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 localized to the anterior knee behind the patella.
There is no one physical exam or imaging test that is a standard for diagnosis.
Treatment is focused on activity modification and correction of specific risk factors.
Nonoperative 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
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