Patellofemoral Pain Syndrome (PFPS)

What is Patellofemoral Pain Syndrome?

• Patellofemoral pain, commonly referred to as Runner’s knee, is a broad term used to describe the painful condition that affects that knee cap (patella) and is considered one of the most common types of knee pain in people under 60. This pain is caused by abnormal tracking of the knee cap (patella) within the groove it sits in which can be due to a variety of factors.

• One systematic review showed that decreased strength in the quadricep muscles may cause an increased risk of patellofemoral pain as it can lead to instability of the patella (Lankhorst et al, 2022).

What are the symptoms of PFPS?

• Symptoms of patellofemoral pain include pain walking up or down stairs, squatting, kneeling or sitting with the knee bent for prolonged periods of time. Pain is typically felt around or underneath the kneecap (patella) and is dull and aching in nature.

• Diagnosis is based on detailed history, physical examination, and imaging. During the physical examination, a series of provocative tests may be utilized to further determine presence of injury.

• Advanced imaging may be required to confirm diagnosis and determine injury severity. X-ray can help determine if any bony structures are involved. A recent study showed both magnetic resonance imaging (MRI) and Ultrasound can help effectively identify and assess surrounding structures to aid in the diagnosis of patellofemoral pain (Pacini et al 2023).

How is PFPS Treated?

• Initial conservative treatment for patellofemoral pain consists of rest, NSAIDs, physical activity modification and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy aims to strengthen and rehabilitate the injured and surrounding areas and help ensure proper tracking of the knee cap (patella). The use of a knee brace or tape, especially when active, can help maintain proper movement of the knee and provide pain relief.

• Surgical intervention is rare for these injuries but may become warranted in severe cases after long term failed conservative treatment. Surgery may involve releasing the tight band of fibrous tissue that pulls the knee cap outwards to restore normal movement of the knee.

RESOURCES

Pacini P, Martino M, Giuliani L, Santilli G, Agostini F, Del Gaudio G, Bernetti A, Mangone M, Paoloni M, Toscano M, De Vito C, Ottonello C, Santilli V, Cantisani V. Patello-Femoral Pain Syndrome: Magnetic Resonance Imaging versus Ultrasound. Diagnostics (Basel). 2023 Apr 21;13(8):1496. doi: 10.3390/diagnostics13081496. PMID: 37189597; PMCID: PMC10138008.

Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Risk factors for patellofemoral pain syndrome: a systematic review. J Orthop Sports Phys Ther. 2012;42(2):81-94.

OTHER KNEE/LEG CONDITIONS

• Calf Strain
• Knee Osteoarthritis
• Ligament Injuries/Chronic sprain
• Meniscus Tears
• MTSS/Shin Splints
• Osgood-Schlatter Disease
• Patella or Quadriceps Tendinopathy (Tendonitis)