The 45-second anterior knee pain provocation test: a quick test of knee pain and sporting function in 10-14-year-old adolescents with patellofemoral pain

Review written by Dr Teddy Willsey info

Key Points

  1. Adolescent knee pain carries a poor prognosis, with many youth athletes playing through symptoms for years.
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Patellofemoral pain (PFP) is one of the most common forms of knee pain. PFP typically develops gradually, fluctuates, and is aggravated by activities that involve knee bending and loading. The incidence of PFP is 29% during adolescence and 23% in the general population (1). PFP is seen with increased frequency in adolescent athletes as compared to non-athletes, and in females as compared to males (1,2). Although a variety of interventions have shown efficacy to improve PFP, the long-term outcomes following adolescent PFP are disappointing, with up to 40% still experiencing varying levels of symptoms for over five years (3,4).

Adolescent knee pain is so common that it was once regarded to be normal, self-limiting, and something that would just disappear over time. To the contrary, research has shown that young athletes will play through quality of life altering knee pain for years, and it has the potential to impact them into adulthood (5,6). Although diagnosing knee pain is straightforward, there is a paucity of functional tests to quantify PFP severity and measure change over time.

The aim of this study was to investigate a simple and time efficient pain provocation test for adolescents with PFP.

The incidence of patellofemoral pain is 29% during adolescence and 23% in the general population.
The AKPP test is a tool clinicians can use to engage and motivate patients, set shared goals, and monitor progress together.


The authors recruited 151 participants with PFP and 50 for the pain-free control group (age = 10-14). The anterior knee pain provocation (AKPP) test was administered in both groups at baseline, and in the intervention group at 4 and 12-weeks.

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