Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome
Knee anatomy
Axial view right knee
Anatomy
Muscles around the knee joint
Patellofemoral Joint
- Static stability of the PFJ is provided by: capsule, femoral trochlear, medial and lateral retinaculum, patellofemoral ligaments.
- Dynamic stability of PFJ is provided by: extensor mechanism ligaments (Quadriceps and patellar ligaments), Vastus medialis oblique, Vastus lateralis and Iliotibial band.
Alignment: Mechanical axis and Patellar alignment
Mechanical axis
Q angle measurement
Patellofemoral Joint bone anatomy
Patellar acts as a lever within the knee joint
Mechanical alignment, specifically patellofemoral alignment (Q angle) with bone and soft tissue structures allow normal patellar tracking
Factors affecting patella tracking
(Bollier M et al 2011)
Patellofemoral morphology affecting patella tracking
- Patella height
- Patella dysplasia
Effect of knee alignment on PFJ tracking
Valgus knee: ↑ Q angle
Causes of anterior knee pain
- Cartilage knee injury and patellar arthritis
- Chondromalacia patellae
- Fat pad impingement
- Bone tumours
- Patellofemoral Pain syndrome
Patellar arthritis
Chondromalacia Patellae Syndrome
Chondromalacia Patellae Syndrome specifically refers to softening of the patellofemoral cartilage.
Patellofemoral Pain Syndrome
Patellofemoral Pain Syndrome is defined as knee pain around or behind the patellar and it is aggravated by at least one activity that loads the patellar during weight bearing on a flexed knee.
Presentation:
- Anterior knee pain
- Pain aggravated by squatting, prolonged sitting and descending stairs
- Aggravating factors:
- Abnormal gait
- Abnormal posture
- Inappropriate footwear
- Risk factors
- Increase in PFJ workload such as running/squatting activities
- Increase in Q angle
- Patellar altar, hypoplasia, hypermobility, instability
- Muscle dysfunction: Quadriceps weakness
- Flexibility dysfunction: Quadriceps and hamstring inflexibility, Iliotibial band and lateral retinaculum tightness
Management of PFJ pain syndrome
Address abnormal foot biomechanics including low arch feet and the causes thereof.
Strengthening Quadriceps weakness
Non operative:
- Address underlying abnormal contributing factors and rehabilitate
- Analgesia: NSAIDS
- Rehabilitation: Quadriceps (including Vastus Medialus muscle) strengthening. Stretching of lateral knee structures. Core strengthening include hip abductor muscle strength exercises
Closed chain Quadriceps strengthening with resistance band
Closed chain Quadriceps strengthening with resistance band
Open chain Quadriceps strengthening using a resistance band
ITB stretching
Download ASSIC Performance Fingerprint or Strength & Conditioning apps for guideline PFJ pain syndrome rehab routines
Knee strapping
Download ASSIC Performance Fingerprint or Strength & Conditioning apps for guideline knee strapping
Surgery considerations for specific PFJ problems:
Recurrent patellar dislocation can be addressed with MPFL reconstruction
MPFL reconstruction
Post Patellar MPFL Reconstruction rehabilitation
Knee bracing with prescription
Progressive knee range of motion under professional supervision
Download ASSIC Performance Fingerprint and Strength & Conditioning apps for guideline on post MPFL reconstruction under your professional supervision
Patellar arthritis
Osteochondral Lesions
Arthroscopic Surgical Options for osteochondral lesions
- oMicrofracture (≤ 2cm2)
Top left arthroscopy pic of cartilage wear. Top right surgery technique using microfracture. Healing (bottom right) with fibrocartilage
Fat Pad Impingement
References
- Patellofemoral Pain Syndrome. Am Fam Physician. 2019 Jan 15;99(2): 88-94. David Y Gaitonde, Alex Ericksen, Rachel C Robbins.
- What is the Effect on Kinesio Taping on Pain and Gait in Patients with Patellofemoral Pain Syndrome? Cureus. 2020 Jul 3; 12(7).
