruciate ligament for the reconstruction with two tibial tunnels was significantly higher than the in situ force of the reconstruction with one tibial tunnel (30° = 89 vs 82 N, P < .05). With a combined rotatory load, the anterior tibial translation of specimens with a tibial two-tunnel technique was significantly lower than that of specimens with one tunnel (0° = 5.7 vs 8.4 mm, P < .05; 30° = 7.5 vs 9.5 mm, P < .05). Conclusions: Anatomic reconstruction with two tibial tunnels may produce a better biomechanical outcome, especially close to extension. Clinical Relevance: At the time of initial fixation, there appears to be a small biomechanical advantage to the second tibial tunnel in the setting of two-bundle anterior cruciate ligament reconstruction.