Disclosures: Marcos R. Henriquez, MD: No financial relationships or conflicts of interest

Case Diagnosis: Patellofemoral Pain Syndrome

Case Description: We describe a 43-year-old female athlete with bilateral anterior knee pain with a higher pain level on her right knee during the past months. She is a weight lifter, cyclist, and marathon runner. Positive bilateral patellar tilt test, patellar apprehension test, crepitus, patellar grinding test, tenderness on knee lateral retinaculum palpation; negative bilaterally McMurray, Apley, patellar ballottement. The visual analog scale of 7 and Functional index Questionnaire score 11/16. Bilateral sunrise x-rays show patellar lateralization confirming the diagnosis. The patient has abandoned physical therapy on past occasions due to increased pain levels. Infiltration with 500 units of abobotulinum toxin A diluted in 4mL of saline along the right vastus lateralis.

Setting: PM&R, Sports Medicine Outpatient ClinicAssessment/

Results: After three weeks, our patient refers 0/10 on VAS and scores 16/16 on the Functional Index Questionnaire for her right knee. She is further managed with physical therapy to strengthen the hip muscles before functional exercises and quadriceps strengthening. Six months after our intervention she refers to no pain.

Discussion: Physical therapy mainly consists of the quadriceps focusing on the vastus medialis and hip muscles strengthening to restore force vectors. Another perspective would be to weaken the vastus lateralis, and creating a lateral release with abobotulinum toxin-A infiltration to taper down the lateral vector and centralize the patella during its path through the trochlear groove.

Conclusion: Patellofemoral pain syndrome can paralyze an athlete’s activity, causing frustration and abandon any athletic training. Infiltration with botulinum toxin opens a pain-free highway for the patient’s rehabilitation process, reversing the patellar maltracking, increasing the odds of patient’s compliance along with physical therapy. Unfortunately, some athletes and vigorous persons become severely disabled by anterior knee pain and fail to improve or are made worse by surgery; non-operative treatment such as infiltration with abobotulinum toxin A should be explored.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/use-of-abobotulinum-toxin-a-in-athletes-with-patellofemoral-pain-syndrome-a-case-report/