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Patellofemoral Pain Syndrome

The knee is the largest joint in the human body and proper function and health of the knees is required to perform most everyday activities. The knee is made up of the lower end of the femur (thighbone), the patella (kneecap), and the upper end of the tibia (shinbone). Articular cartilage, which is a smooth substance that protects the bones and allows them to move freely, covers the ends of the three bones and acts as the main "shock-absorber". Between the femur and the tibia are two C-shaped cushioning wedges known as the menisci that act as the secondary "shock absorbers". Large ligaments (tough bands of tissues) help hold the femur and the tibia together in order to stabilize the joint by preventing excessive movement. The lining joint is covered by the synovial membrane, which is a thin lining that releases fluid that lubricates the cartilage, reducing the friction within the knee joint and providing nutrition to the cartilage. All of these components work together to facilitate proper function of the knee.

Overview

As the knee bends and straightens the patella slides up, down, side-to-side, tilting and rotating along a groove in the femur called the trochlear groove. Repetitive abrasion on any surface of the patella or the femur exerts stress on the soft tissues of the patellofemoral joint and can lead to bruising or wear of the articular cartilage within the knee joint.
Patellofemoral pain syndrome (PFPS), often referred to as a "runner's knee", is a common condition that occurs when an individual feels pain in the front of the knee, either under or around the patella (kneecap). It primarily occurs in teenagers and athletes involved in sports and activities that require significant use of the knees. There are many factors that can contribute patellofemoral pain such as overuse of the knee, improper rotation or alignment of the hip and knee joints, muscular weakness or tightness, tightness of the ligaments around the kneecap, or flatfeet.

Symptoms

Individuals who experience patellofemoral pain syndrome may have the following symptoms:

  • Mild to severe pain around the kneecap, especially when sitting with bent knees for a prolonged period of time (also known as "theater ache"), squatting, jumping or going up/down the stairs
  • Occasionally buckling of the knee or the sensation that the knee is "giving way"
  • Sensation that the knee joints are catching, locking, or grinding when walking or moving the knee

Diagnosis

Patellofemoral pain syndrome can be diagnosed with a combination of patient history, physical examination, and imaging studies. The physician may examine the knee to assess the motion, stability, and overall strength. In some cases, the physician may order X-rays or an MRI scan to determine the extent of damage and rule out any structural damage to the knee and the tissues connected to it.

Treatment

The treatment approach for patellofemoral pain syndrome depends on many factors including the severity of the condition. Appropriate non-operative treatment will relieve most symptoms and is always the first method of treatment. Operative treatments are not commonly required and should only be considered after trying more-conservative approaches.

  • Rest - It is advised to decrease or completely stop the activity that makes the pain worse. A great way to stay active while allowing the symptoms to subside is to switch to low-impact, cross-training activities such as biking or swimming.
  • Ice - Placing ice (with a barrier such as a towel) on the most painful areas of the knee for up to 30 minutes (less if the skin becomes numb) three to four times a day can greatly soothe the pain and keep the swelling down.
  • Medication - Over-the-counter anti-inflammatory medication such as ibuprofen and naproxen can help reduce pain and swelling.
  • Durable Medical Equipment - The physician might prescribe orthotic devices such as a shoe inserts or special footwear to relieve pressure, support the arch, and absorb impact. The physician or physical therapist may recommend a knee sleeve or brace for some time to support the joint and facilitate position of the kneecap during the healing process.
  • Surgery - Surgery is not commonly required and should only be considered if more-conservative treatments have failed to reduce the symptoms. The specific type of surgery depends on the exact nature and the severity of the patellofemoral pain syndrome and should be discussed with the physician extensively when the need is identified.

Recovery

Recovery from patellofemoral pain syndrome can be an extensive process and depends greatly on the chosen method of treatment. Non-operative recovery usually takes weeks or months. Activities that require heavy use of the knee need to be eased into gradually. In order to reach pre-injury activity level, the patient needs to build strength and flexibility in the muscles around the core, hips, and knees. Recovery post-operatively can take much longer than non-operative recovery. Each patient is unique and their recovery will depend on the treatment method prescribed by the physician.

 

Disclaimer

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