Description

Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the patella (kneecap). These soft tissues include the tendons, the fat pad beneath the patella, and the synovial tissue that lines the knee joint. The patella slides over the femur (upper thigh bone) during knee flexion and extension.

In some cases of patellofemoral pain, a condition called chondromalacia patella is present. Chondromalacia patella is the softening and breakdown of the articular cartilage on the underside of the kneecap. There are no nerves in articular cartilage—so damage to the cartilage itself cannot directly cause pain. It can, however, lead to inflammation of the synovium and pain in the underlying bone.

Causes
  • Overuse
    • Many cases of patellofemoral pain is caused by vigorous physical activities that put repeated stress on the knee including jogging, squatting and climbing stairs.
    • Sudden changes in physical activity
      • Increased frequency, duration or intensity of exercise
    • Changes in foot wear
    • Improper training techniques or equipment
    • Osteoarthritis
    • Frequent patellar dislocations
  • Patellar malalignment
    • Problems in alignment may result in a patella that shifts too far toward the outside or inside of the leg, or one that rides to high in the trochlear groove. This causes rubbing on the inside of the patella.
    • Muscular imbalances in the quadriceps muscles at the front of the thigh. If the inner thigh muscles are stronger than outside (or visa versa), this will pull the patella outside of the natural groove.
Symptoms
  • The most common symptom is a dull, aching pain in the front of the knee
  • Increase in pain on activities that repeatedly bend the knee
    • Running, jumping, squatting, climbing stairs
  • Pain after sitting for long periods of time with the knees bent
  • Popping or cracking sounds in your knee when climbing stairs or when standing up after prolonged sitting.
Treatment
  • Rest: Avoid activities that aggravate your pain until symptoms resolve
  • Ice: Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
  • Compression
  • Elevation
  • Bracing
    • Patello-femoral knee stabilizing brace
  • Physiotherapy
    • Quadriceps strengthening (Vastus medialis) to realign the patella into the trochlear groove
  • Medications
    • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
    • Topical anti-inflammatories
      • Compound Topical Creams
      • Voltaren
  • Injections
    • Steroid (Depo-Medrol, Kenalog, Decadron)
    • Gel – Hyaluronic acid (Viscosupplementation)
    • Blood (PRP – Platelet Rich Plasma)