Patellofemoral Pain Syndrome

Patellar femoral pain syndrome is a broad term that is used to describe chronic pain in the front of the knee and around the patella, or knee-cap, often caused my malalignment of the tracking of the patella or from intense overuse.

 

Symptoms

• Dull aching in the front of the knee

• Pain gradually increases with increase in activity

• Inflammation surrounding patella

• Can be in one or both knees

• Pain with exercise involving repeatedly bending the knee (such as climbing stairs, running, jumping, squatting)

• Pain related to activity change or increase in activity

• Popping or crackling sounds in knee while climbing stairs, squatting, or getting up after prolonged sitting with the knees bent

 

Causes

• Malalignment of the patella in the patellar groove leading to abnormal tracking (patella is pushed to one side when the knee is bent)

• Muscular imbalances in the quadriceps muscles causing the patella to be pulled to one side and causing poor tracking

• Intense physical activity putting repeated stress on the knee joint (such as climbing stairs, running, jumping, squatting)

• Sudden change or increase in physical activity (frequency, duration, or intensity)

• Improper technique or equipment

• Change in footwear or playing surface

• Faulty alignment of the legs

• Past injury to the knee

 

Risk factors

• Most often found in young adults under 50

• Individuals involved in heavy running and jumping activities

• More often seen in females 

 

Prevention

• Strengthen the quadriceps muscles and stretch the hamstring muscles

• Gradual progressive increase in activity

• Avoid painful activities

• Focus on proper technique

• Wear supportive and appropriate shoes

• Proper warm-up and cool-down

• Maintain a healthy weight

• Stretching and flexibility program

 

Diagnosis

• Physician examination including a thorough history, palpation, checking patellar tracking, checking patient’s gait

• X-rays in multiple positions can better show patellar alignment and tracking

 

Treatment options

Non-surgical:

• Most patients will improve with non-surgical conservative treatment which includes activity change

• Physical therapy- especially to stretch and strengthen quadriceps muscles

• Stop doing things that cause pain. Modify activity. Biking and swimming often do not cause pain.

• Orthotic shoe inserts to fix structural foot issues or simply change footwear to be more supportive

• Lose weight if overweight

 

Surgical:

• Surgical treatment is rarely needed

• Arthroscopy- for debridgement and possible lateral release

• Tibial tubrical transfer