From the Guidelines
Patellofemoral pain syndrome (PFPS) and chondromalacia patella are distinct conditions, with PFPS being a broader clinical syndrome and chondromalacia patella referring to specific structural damage to the cartilage under the patella. The key difference between the two conditions lies in their definitions and diagnostic approaches. PFPS is characterized by anterior knee pain around the patella during activities that load the patellofemoral joint, such as climbing stairs, squatting, or sitting for long periods 1. On the other hand, chondromalacia patella involves the softening and deterioration of the cartilage on the underside of the patella, which can be confirmed through imaging or arthroscopy.
Treatment Approaches
- Exercise therapy is a highly effective management strategy for PFPS, as supported by the existing consensus 1.
- Adjunctive treatments, such as prefabricated foot orthoses, may also be beneficial in certain cases.
- Physical therapy focusing on quadriceps and hip strengthening is a common approach for both conditions.
- Activity modification and anti-inflammatory medications like ibuprofen may be used to manage acute pain.
- Bracing or taping techniques can provide additional support and relief.
Outcomes and Prognosis
- Most patients with PFPS or chondromalacia patella improve with conservative management within 4-6 weeks.
- Complete resolution of symptoms may take 3-6 months.
- Surgery is rarely needed and is typically reserved for cases with specific anatomical abnormalities or severe cartilage damage that hasn't responded to conservative treatment.
- The best practice recommendations for patellofemoral pain, as outlined in a recent study 1, emphasize the importance of evidence synthesis, patient preferences, and expert clinical reasoning in guiding treatment decisions.
From the Research
Patellofemoral Pain Syndrome vs Chondromalacia Patella
- Patellofemoral pain syndrome (PFPS) is a common cause of anterior knee pain, 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 2.
- Chondromalacia patella, also known as runner's knee, is a condition where the cartilage on the underside of the patella (kneecap) deteriorates and becomes soft, leading to knee pain and tenderness.
- While both conditions can cause knee pain, they have distinct differences in terms of their causes, symptoms, and treatment options.
- PFPS is often attributed to altered stress to the patellofemoral joint from intrinsic knee factors, alterations in the kinetic chain, or errors in training 3.
- Chondromalacia patella is often caused by overuse, poor tracking of the patella, or direct trauma to the knee.
- Treatment for PFPS typically includes rest, nonsteroidal anti-inflammatory drugs, and physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups 2.
- Treatment for chondromalacia patella may include physical therapy, orthotics, and in some cases, surgery to repair or remove the damaged cartilage.
- The use of semiflexible foot orthoses has been shown to be effective in reducing symptoms of patellofemoral pain syndrome, with 76.5% of patients showing improvement in a retrospective review 4.
- Diagnosis of PFPS is primarily based on history and physical examination, with findings such as Q angle, patellar tilt, crepitus, and strength and functional testing being used to assist in diagnosis 5.