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The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain

Centre for Musculoskeletal Studies, School of Surgery M424, the University of Western, 35 Stirling Highway, Nedlands, WA 6009, Australia
Faculty of Medicine, Dentistry and Health Science, the University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
Author to whom correspondence should be addressed.
Academic Editor: Bahman Jabbari
Toxins 2015, 7(9), 3388-3404;
Received: 2 June 2015 / Revised: 12 August 2015 / Accepted: 17 August 2015 / Published: 25 August 2015
(This article belongs to the Collection Botulinum Toxins on Human Pain)
Anterior knee pain is a highly prevalent condition affecting largely young to middle aged adults. Symptoms can recur in more than two thirds of cases, often resulting in activity limitation and reduced participation in employment and recreational pursuits. Persistent anterior knee pain is difficult to treat and many individuals eventually consider a surgical intervention. Evidence for long term benefit of most conservative treatments or surgical approaches is currently lacking. Injection of Botulinum toxin type A to the distal region of vastus lateralis muscle causes a short term functional “denervation” which moderates the influence of vastus lateralis muscle on the knee extensor mechanism and increases the relative contribution of the vastus medialis muscle. Initial data suggest that, compared with other interventions for anterior knee pain, Botulinum toxin type A injection, in combination with an active exercise programme, can lead to sustained relief of symptoms, reduced health care utilisation and increased activity participation. The procedure is less invasive than surgical intervention, relatively easy to perform, and is time- and cost-effective. Further studies, including larger randomized placebo-controlled trials, are required to confirm the effectiveness of Botulinum toxin type A injection for anterior knee pain and to elaborate the possible mechanisms underpinning pain and symptom relief. View Full-Text
Keywords: anterior knee pain; muscle imbalance; botulinum toxin type A anterior knee pain; muscle imbalance; botulinum toxin type A
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Singer, B.J.; Silbert, B.I.; Silbert, P.L.; Singer, K.P. The Role of Botulinum Toxin Type A in the Clinical Management of Refractory Anterior Knee Pain. Toxins 2015, 7, 3388-3404.

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