What is Patellofemoral Syndrome
Patellofemoral syndrome describes a variety of conditions involving the patellofemoral joint which is in the front of the knee and consists of the space between the undersurface of the knee cap (patella) and “groove” of the femur (trochlea). Pain in the front of the knee can be classified as patellofemoral syndrome but can really incorporate several different causes for the pain.
Is it the same as Runner’s Knee?
Runner’s or Jumper’s knee is a specific variant of patellofemoral pain where the pathology and pain are localized at the proximal portion of the patellar tendon off of the inferior pole of the patella. The stress created by frequent impact from running or pull on this tendon through jumping and landing can lead to small microtears within this portion of the patellar tendon which leads to inflammation and pain.
These symptoms are common among young people who are active in sports, however anyone can experience pain related to patellofemoral syndrome
Common symptoms include pain and swelling in the front of the knee at the patellar tendon origin at base of patella. Typically pain is felt behind the kneecap. Patients may also experience painful popping or cracking that is audible, pain commonly associated with kneeling, deep squatting or transitioning from prolonged sitting to a stand.
Causes can be multi-factorial and include:
1. Types of activity or exercise, overtraining, quickly increasing the amount or intensity of exercise
2. Patella maltracking which can be related to a patient’s abnormal alignment or anatomy of the lower extremity vs muscle imbalances like quadricep weakness, iliotibial band tightness
3. Related to chondromalacia or breakdown of the cartilage behind the kneecap
When to see a doctor
If this pain does not improve with a period of rest (2-4 weeks of decreasing the activity), ice, oral anti-inflammatories (NSAIDs) it may be time to visit a doctor.
Mostly a clinical diagnosis based on location of pain, patella maltracking, muscle atrophy and alignment of the lower extremity. X-rays will be done to assess bony abnormalities, malalignment of the kneecap or entire lower extremity. MRI may be useful to further evaluate the extent of cartilage damage from chondromalacia.
Treatment for Runner’s Knee
Most cases of patellofemoral syndrome improve with conservative treatment which address controlling pain and inflammation with oral/topical NSAIDs and ice, rest from triggering activity (for 4-8 weeks), bracing and a formal physical therapy program.
Physical therapy is critical for proper core, gluteal, quadricep strengthening and hamstring/ITB stretching to ensure proper patellar tracking and decreasing stress on the patellar tendon while allowing the tissue to rest and heal
Biologic injections such as Platelet-Rich Plasma can be helpful if these modalities fail, however, this requires rest and PT period as well.
Successful conservative treatment may take several weeks to months, however if conservative treatment options have been exhausted and symptoms persist, surgery may be an option and could include:
- Debridement of the patellar tendon with repair
- If pain is more under the patella from patellar cartilage wear then arthroscopy for cartilage debridement can sometimes help
- If there is an area of severe cartilage loss, sometimes arthroscopic or open cartilage transplant procedures with or without offloading osteotomies may be indicated
- Knee arthroscopy with a possible lateral release or cartilage preserving procedure to address areas of focal cartilage loss on the patella or femur.
- There are other surgical options to address malalignment issues or laxity of the kneecap, if indicated including tibial tubercle transfer, medial patellofemoral ligament reconstruction, high tibial osteotomy and distal femur osteotomy.
There is no FAST recovery for this problem.
Typically requires activity modification, rest and a formal physical therapy program with a professional to learn proper exercises to re-balance muscle groups that are not working together properly. If surgery is indicated, the recovery process is a 4-6 months to a year depending on the procedure or procedures that were recommended.
Patellofemoral Syndrome FAQ:
How long does it take to recover?
It can take 6 weeks to 6-12 months to fully recover
What activities would hinder a quick recovery?
Continuing to perform the activity or exercise that triggers pain and symptoms and avoiding a formal rehab program with a physical therapist
What exercises can I do while in recovery?
Closed chain quad exercises, hip abductor strengthening, Iliotibial band and hamstring stretching and foam rolling.
Does Runner’s Knee ever go away completely?
Typically yes, but there may need to be adjustments to your exercise routine that will require adding specific stretching and strengthening exercises to your regular repertoire of activities/exercise on a daily or weekly basis. Patient’s can have “flare ups” during periods of increased activity or if they slack in their exercise program.
Can you develop Patellofemoral Syndrome even if you are not an athlete?
This commonly occurs in athletes and non-athletes alike.
Does walking up and down hills worsen, or even cause, this condition?
Hills or stairs does not cause this condition, but can exacerbate it as going down stairs especially puts a lot of stress on the patellofemoral joint.
How likely is it that this condition will reoccur after treatment?
The condition can recur after successful treatment and is best mitigated through continued balanced training focused on core, gluteal and quad strength and stabilization with proper hamstring and ITB flexibility to maximize proper patellar tracking, decrease stress on the patellofemoral joint and patellar tendon as well as maintain proper weight and form during exercise.
Dr. Mark Sando is an internationally recognized orthopaedic surgeon specializing in sports medicine, arthroscopy and injuries of the shoulder, knee and hip. He earned his medical degree from Case Western Reserve University School of Medicine and completed residency at the University of Maryland Medical Center and R Adams Cowley Shock Trauma Center. After residency, Dr. Sando went on to complete subspecialized training in Sports Medicine as a fellow at the prestigious Kerlan-Jobe Orthopaedic Clinic in Los Angeles, CA under the direction of Dr. Neal ElAttrache. He has worked with numerous college athletic programs and professional teams including the world champion Los Angeles Kings, Los Angeles Lakers, Los Angeles Dodgers, and Los Angeles Sparks. Dr. Sando has been with the Orthopaedic Medical Group of Tampa Bay since 2015. Full Bio