Patellofemoral Pain

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.

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.

Patellofemoral pain
The pain felt by athletes with patellofemoral pain is usually diffuse, all around the front of the knee (white circle).
If the pain is limiting an athlete’s ability to do what he or she would like to do, evaluation by a sports medicine physician can be very helpful. Physical examination can not only help to diagnose pain but also reveal underlying issues that can contribute to the symptoms, such as the patellar instability or maltracking, muscle weakness, alignment of the knees, and tightness of the lateral retinaculum. X-rays are usually negative, although they are important especially to determine if one patella tilts more toward the outside of the knee than the other. Also degenerative changes between the patella and the femur can be visualized on x-rays. MRI’s are rarely needed initially, as often there are no underlying structural abnormalities.

Fortunately treatment is almost always nonsurgical, and its surgery is almost never the first option.

Lateral release
I release the lateral retinaculum to decrease compression forces on the outside of the patella in the rare patients with patellofemoral pain who fail nonoperative treatment.
Rehabilitation is almost always a good 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. Occasionally taping or bracing the knee can be helpful, and occasionally shoe orthotics might be recommended, again depending on the underlying problem. There are rare instances where nonsurgical treatment fails to improve the symptoms. In these cases, surgery such as a lateral release or patella realignment surgery might be indicated. Usually these surgeries are performed after the patient has failed many months of physical therapy, bracing, and other nonsurgical treatments.

7 Responses to Patellofemoral Pain

  1. Does Patellofemoral pain syndrome resulting from pronation and Q angle make you more susceptible to other knee injuries? What about shin splints?

    • I can’t say that I have read studies claiming that PFPS causes other injuries but I suppose there are associated patient variables that could be associated with other injuries.

  2. I have pain in my left knee that started last evening, for no particular reason. Went to stand and all of the sudden felt pain in my knee, hurts to stand, walk and straighten it. Sleep through the night and woke this morning with the same pain. The pain is in the front, back and travels to the back of my leg.

  3. Since September 18 I hit my knee on a piece of metal on a table… Since then I’ve been having lots of pain!!! Went to therapy, not helping, I wear a brace, not helping… Now I feel the pain all over my knee, top of the knee, back of knee and side… Sometimes it’s swollen…. I am schedule for in MRI in 2 weeks!!!! Did a X-Ray, doctor said can t see Nuttin!!!! At night I m really in pain..

  4. I hurt my knee about three days ago i was skating and slipped and fell on my right knee i didnt feel a pop or hear one but i was limping right away but i still kept skating cause it didnt hurt much then after a while suddenly my knee hurt a lot but i didnt hear a pop so i just went inside to take a break and after two days of icing elevation and compression my knee still hurts a bit when i touch it and also i feel a little pain when i squat basically little pain when i bend the knee and put pressure on it other than that i can walk normally after three days extend and contract my knee fully with no problem but i do hear a little pop when i contract it fully although it does not hurt. Do you think its something serious or maybe i just need a little more rest?

  5. My son fell on his knee in Dec while playing basketball… he’s had continued pain off an on… mri shows “full thickness cartilage defect right knee lateral patellar facet inferiorly with surrounding chondromalacia”… Ive worked for an ENT for 25 years… she says not to get the steroid inj because of the side effects to bone and cartilage… can you help me feel better about the injection if that’s the only option given? This will be his first year pitching in college. Hopefully they’ll work out a personal conditioning routine for him…. Of note… he saw you as a patient around six years ago for elbow tendonitis. He followed all of your advice… and eventually ended up pitching sidearm.

    • One injections is probably not that harmful, but there are some studies showing that cortisone can soften cartilage and be harmful in the long run.

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