Patellofemoral Pain Syndrome Frequently Asked Questions

As the knee bends and straightens, the patella slides within a slot on the femur called the trochlear groove. The patella moves in many directions within this groove to provide efficient, frictionless movement up and down, side-to-side, rotational, and tilting. The bone surfaces are covered with articular cartilage to make joint movement smooth.
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Repeated abrasion on any of the surfaces of the patella and femur stresses the soft tissues of the patellofemoral joint and may even lead to a bone bruise. In some cases, the pain is caused by a weakening of the articular cartilage and/or swelling within the joint.

1. Overuse
2. Alignment
3. Muscular weakness
4. Muscular tightness
5. Flat feet
6. A decrees in patellar mobility

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1. Pain around the kneecap
2. History of a dull, aching pain in the knee
3. Pain in of the knee below the kneecap
4. Running, going down stairs, squatting, or sitting for a long time with knees bent usually increases pain.
5. Flexing the knee completely is painful.
6. Crackling noise under the patella (crepitus) during knee movement
7. Slight swelling
8. Decreased kneecap motion
9. Symptoms may be present in one or both knees

The doctor will ask for the history and location of the knee pain along with the activity level of the patient. Then a physical examination is performed. An Magnetic Resonance Image (MRI) or TEC (Technician 99 Readiosotope) Scan may be recommended if symptoms persist after non-operative treatment.
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It can take the knee six weeks or more to show improvement once treatment begins; this is often the same length of time the pain has been present. The following options are typically used:

1. Activity modification
2. Anti-inflammatory medication
3. Icing
4. Specific exercises
5. A knee sleeve, splint, or taping
6. Special footwear or orthotics

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Recovery from patellofemoral pain can be a long process usually taking 6 weeks or more. Sport activities that heavily load the knee should only be resumed very gradually and cautiously. To reach pre-injury activity level, the patient must build greater strength and flexibility in the muscles around the knee than existed before the injury. By maintaining a high level of fitness, the patient will reduce the likelihood of re-injury.

If surgery is recommended, a second opinion from another orthopaedic surgeon can help the patient make an informed decision. Surgery should only be considered as a last resort, when conservative treatment has failed to alleviate symptoms.
A diagnostic arthroscopy allows the doctor to examine and treat the inside of the joint. In this procedure, instruments are inserted through small incisions in the knee. Rough or frayed spots in the cartilage that covers the bone can be smoothed, plica can be trimmed, and the patella can be realigned if necessary.

The most common complications from surgery are persistent swelling, loss of muscle tone, and scar tissue formation.

Recovery after surgery for patellofemoral pain syndrome can take even longer than recovery from non-operative treatment. The patient should expect:
1. Crutch use, usually necessary for 1-3 weeks after surgery
2. 2-3 months of healing and rehabilitation
3. A gradual return to desired activities that usually take between 3-6 months.

A knee with patellofemoral pain syndrome hurts during exercise because of the increased fluid in the joint or swelling in the tissues. This interferes with the motion of the knee and can cause increased friction in the joint as the knee moves.

A typical non-operative program can take 6 weeks or more. It is a good idea to give the knee at least as much time for the symptoms to begin to improve as it has experienced discomfort.

A very high percentage (about 95%) of patients with patellofemoral pain syndrome will respond successfully to a conservative, non-operative treatment program such as the one outlined here.