What is the appropriate management for a 46‑year‑old woman with isolated right patellar‑border pain after slipping, worsened by knee flexion and kneeling, with normal range of motion, intact ligaments, no swelling, and partial relief from ibuprofen?

Management of Lateral Patellar Border Pain Following Slip Injury

Diagnosis

This presentation is consistent with patellofemoral pain syndrome (PFPS), specifically lateral patellar facet irritation. The clinical picture—lateral patellar border tenderness, pain with knee flexion and kneeling, normal ligaments, no effusion, and normal X-ray—strongly supports this diagnosis rather than patellar tendinopathy or other structural pathology 1, 2.

Key Diagnostic Features Present

• Gradual onset diffuse peripatellar pain worsened by activities requiring knee flexion (kneeling, bending) 2
• Pain localized to the lateral border of the patella on examination 1
• Normal range of motion with pain at end-range flexion 2
• Intact ligaments excluding ligamentous injury 2
• Normal radiographs excluding fracture or significant osteoarthritis 2

Treatment Algorithm

Step 1: Optimize Current Pain Management

Scheduled NSAIDs are superior to as-needed dosing for this condition. She should take ibuprofen 400-600mg three times daily with food for 2-3 weeks, not just when painful 1. Topical NSAIDs are an alternative if she has gastrointestinal concerns 1, 3.

Step 2: Initiate Knee-Targeted Exercise Therapy (Primary Treatment)

Individualized knee-targeted exercise therapy is the cornerstone of treatment and should begin immediately 1. Given her pain with loaded knee flexion, start with:

• Quadriceps strengthening at 60-70% of one-repetition maximum, 8-12 repetitions, 2-4 sets, 2-3 days per week 3
• Focus initially on exercises she can tolerate (straight leg raises, quad sets, terminal knee extension) before progressing to loaded knee flexion 1
• Allow at least 48 hours rest between training sessions for the same muscle group 3

Step 3: Add Supporting Interventions

Patellar taping should be applied immediately given her elevated symptom severity that limits daily activities (kneeling for prayer) 1, 3. Medially directed patellar taping can provide short-term relief and allow better engagement with exercise therapy 3.

Deep transverse friction massage to the lateral patellar border may reduce pain and provide additional benefit 3.

Step 4: Patient Education (Critical Component)

Education must underpin all interventions 1. Explain that:

• This represents patellofemoral irritation, not structural damage 1
• Pain during exercises does not mean tissue damage is occurring 3
• Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment 3
• Complete rest will cause muscle atrophy and worsen the condition 3

Step 5: Reassessment Timeline

If no improvement after 6 weeks of consistent therapy, reassess the diagnosis and consider MRI to rule out other pathologies 2. However, given the classic presentation, imaging is not indicated initially 2, 4.

Critical Pitfalls to Avoid

• Never inject corticosteroids into or around the patellar tendon, as this inhibits healing and predisposes to rupture 3
• Avoid complete rest or immobilization, which causes muscular atrophy and deconditioning 3
• Do not allow her to continue as-needed NSAIDs only—scheduled dosing for 2-3 weeks is more effective for this inflammatory condition 1
• Do not proceed to advanced imaging or specialist referral without a 6-week trial of appropriate conservative management 2, 4

Expected Outcome

With adherence to knee-targeted exercise therapy, scheduled NSAIDs, and patellar taping, she should experience significant improvement within 6 weeks and complete resolution within 3-6 months 3. The key is consistent exercise therapy, not just pain medication 1.