Patellofemoral pain syndrome is a broad term used to describe pain in the front (anterior) part of the knee. It is one of the most common complaints seen by physicians very common among young women. Patellofemoral pain syndrome results from a combination of structural factors and muscular imbalance. While the causes are many, patients often see dramatic improvement with oral anti-inflammatory medication and a structured physical therapy program.
Anatomy and Function
- The knee is the largest joint in the body and is made up of three bones: thighbone (femur), kneecap (patella), and shinbone (tibia) all of which need to move in a coordinated fashion normally.
- The kneecap (patella) rests in a groove of the thighbone (femur) called the trochlea. As you bend and straighten your knee the patella slides up and down within the groove.
- Both the underside of the patella and the trochlea are normally covered by thick cartilage that allows them to slip and slide past each other without much friction.
- Many muscles in your CORE, butt, hip, and thigh have to be strong and coordinate their actions to ensure that the patella tracks in the trochlea as it should. When there is muscle imbalance, the patella no longer tracks within the trochlea as it shoulder leading to abnormal rubbing and pressure on the cartilage and pain.
- Synovium is a tissue that lines the knee, secretes joint fluid (synovial fluid) that lubricates the knee.
- Physical therapy is focused on addressing deficits in strength and coordination.
Causes
- Patellofemoral pain syndrome may result from numerous factors:
- Misalignment of the lower extremity that result in a kneecap that shifts too far toward the outside or inside of the knee, or rides too high in the trochlea.
- Flattened trochlea
- Laxity of soft tissue constraints
- Muscular imbalance
- Chondromalacia (softening/breakdown of cartilage on underside of patella)
Symptoms
- Pain during exercise (squatting, running, jumping, etc.)
- Pain with stairs (going down often worse than going up)
- Pain related to change in activity level, intensity, playing surface, or equipment.
- Popping or crackling sounds in the knees when climbing stairs or after prolonged sitting.
Diagnosis
- Physical examination is the most important diagnostic tool. Dr. Taylor will evaluate your knee for areas of tenderness, amount of swelling, range of motion, evidence of abnormal laxity, and for co-existing injury of other structures in and around the knee
- X-ray is important to look for fractures and other bony abnormalities.
- MRI may be ordered for some patients with particularly concerning findings on examination.
Treatment
Treatment of Patellofemoral Syndrome can almost always be successfully managed without surgery.
- Non-Surgical
- Rest, Ice, Compression, and Elevation (RICE)
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as aspirin, naproxen, or ibuprofen are helpful to reduce pain and swelling
- Orthotic shoe inserts can help align and stabilize your foot and ankle, taking stress off of your lower leg. These can be custom made or off the shelf.
- Steroid (cortisone) injection may be appropriate in some patients
- Viscosupplementation (lubricating shots) may be appropriate for some patients
- Physical therapy focused on CORE, hip, thigh strengthening, flexibility, and coordination is essential for recovery.
- Surgical
- Surgical treatment is rarely needed but can range from chondroplasty, which is simple removal of unstable cartilage flaps, to advanced cartilage restoration procedures, and bony and soft tissue realignment procedures.
- Rehabilitation following surgery will be necessary.
- Taylor will discuss options during your visit.