Patellar femoral pain syndrome is a broad term that is used to describe chronic pain in the front of the knee and around the patella, or knee-cap, often caused my malalignment of the tracking of the patella or from intense overuse.
Symptoms
Dull aching in the front of the knee
Pain gradually increases with increase in activity
Inflammation surrounding patella
Can be in one or both knees
Pain with exercise involving repeatedly bending the knee (such as climbing stairs, running, jumping, squatting)
Pain related to activity change or increase in activity
Popping or crackling sounds in knee while climbing stairs, squatting, or getting up after prolonged sitting with the knees bent
Causes
Malalignment of the patella in the patellar groove leading to abnormal tracking (patella is pushed to one side when the knee is bent)
Muscular imbalances in the quadriceps muscles causing the patella to be pulled to one side and causing poor tracking
Intense physical activity putting repeated stress on the knee joint (such as climbing stairs, running, jumping, squatting)
Sudden change or increase in physical activity (frequency, duration, or intensity)
Improper technique or equipment
Change in footwear or playing surface
Faulty alignment of the legs
Past injury to the knee
Risk factors
Most often found in young adults under 50
Individuals involved in heavy running and jumping activities
More often seen in females
Prevention
Strengthen the quadriceps muscles and stretch the hamstring muscles
Gradual progressive increase in activity
Avoid painful activities
Focus on proper technique
Wear supportive and appropriate shoes
Proper warm-up and cool-down
Maintain a healthy weight
Stretching and flexibility program
Diagnosis
Physician examination including a thorough history, palpation, checking patellar tracking, checking patient’s gait
X-rays in multiple positions can better show patellar alignment and tracking
Treatment options
Non-surgical:
Most patients will improve with non-surgical conservative treatment which includes activity change
Physical therapy- especially to stretch and strengthen quadriceps muscles
Stop doing things that cause pain. Modify activity. Biking and swimming often do not cause pain.
Orthotic shoe inserts to fix structural foot issues or simply change footwear to be more supportive
Lose weight if overweight
Surgical:
Surgical treatment is rarely needed
Arthroscopy- for debridgement and possible lateral release
Tibial tubrical transfer
