From the Guidelines
For patients with patellofemoral pain syndrome (PFPS) that has not responded to conservative management, the most effective treatment approach is to deliver knee-targeted exercise therapy, with supportive interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping, underpinned by education. This approach is based on the latest evidence from high-quality studies, including a systematic review and expert clinical reasoning 1. The treatment should be tailored to the individual patient's needs and preferences, taking into account their background risk factors, reasons for seeking care, greatest symptoms, and physical impairments.
Key components of the treatment approach include:
- Knee-targeted exercise therapy, with or without hip-targeted exercise therapy, to address muscle strength and movement patterns
- Education to challenge inaccurate beliefs, build confidence, and promote autonomy and understanding of the diagnosis
- Supporting interventions, such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping, to address specific impairments and symptoms
- Ongoing assessment and adjustment of the treatment approach to ensure it remains effective and aligned with the patient's needs and preferences.
It is essential to note that pharmacological interventions, such as NSAIDs or corticosteroid injections, may be considered for short-term pain management, but their use should be limited and carefully monitored to avoid potential side effects 1. Surgical options, such as arthroscopic debridement or tibial tubercle osteotomy, may be considered in severe cases that fail to respond to conservative management, but their outcomes are variable and should be approached with caution.
Overall, the treatment approach for PFPS should prioritize a comprehensive and individualized approach, addressing the patient's unique needs and preferences, and incorporating the latest evidence-based interventions to optimize outcomes and improve quality of life.
From the Research
Treatment Options for Patellofemoral Pain Syndrome Refractory to Conservative Management
The management of patellofemoral pain syndrome (PFPS) that is refractory to conservative management involves a multi-faceted approach. The following are some treatment options:
- Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFPS 2
- Orthotic devices, such as knee braces, knee straps, and foot orthotics, may be effective in reducing pain and improving function in patients with PFPS 3
- Taping and bracing have been found to be helpful in the short-term management of pain and improving function in patients with PFPS 4
- Injections, such as platelet-rich plasma (PRP), sclerosing, high volume, or stem cell injections, are being investigated as a potential treatment for PFPS, but the evidence is limited and more well-designed studies are needed 4
- A comprehensive program including strength training, stretching, and proprioceptive training may be effective in reducing knee pain symptoms and improving functionality in patients with PFPS 5
- New techniques, such as blood flow restriction therapy, gait retraining, and acupuncture, show promise but require further well-designed studies 6
Key Considerations
When managing PFPS that is refractory to conservative management, it is essential to:
- Conduct a thorough history and physical examination to identify the patient's specific impairments and functional limitations 2
- Develop an individualized treatment plan that addresses the patient's specific needs and goals 2
- Consider the use of adjunctive therapies, such as taping, bracing, and orthotics, in addition to exercise therapy and other conservative treatment modalities 3, 4, 5
- Monitor the patient's progress and adjust the treatment plan as needed to ensure optimal outcomes 2