Patellofemoral pain syndrome is one of the most common disorders of the knee, accounting for 25% of knee injuries seen in a sports medicine clinic.
The causes of patellofemoral problems are multifactorial, including abnormal patellofemoral joint mechanics, lower kinetic chain alterations, and overuse.
Patients typically note the insidious onset of an ill-defined ache localised to the anterior knee behind the patella.
There is no one physical examination or imaging test that is a standard for diagnosis.
Treatment is focused on activity modification and correction of specific risk factors.
Non-operative treatment is successful in the majority of cases.
Patellofemoral pain syndrome is defined as knee pain resulting from mechanical and biochemical changes to the patellofemoral joint.
History and exam
Key diagnostic factors
- ill-defined ache
- pain aggravated by compressive force
- Q angle
- pain on palpation of patellar retinaculum
- patellar tilt test
- mediolateral glide test
- patellar mobility test
- patellar apprehension test
- patellar maltracking test
- decreased muscle flexibility
- muscle weakness
- bony and structural abnormalities
- iliotibial band tightness
- abnormal patellar mobility
- quadriceps muscle weakness
- subtalar joint pronation
- hip internal rotation
- gait deviations
1st investigations to order
- no initial test
Investigations to consider
- knee x-ray
- kinematic MRI or CT
abnormal patellofemoral joint mechanics
lower kinetic chain problems
overuse in athletes
post initial and reactivation-phase treatment
Michael Fredericson, MD, FACSM
Associate Professor and Director
Physical Medicine & Rehabilitation Clinics
MF declares that he has no competing interests.
Dr Michael Fredericson would like to gratefully acknowledge Dr Jong In Lee and Dr Julia Arroyo, previous contributors to this topic. JIL and JA declare that they have no competing interests.
John Cianca, MD
Clinical Associate Professor
Department of Physical Medicine & Rehabilitation
Baylor College of Medicine
JC declares that he has no competing interests.
John Halperin, MD
Sharp Rees-Stealy Medical Group
JH declares that he has no competing interests.
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