From the Guidelines
Patellofemoral Syndrome
Patellofemoral syndrome is a common condition characterized by anterior knee pain, typically exacerbated by activities such as climbing stairs, squatting, or jumping 1.
Key Characteristics
- The pain is usually diffuse retropatellar and/or peripatellar and can be persistent, with over 50% of people reporting pain more than 5 years post-diagnosis despite receiving treatment 1.
- People with patellofemoral pain are six times more likely to be anxious or depressed and have poorer health-related quality of life than their asymptomatic peers 1.
Treatment Approach
Treatment involves a multimodal approach, including:
- Knee-targeted exercise therapy, with supportive interventions as required 1.
- Education should underpin all interventions, adjusted to reflect the needs of the person, and may seek to challenge inaccurate beliefs, build confidence, and promote autonomy and reduce fear 1.
- Prefabricated foot orthoses may be prescribed to those who respond favourably to treatment direction tests and be customized for comfort by modifying density and geometry 1.
- Movement/running retraining can be considered in those with symptoms reasoned to be associated with assessment findings aligning with the intervention 1.
- Taping should be considered for people where rehabilitation is hindered by elevated symptom severity and irritability 1.
Important Considerations
- Goal setting and objective evaluation of physical impairments are crucial in determining the most effective treatment approach 1.
- Hip-and-knee targeted exercise therapy may be required, with a greater focus on hip exercises in people with poor tolerance to loaded knee flexion 1.
- Education and supportive interventions should be tailored to the individual's needs and preferences 1.
From the Research
Definition and Causes of Patellofemoral Pain Syndrome
- Patellofemoral pain syndrome (PFPS) is a common cause of anterior knee pain, affecting adolescents and adults younger than 60 years, with an incidence of 3% to 6% in the United States 2.
- The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities, such as squatting, running, jumping, and walking up stairs 2, 3.
- Potential pain sources include connective or soft tissue irritation, intra-articular cartilage damage, mechanical irritation, nerve-mediated abnormalities, systemic conditions, or psychosocial issues 3.
- Dynamic valgus of the lower extremity, weak hip muscles, and rearfoot eversion with pes pronatus valgus are key factors in the development of PFPS 4, 5.
Symptoms and Diagnosis
- Patients with PFPS often report pain during weight-bearing activities that involve significant knee flexion, such as squatting, running, jumping, and walking up stairs 2, 3.
- The most sensitive physical examination finding is pain with squatting, and examining a patient's gait, posture, and footwear can help identify contributing causes 2.
- Plain radiographs of the knee are not necessary for the diagnosis of PFPS but can exclude other diagnoses, such as osteoarthritis, patellar fracture, and osteochondritis 2, 3.
Treatment and Management
- Treatment of PFPS includes rest, a short course of nonsteroidal anti-inflammatory drugs, and physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups 2, 4, 5.
- Patellar kinesiotaping may provide additional short-term pain relief, and the use of foot orthoses can also be beneficial in patients with additional foot abnormalities 2, 4, 5, 6.
- A multimodal non-operative therapy concept with short-term use of NSAIDs, exercise programs, and orthotics is recommended, and patients should be informed that it may take several months for symptoms to resolve 3, 4, 5.