Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a painful condition of the knee where the pain is felt around and behind the knee cap and aggravated by at least one of the following activities like, running, climbing stairs or squatting. Also complains of knee stiffness following prolonged sitting in knee flexed position. It is a common cause of knee pain in adolescents and adults younger than 60 years. It is a very common overuse stress of knee cap without any organic changes of kneecap cartilage.

Female gender and activity like running, jogging, squatting and frequent use of stairs are the established risk factors for developing patellofemoral pain syndrome (PFPS). Patellar instability plays a major role in developing PFPS. Anterior thigh muscle (quadriceps) weakness, dynamic valgus of knee where knee collapse on inner aspect from excessive valgus (outwards alignment of leg below knee) on weight bearing, foot deformities like forefoot eversion and pronation (flat foot) deformity also contribute in PFPS development.

Foot deformity leads to internal rotation of the tibia and contributes to development of dynamic valgus of the knee. Dynamic valgus increases lateral force on patella thus contributes to patellar mal-tracking (moves off the grove of thigh bone during knee movement). Dynamic valgus is very common in female athletes contributing to the higher incidence among them.

Diagnosis of PFPS is purely clinical. Complaining about pain during squatting is the most sensitive finding. Fluid collection in the knee joint, redness and increased temperature at the knee are never associated with patellofemoral pain syndrome. Physical examinations to elicit patellofemoral pain like clerk test patellar tilt test are helpful. Examination of gait, posture, foot deformity, wear pattern of footwear, quadriceps power, hamstring muscle flexibility all can give clues in finding contributory factors of PFPS development. Knee x-ray in two plane and skyline view to assess patellofemoral joint alignment is the standard basic requirement. Imaging is done for exclusion of other causes of anterior knee pain like chondromalacia patellae, trauma, infection, arthritis or other cause which were suspected clinically. Other than x-ray basic blood tests with inflammatory markers are also advised. All these tests are done for exclusion of other possibilities of anterior knee pain.

Physical therapy is the one and only effective treatment solution for patellofemoral pain syndrome. Analgesics and other measures like icing are recommended for short term pain relief. Kinesiotaping of patella helps in symptomatic relief during acute phase along with analgesics. Corrective foot orthotics are recommended along with physical therapy to improve gait and kinematics of the knee thus optimising the contributory factors. Knee braces do not help much and there is no role of surgical intervention. Non resolving of symptoms beyond 6-8 weeks render imaging test like x-ray or MRI to find other causes of patellofemoral pain.