Patellofemoral pain syndrome

What causes patellofemoral pain syndrome?

The true underlying cause in any one patient may be remote - such as a bony rotation in the hip or thigh, or even a structural problem in the foot and ankle - any of which can put pressure on the patella (kneecap) area because the patella is the pulley through which any abnormal lower limb forces pass.

Pain may of course also be a result of local issues, such as -

• tight structures at the side of the kneecap causing it to tilt, eg a tight lateral retinaculum
• a patellar tendon attached to the tibia too far to the side, and putting stress on the patella
• constitutional ligament laxity, allowing the patella to frequently sublux
• an irritated fat pad
• a synovial plica being nipped between patella and femur
• an inflamed and impinging fat pad under the patella
• inflammation of the synovial lining of the joint

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How is patellofemoral pain syndrome managed?

Management begins with a full assessment of the patient, looking from the lower back to the feet for all those structural issues that may be putting strain on the pulley system of the patella.

Correction of alignment may include shoe inserts, core strengthening, building muscle strength and balance, patellar mobilisations, stretches.

Surgery should not be considered until all physiotherapy and orthotic options have been exhausted.

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Other relevant links on KNEEguru

A-Z Keywords -

• Patellar tilt, Lateral retinaculum, Fat pad, Plica syndrome, Core strength, Orthotics, Patellar mobilisations, Anterior knee pain, Miserable malalignment. Fat pad syndrome, Plica syndrome, Ligamentum mucosum, Patellar tendinopathy, Quadriceps tendinopathy

Contributions from Experts -

• Dr Thomas Smallman - An alternative viewpoint on Anterior Knee Pain
• Dr Ronald Grelsamer - Patellofemoral pain

eBooks -

• Dr Lars Blønd - Anterior Knee Pain - and approach to investigation

Forum discussions

• Success Story - patellofemoral pain syndrome - A happy patient.

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