Patellofemoral Pain Syndrome
Patellofemoral pain syndrome is a general term that refers to pain in the front of the knee around the patella or kneecap. The condition tends to be more common in women and in athletes, but it is possible for anyone to develop patellofemoral pain syndrome.
The knee joint is made up of the femur, tibia and patella (knee cap). All these bones are lined with articular (surface) cartilage. This articular cartilage acts as a shock absorber and allows a smooth low friction surface for the bones that make up the knee. There are other important structures that help to make movement easier. The patella rests in an important structure called the trochlear groove. The allows the patella move more easily when bending and straightening the knee. Just below the patella, there is a fat pad that helps to cushion the patella acting as a shock absorber. The joint also produces synovium, fluid that helps to lubricate the joint and allow the bones to glide easily.
In most cases patellofemoral pain is caused by repetitive activities that put stress on the knee. These activities include running, squatting, and stair climbing. A sudden increase or change in physical activity can also cause pain around the kneecap. This change can be in the frequency, intensity, or duration of physical activity. Improper footwear and or using improper form or technique can also contribute to this pain. Other causes include patellar malalignment. If the patella does not track correctly in the groove in which it sits this can cause pain over time. Muscle imbalances or weakness especially in the quadriceps muscle can also cause this type of pain.
The most common symptom associated with patellofemoral syndrome is a dull pain in the front of the knee or around the kneecap. The onset is often gradual and can become more frequent or worse with activities. You may notice pain after sitting for long periods of time, during activities such as squatting or running, or going up and down stairs. A popping sensation is also possible.
The diagnosis of patellofemoral pain syndrome is based on a thorough history and physical examination. You may be asked about any physical activities or sports in which you participate. During the exam, Dr. Faucett will check for any tenderness or swelling around the knee cap. They will also examine how the patella moves or tracks as you bend and straighten your leg. Xrays may help to rule out any abnormalities that may contribute to the pain. Further imaging may be needed if there is a question of patellar tracking issues.
Fortunately, most cases of patellofemoral pain syndrome resolve with nonoperative treatment. Initial treatment includes rest, ice, and activity modification. NSAIDS may be helpful in reducing pain and inflammation. Other treatment options include:
- Physical therapy to help strengthen the muscles around the knee especially the quadriceps, and to correct any muscular imbalances
- Orthotics to help stabilize and align the lower leg and foot
Occasionally, surgical treatment may be necessary to debride or remove any damaged cartilage from the undersurface of the patella or to correct significant patellar tracking or alignment issues.
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Dr. Scott Faucett
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