Patellofemoral Pain Syndrome Causes, Symptoms & Treatment

Patellofemoral pain is a term used to describe pain that comes from the front of the knee, around the kneecap (patella) and the surrounding muscles. As it occurs in the front, or “anterior” part of the knee, doctors often call it anterior knee pain. Athletes sometimes refer to this type of pain as “runner’s knee” because it often is associated with running and being physically active. Climbing stairs, kneeling down, or engaging in your favorite sports can be difficult when you have this type of pain.

Several factors are associated with patellofemoral pain. Vigorous physical activity can place repeated stress on the knee, causing irritation and damage that results in significant pain. Knee pain may also result when the kneecap (patella) is partially or completely dislocated from the rest of the knee. This condition can cause the kneecap to push to one side when the knee is bent, putting it out of alignment with the rest of the leg. These factors can lead to several underlying conditions that can cause patellofemoral pain, including:

Patellar tendonitis: This condition refers to inflammation of tendons (fibrous tissue that connects muscle to bone) connecting the kneecap to the shinbone. Also known as “jumper’s knee,” patellar tendonitis is commonly associated with sports that require jumping. This condition can produce pain just below the kneecap, weakness, and localized swelling over the tendon.

Quadriceps tendonitis: This condition affects the tendons connecting the muscles of the thigh to the lower leg. This condition can produce pain just above the kneecap, weakness, and localized swelling just above the kneecap.

Chondromalacia patella: One of the most common causes of knee pain, this condition results from the breakdown of cartilage behind the kneecap.

Lateral compression syndrome: A condition where the patella is abnormally tilted sideways. Over time, even a slight tilt can cause pain and damage to the tissue around the knee.

Plica syndrome: This is a rare source of knee pain, caused by injury or overuse that results in a normal fold in the lining of the knee joint (called a “plica”) becoming inflamed. This leads to pain on the inside of the kneecap.

Osgood-Schlatter disease: This is a very common condition that most often affects adolescents during growth spurts. It causes inflammation below the knee where the patellar tendon inserts into its growth plate. Children who play sports, particularly those that require running and jumping, are at increased risk due to the increased stress on their muscles and joints. This condition almost always resolves when the athlete is done growing. It is commonly referred to as “growing pains” of the knee.

Patellofemoral pain is sometimes called “runner’s knee” or “jumper’s knee” because it is common among people who play sports, such as:

• Running
• Soccer
• Basketball
• Skiing
• Gym exercises (e.g. squats, deep knee bends)

With patellofemoral pain syndrome, you usually experience a dull, aching pain in the front of the knee. This pain typically begins gradually, often first with running or jumping and then with other physical activities, such as going up and down stairs or squatting. Pain can also occur with sitting for long periods of time, like when you’re driving. Sometimes you will feel the pain after hearing popping or crackling sounds in the knee.

It’s not uncommon for physically active people to experience knee pain, particularly after vigorous exercise or playing sports. But when should you see a doctor for knee pain? Here are some signs that indicate you should get your knee checked out:

• If you suffered a serious injury to your knee
• Pain lasts more than a week
• Swelling
• Loss of range of motion
• When your knee feels unstable (like it could give way)

Your doctor will take your medical history and perform a careful physical examination to help determine the exact cause of your pain. He/She may suggest:

• X-rays to evaluate the kneecap and its position
• MRI scan to rule out other causes of pain

Once you and your doctor figure out the exact cause of your pain, you can plan a treatment program.

All patellofemoral pain syndromes are initially treated non-operatively. Treatment may include:

• Rest
• Ice
• NSAIDs (nonsteroidal anti-inflammatory medications like Aspirin)
• Braces
• Home exercises
• Physical Therapy

These exercises may also be recommended:

Patellofemoral Pain

Some conditions can only be treated non-operatively. These include quadriceps tendonitis, patella tendonitis, and Osgood-Schlatter disease.

Patella Tendonitis Treatment

This is the true “jumper’s knee” and can be quite debilitating. The best treatment is relative rest, meaning you can play as tolerated. NSAIDs like Aspirin or ibuprofen may be helpful, especially before activity. A brace or “patella band” can also help to minimize the symptoms. A good therapy program that includes adequate warm-up, stretching both before and after activity, and appropriate strengthening exercises is very important for athletes with this condition. If your symptoms persist despite conservative treatment, an injection of platelet-rich plasma (PRP) may be offered by your doctor.

(see below info on PRP)

Quadriceps Tendonitis Treatment

Tendonitis of the quadriceps tendon is more common in older athletes.The best treatment is relative rest, meaning you can play as tolerated. NSAIDs like Aspirin or ibuprofen may be taken to reduce pain. A good therapy program is essential, including adequate warm-up, stretching both before and after activity, and appropriate strengthening exercises. If your symptoms persist with these conservative treatment methods, your doctor may recommend an injection of platelet-rich plasma (PRP).

(see below info on PRP)

Osgood-Schlatter Disease Treatment

Fortunately, this condition goes away when you stop growing. However, it can be quite painful and limit your activities. The best treatment is relative rest, meaning you can play as tolerated. It is important to ice the affected area after sports. Over-the-counter NSAIDs like Aspirin or ibuprofen may be helpful, especially before activity. A brace or “patella band” can help to minimize the symptoms. A good therapy program that includes adequate warm-up, stretching both before and after activity, and appropriate strengthening exercises is key to managing this condition.

In rare cases, if non-operative treatments are not effective, your doctor may recommend surgery for some conditions causing patellofemoral pain. These conditions include chondromalacia patella, lateral compression syndrome, and plica syndrome. The exact surgical procedure will depend on the underlying problem.

Chondromalacia Patella Surgical Treatment

When non-operative treatments for chondromalacia patella fail, surgery may be indicated as a last resort. The surgery for this condition is an arthroscopic procedure during which your physician looks inside your knee with a small camera called an “arthroscope” and tries to smooth out the damage under the kneecap.,

Lateral Compression Syndrome Surgical Treatment

When non-operative treatments for lateral compression syndrome are not successful, surgery may be offered as a last resort. During this arthroscopic operation, your orthopedist will look inside your knee with a small camera called an “arthroscope” and perform a surgical procedure in which the scar tissue that is causing the kneecap to be compressed is released. This is called a “lateral release.”

Plica Syndrome Surgical Treatment

When non-operative treatments for plica syndrome have been attempted without success, surgery may be recommended by your doctor as a last resort. This is an arthroscopic procedure during which your physician looks inside your knee using a small camera called an “arthroscope” to remove the inflamed “plica” folds that are causing pain within the kneecap.

Knee pain is uncomfortable and can interrupt your physical activities and lifestyle. Fortunately, it is usually relieved with simple, non-invasive measures. If surgery is required, recovery will depend on the underlying condition.

You can also take proactive steps to prevent knee pain from returning. These include:

• Maintaining a healthy body weight
• Increasing physical activity gradually
• Wearing appropriate footwear for your activity
• Performing stretching and conditioning exercises recommended by your doctor
• Taking these steps and following your doctor’s advice can help keep knee pain from recurring, and allow you to resume your normal activities.