Patellofemoral Syndrome

FAQS on Patellofemoral Syndrome

 

Runner’s knee disorder or patellofemoral syndrome is the most common cause of pain around the kneecap. It is the most frequently diagnosed solitary cause of knee pain among runners, teenagers, and manual laborers. The syndrome usually improves with physiotherapy, exercises, and other simple treatment procedures.

What is patellofemoral syndrome?

Patellofemoral syndrome refers to pain in the area in and around your knee cap. The name patellofemoral is derived from its area of impact – painful sensation seems originating from the place where the femur connects with the back of the kneecap. It signals pain in the front of the knee or injury the kneecap.

Patellofemoral syndrome occurs without any visible sign of damage to the kneecap or joint. At least a fourth of all injuries in runners are due to this kneecap pain problem. Similarly, the disorder is responsible for the majority of anterior knee pain complaints traced to the office setting

What are the symptoms of patellofemoral syndrome? When to see a doctor?

  • Dull, aching pain impacting the front knee
  • Worsening pain as you do workouts, up or down on the staircase, running, squatting, or jumping
  • Knee pain when you bent or straighten you knee following prolonged rest
  • Pain varies according to playing surface, intensity of activity
  • Popping or crackling sensation in the knee as you climb steps
  • Stress on the knee leading to pain
  • Felling of knee giving out
  • Nil to mild swelling
  • Occasional knee buckling
  • Irregular pain around the kneecap bone

How does patellofemoral syndrome occur?

The patella, the thick, circular-triangular kneecap bone protecting the joint, sits on a cartilage. It slides over and back on this thick elastic tissue, as you straighten your leg or bend it. Softening of the cartilage or its wearing down or abrasion causes painful patellofemoral syndrome. Similarly, tendinitis in quadriceps, which holds the patella, leads to the disorder.

When bones of the lower leg are not aligned properly, knee flexion and extension result in abnormal gliding of the patella and the femur against each other. This causes accelerated wear of the cartilage and its degeneration setting the tone for patellofemoral syndrome.

Direct blow to the kneecap also damages the cartilage and causes the syndrome.

What are causes of patellofemoral syndrome?

  • Wearing down of kneecap cartilage
  • Excessive force or blow on patellofemoral joint
  • Overuse of or injury to the kneecap
  • Patellar tracking disorder or improper kneecap alignment
  • Injury to quadriceps tendons or thigh muscles, quadriceps tendonitis
  • Disorders, such as patellofemoral arthrosis, meniscal injury, chondromalacia, bone bruises, and prepatellar bursitis
  • Patellar dislocation
  • Twisting or traumatic knee injury
  • Foot disorder, including flat feet
  • Falling knee and leg muscle strength
  • Excessive hip, sine bone rotation
  • Running wearing old shoes
  • Foot problems

What are risk factors?

Those with flat feet, with degenerative knee disorders, involved in contact sports, or with injured knee are at the increased risk of getting patellofemoral syndrome.

How is patellofemoral syndrome diagnosed?

  • Physical Examination: Symptoms are analyzed and questions are asked about origin and nature of knee pain and activities leading to pain. The kneecap is pressed to elicit pain sensation, analyze alignment problems, and knee strength. Patients have to perform a range of activities to allow the doctor examine symptoms.
  • Differential Diagnosis: Comprehensive examination is done to check the knee for stability, kneecap dislocation, condition of thigh muscles, and the flexibility of the feet. This coupled with imaging tests help rule out other forms of knee injury.

What are the treatment methods available for patellofemoral syndrome?

  • Activity Changes: Avoid activities that hurt or put stress on the knee. Switch to low-impact workouts and change your life style. Losing weight also reduces force on the knee.
  • Self-Care: Follow the RICE protocol – take REST, apply ICE to the injured area regularly, keep it COMPRESSED by using an elastic bandage, and rest your knee in an ELEVETED posture. Allow you knee to remain away from stress and strain and use cold packs multiple times every day. Keeping it gently compressed helps inhibit swelling.
  • Medication: NSAIDs are useful to prevent worsening of swelling and pain that cause cessation of daily activities.
  • Use Support Devices:
  • Brace: It helps to keep quadriceps stress free and swelling under control while providing support to the knee joint.
  • Orthotics: These shoe inserts are extremely important in ensuring proper foot and ankle stabilization and alignment. The aids also help keep the lower legs stress free.
  • Arch Support: It is vital to save you from patellofemoral pain syndrome associated with stressful lower extremities and overpronation. Improved lower extremity biomechanics assure better protection against the disorder.
  • Suitable Footwear: Using right footwear while running to provide comfort to your knee and foot. It prevents injuries to the kneecap bone by reducing strain on it.

 

  • Exercise Therapy: When used with other types of treatment, exercises help in long-term recovery and prevention of patellofemoral syndrome. Isotonic and isometric exercises strengthen the knee muscle functions and make them more powerful to resist any traumatic force. A 2011 report claims that quadriceps strengthening exercise is the most effective way to manage patellofemoral syndrome, as it reinforces thing muscles responsible to keep the kneecap from any injury.
  • Alternative Therapy: This category includes chiropractic procedures and acupuncture. Laser therapy is also used to treat the disorder.
  • Surgical Treatment:
  • Lateral release surgery that cuts the tight ligament forcing the kneecap to slide out of trochlear groove and move toward it.
  • Debridement or removal of abraded articular cartilage
  • Tibial tubercle transfer or realignment of the kneecap by repositioning patellar tendon

 

  • Prolotherapy (PRP/ Stem Cell Injection): An alternative to the surgical method, the method treats a patellofemoral syndrome with stem cells or platelet rich plasma collected from the patient’s blood. The therapy helps regeneration of new cells and tissues that replace the damaged cartilage.

References

Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A Systematic Review of Complications and Failures Associated With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation. Am J Sports Med. 2012 Jun 7.

Hauser RA, Cukla JJ. Standard Clinical X-ray Studies Document Cartilage Regeneration in Five Degenerated Knees After Prolotherapy. Journal of Prolotherapy. 2009;1:22-28.

Donna A. Prolotherapy For Knee Pain, Practical Pain Management, July/August 2007, 70-79

Hauser RA, Sprague IS. Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function. Clin Med Insights Arthritis Musculoskelet Disord. 2014; 7: 13–20.

Dixit S, Burton M, Mines B. Management of Patellofemoral Pain Syndrome. Am Fam Physician. 2007 Jan 15;75(2):194-202.

Callaghan, MJ; Selfe, J (Apr 18, 2012). “Patellar taping for patellofemoral pain syndrome in adults.”. The Cochrane database of systematic reviews 4

Tria Jr, AJ; Palumbo, RC; Alicea, JA (1992). “Conservative care for patellofemoral pain”. The Orthopedic clinics of North America 23 (4): 545–54.

Gross, M. L.; Davlin, L. B.; Evanski, P. M. (1991). “Effectiveness of orthotic shoe inserts in the long-distance runner”. The American Journal of Sports Medicine 19 (4): 409–12.

Price JL. Patellofemoral syndrome: how to perform a basic knee evaluation. JAAPA. Dec 2008;21(12):39-43.

Kooiker L, Van De Port IG, Weir A, et al. Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. Jun 2014;44(6):391-B1.

Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ. Oct 24 2008;337:a1735.

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