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Patellofemoral pain syndrome

Last reviewed: 1 Apr 2025
Last updated: 10 Jan 2025

Summary

Definition

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
Full details

Risk factors

  • bony and structural abnormalities
  • iliotibial band tightness
  • abnormal patellar mobility
  • quadriceps muscle weakness
  • subtalar joint pronation
  • hip internal rotation
  • gait deviations
Full details

Diagnostic tests

1st tests to order

  • no initial test
Full details

Tests to consider

  • knee x-ray
  • MRI
  • kinematic MRI or CT
Full details

Treatment algorithm

INITIAL

acute pain

ACUTE

abnormal patellofemoral joint mechanics

lower kinetic chain problems

overuse in athletes

ONGOING

post initial and reactivation-phase treatment

Contributors

Authors

Michael Fredericson, MD, FACSM
Michael Fredericson

Associate Professor and Director

Physical Medicine & Rehabilitation Clinics

Stanford University

Stanford

CA

Disclosures

MF declares that he has no competing interests.

Acknowledgements

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.

Peer reviewers

John Cianca, MD

Clinical Associate Professor

Department of Physical Medicine & Rehabilitation

Baylor College of Medicine

Houston

TX

Disclosures

JC declares that he has no competing interests.

John Halperin, MD

Physician

Sharp Rees-Stealy Medical Group

La Mesa

San Diego

CA

Disclosures

JH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Fredericson M, Powers CM. Practical management of patellofemoral pain. Clin J Sport Med. 2002;12:36-38. Abstract

Earl JE, Vetter CS. Patellofemoral pain. Phys Med Rehabil Clin N Am. 2007;18:439-458,viii. Abstract

Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome: a review. Am J Phys Med Rehabil. 2006;85:234-243. Abstract

American College of Radiology. ACR Appropriateness Criteria. Chronic knee pain. 2018 [internet publication].Full text

Collins NJ, Bisset LM, Crossley KM, et al. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials. Sports Med. 2012;42:31-49. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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