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Patellofemoral Pain Syndrome

Categories
  • Joint/Tendon
  • Knee
Tags
  • knee injury
Knee Anatomy & Examination

Patellofemoral Pain Syndrome

Knee anatomy

Coronal view right knee
Coronal view right knee
Anterior Drawer Test
Axial view right knee

Anatomy
Muscles around the knee joint

Resisted hip flexion (hip flexor muscles)
Muscles around the hip joint
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.
Patellar Femoral joint_Soft tissue
Tendon attachments

Alignment: Mechanical axis and Patellar alignment

Mechanical axis​
Mechanical axis
Q angle measurement
Q angle measurement

Patellofemoral Joint bone anatomy

Patellofemoral Joint bone anatomy
Patellar acts as a lever within the knee joint
Muscle and tendon attachments
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)
Q Angle

Patellofemoral morphology affecting patella tracking

  • Patella height
  • Patella dysplasia
Patella height

Effect of knee alignment on PFJ tracking

Valgus knee: ↑ Q angle

Valgus Knee

Causes of anterior knee pain

  • Cartilage knee injury and patellar arthritis
  • Chondromalacia patellae
  • Fat pad impingement
  • Bone tumours
  • Patellofemoral Pain syndrome
Muscle Injury

Patellar arthritis

Patellar arthritis
Front View Knee
Knee Fat Pad Anatomy

Chondromalacia Patellae Syndrome

Chondromalacia Patellae Syndrome specifically refers to softening of the patellofemoral cartilage.

Chondromalacia patella

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:
    1. Abnormal gait
    2. Abnormal posture
    3. Inappropriate footwear
  • Risk factors
    1. Increase in PFJ workload such as running/squatting activities
    2. Increase in Q angle
    3. Patellar altar, hypoplasia, hypermobility, instability
    4. Muscle dysfunction: Quadriceps weakness
    5. Flexibility dysfunction: Quadriceps and hamstring inflexibility, Iliotibial band and lateral retinaculum tightness

Management of PFJ pain syndrome

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
Quadriceps muscle
Quadriceps strengthening using body weight
Closed chain Quadriceps strengthening with resistance band
Closed chain Quadriceps
Closed chain Quadriceps strengthening with resistance band
Quadriceps strengthening with resistance band
Open chain Quadriceps strengthening using a resistance band
ITB Stretch
ITB stretching

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for guideline PFJ pain syndrome rehab routines

apple app store  google play store

Knee strapping

Knee strapping

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for guideline knee strapping

apple app store  google play store

Surgery considerations for specific PFJ problems:

Patellar dislocation​
Recurrent patellar dislocation can be addressed with MPFL reconstruction
MPFL reconstruction
MPFL reconstruction

Post Patellar MPFL Reconstruction rehabilitation

Knee bracing with prescription
Knee bracing with prescription
Progressive knee range of motion
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

apple app store  google play store

Patellar arthritis

Knee arthritis
Total Knee Implant
Patellar tracking after TKA

Osteochondral Lesions

Arthroscopic Surgical Options for osteochondral lesions

  • oMicrofracture (≤ 2cm2)
Osteochondral Lesions
Osteochondral Lesions

Top left arthroscopy pic of cartilage wear. Top right surgery technique using microfracture. Healing (bottom right) with fibrocartilage

Fat Pad Impingement

Arthroscopic partial debridement of fat pad

References

  1. Patellofemoral Pain Syndrome. Am Fam Physician. 2019 Jan 15;99(2): 88-94. David Y Gaitonde, Alex Ericksen, Rachel C Robbins.
  2. What is the Effect on Kinesio Taping on Pain and Gait in Patients with Patellofemoral Pain Syndrome? Cureus. 2020 Jul 3; 12(7).

Contributor:

Dr M Y Hassan

Learn More

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