Patellofemoral Pain Syndrome

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome (PFPS) is characterised by pain at the front of the knee, which results in joint stiffness and reduces mobility. Patellofemoral pain syndrome (PFPS) is a medical condition where you experience pain around and under the kneecap, also called the patella. The patella is where the knee connects with the lower-end portion of the femur (thighbone). Also called runner's or jumper's knee, the condition affects both children and adults. Patellofemoral pain syndrome may occur in one or both knees.

The pain and stiffness caused by patellofemoral pain syndrome may result in difficulty climbing stairs, kneeling down, and performing other everyday activities. Various issues may result in Patellofemoral pain syndrome (PFPS), such as improper alignment of the kneecap and repetitive overuse.

What causes patellofemoral pain syndrome?

In most cases, patellofemoral pain syndrome may be caused by vigorous physical activities that result in repeated stress on the knee, like squatting, climbing stairs and jogging. PFPS may also be caused by a change in physical activity. This change may be in the frequency of the activity, like increasing the number of days you exercise per week, or it may be the duration or intensity of activity, like running longer distances.

Other causes that may contribute to the development of patellofemoral pain syndrome include:

• The use of improper sports training equipment and techniques
• Any changes in footwear or playing surface
• Trauma to the kneecap, like a dislocation or fracture
• Knee surgery, especially repair to the anterior cruciate ligament with the use of your own patellar tendon as a graft
• Muscle imbalances or weaknesses

What are the signs of patellofemoral pain syndrome?

Patellofemoral pain syndrome normally causes a dull, aching pain in the front of your knee. Other common symptoms of runner’s knee include:

• Kneecap that is very tender to touch
• Grinding, rubbing, or clicking sound of the kneecap which may be heard when bending or straightening the knee
• Pain in the kneecap that occurs when you are active
• Pain in or around the kneecap when you are sitting for a long period of time with your knees bent. This may result in joint weakness or instability.

Symptoms of patellofemoral pain syndrome may occur and look like other medical conditions. Therefore, it is important that you seek medical attention when you experience the above-mentioned symptoms.

How does Dr van Niekerk check for Patellofemoral pain syndrome?

After conducting a physical exam, Dr van Niekerk may deem it necessary to order an x-ray or MRI to see if there is any damage to nearby tissue and bone in the knee.

How is patellofemoral pain syndrome treated?

Treatment for patellofemoral pain syndrome (PFPS) focuses on reducing pain, improving knee function, and correcting the underlying causes contributing to the condition. In most cases, conservative (non-surgical) treatment is highly effective.

Initial treatment may include:

• Rest or modification of activities that aggravate the knee
• Applying ice to reduce pain and inflammation
• Compression and elevation to help manage swelling
• Anti-inflammatory medication or pain relief medication, when appropriate
• Physiotherapy to strengthen and stretch the muscles surrounding the knee and improve patellar tracking

When is surgery necessary for patellofemoral pain syndrome?

Surgical treatment for patellofemoral pain syndrome is generally only considered when symptoms do not improve with conservative management and there is evidence of structural abnormalities within the knee joint. Before recommending surgery, Dr van Niekerk will perform a thorough clinical assessment and may request imaging studies, such as X-rays or an MRI scan, to identify the underlying cause of the pain and instability.

What surgical procedures are used to treat patellofemoral pain syndrome?

The type of surgery performed will depend on the specific problem affecting the kneecap and surrounding structures.

Common surgical procedures include:

• Knee arthroscopy – a minimally invasive procedure used to assess and treat damaged cartilage, remove loose fragments, or smooth joint surfaces.
• Lateral release surgery – performed to release tight tissues on the outer side of the kneecap that may be pulling the patella out of alignment.
• Tibial tubercle transfer (osteotomy) – a procedure that repositions the attachment of the patellar tendon to improve kneecap tracking and reduce pressure on the joint.
• Cartilage restoration procedures – used when there is significant cartilage damage beneath the kneecap.
• Medial patellofemoral ligament (MPFL) reconstruction – sometimes performed in patients with recurrent kneecap instability or dislocations.

For PFPS specifically, the most commonly procedure is usually arthroscopic surgery or patellar realignment surgery, depending on the structural issue being treated.

Many procedures can be performed using minimally invasive arthroscopic techniques, which involve smaller incisions, reduced pain, and a faster recovery compared to traditional open surgery.