Can surgery help knee pain from patellofemoral pain syndrome?

Patellofemoral pain is one of the most common knee problems active people battle. In this week’s Ask Dr. Geier video, I answer a question from a reader who feels he is not getting better with nonsurgical treatments.

Kevin asks:

Hello Dr. Geier,
Back at the end of April, I made a poor decision with overtraining. To make a long story short, I basically walked about 50 miles in 6 days. To be honest, I felt great after every walk – no pain, or even soreness. However, when I went back to work, I started to get burning in my knees. I am a financial analyst and sit all day for 8 to 9 hours.

I got X-rays and an MRI, and all is good there. My orthopedic surgeon says I have amazing joint space for a 51-year-old athlete. However, he said I have patellofemoral pain syndrome or mild chondromalacia. I have done physical therapy, but I still have achy pain most days, especially when sitting.

I have heard there is no great surgery for this. But, he did say if pain got so unbearable, he could try chondroplasty to reduce pain. Your thoughts on chondroplasty for this type of condition? Or just continue physical therapy exercises and strengthen my quads and the muscles around the knee?

Patellofemoral pain is a generic term for a variety of conditions that cause pain along the front of the knee. In the past, doctors referred to these symptoms as chondromalacia. Specifically chondromalacia refers to softening or injury to the cartilage underneath the kneecap. Patellofemoral pain refers to pain coming from the kneecap or front of the femur. There are a number of underlying causes for patellofemoral pain, including instability of the patella, malalignment of the lower extremities, weakness of the muscles of the hip or quadriceps, tightness of the lateral retinaculum (tissue on the outside of the kneecap), and overuse of the knee with certain sports and activities.

Also read:
What type of doctor should I see for my knee injury?

Typically an athlete with patellofemoral pain denies having a specific injury that initiates the symptoms. He or she will complain of pain along the front of the knee that has increased over time. Often the pain will be worse with activities, such as running or jumping. Often the pain increases to the point that he or she experiences it at rest. Patients often give two classic complaints with patellofemoral pain. They will often note difficulty going up and down stairs, especially going down stairs. They will also notice pain sitting with the knee bent for long periods of time, such as in a movie theater, on an airplane, etc. He or she will feel that he needs to stand up and straighten the knee out to relieve the pain. Other complaints include pain with deep squatting and pain standing for long periods of time. Usually patients do not notice significant swelling of the knee or symptoms such as locking, catching, or giving way.

Fortunately treatment is almost always nonsurgical, and its surgery is almost never the first option. Working with a sports physical therapist can help the athlete determine the underlying cause of the pain and work aggressively to get rid of it while getting back to sports. Home exercises can also improve the symptoms. Occasionally taping or bracing the knee can be helpful, and occasionally shoe orthotics might be recommended.

In this video, I discuss surgical options if nonsurgical treatment is failing to help the patient. I explain when chondroplasty, or smoothing out loose flaps of articular cartilage, might or might not be helpful.

Also read:
Preventing Patellofemoral Pain

Knee pain from patellofemoral pain syndrome