From the Guidelines
Patellofemoral syndrome is a condition characterized by gradual onset diffuse retropatellar and/or peripatellar pain during activities such as squatting, stair ambulation, and running.
Key Characteristics
- Typically affects adolescents and adults
- Has a poor prognosis, with over 50% of people reporting persistent 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 are on average less physically active, and have poorer health-related quality of life than their asymptomatic peers 1
Diagnosis and Management
- Thought to be a precursor to patellofemoral osteoarthritis, making a greater understanding of optimal management essential 1
- Best practice guides recommend delivering knee-targeted exercise therapy, with supportive interventions as required, and education should underpin all interventions, adjusted to reflect the needs of the person 1
- Prefabricated foot orthoses should be prescribed to those who respond favourably to treatment direction tests and be customised 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
From the Research
Definition and Causes of Patellofemoral Syndrome
- Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain in the outpatient setting, caused by imbalances in the forces controlling patellar tracking during knee flexion and extension, particularly with overloading of the joint 2.
- Risk factors include overuse, trauma, muscle dysfunction, tight lateral restraints, patellar hypermobility, and poor quadriceps flexibility 2, 3.
- The syndrome is characterized by retropatellar or peripatellar pain, often referred to as anterior knee pain, which occurs when load is put on the knee extensor mechanism during activities such as climbing stairs, squatting, running, cycling, or sitting with flexed knees 4.
Symptoms and Diagnosis
- Typical symptoms include pain behind or around the patella that is increased with running and activities that involve knee flexion 2.
- Findings in patients with PFPS range from limited patellar mobility to a hypermobile patella 2.
- An examination of the knee focusing on the patella and surrounding structures is essential to confirm the diagnosis, and imaging studies are not necessary before beginning treatment in many cases 2.
Treatment and Management
- Exercise therapy is effective in treating PFPS, with evidence showing that it can result in clinically important reductions in pain and improvements in functional ability, as well as enhancing long-term recovery 4.
- Hip and knee exercises may be more effective in reducing pain than knee exercises alone, but further research is needed to determine the best form of exercise therapy 4.
- A combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group, is the most effective and strongly supported treatment modality for patients with PFPS 5.
- Surgery should be avoided in all patients with PFPS, and pharmacologic therapies are not effective for the management of the syndrome 5.