Nathan WM. Skelley, M.D.

Patellofemoral Pain syndrome – A general category of anterior knee pain from patella malalignment. Also termed anterior knee pain, Patellar malalignment, and Patellofemoral anthralagia.

Chondromalacia – Softening and fissuring of the underside of the patella. Chondral lesions themselves are asymptomatic unless worn down to subchondral bone (2). Chondromalacia can only be diagnosed by X-ray (Merchant, sun rise, or skyline view) or surgery.

 

Presentation

PFPS usually presents as an insidious onset of peripatellar or retropatellar pain. Commonly patients are young, active, and females are affected more than males. PFPS can also be caused from a traumatic injury to the patella.

 

Indications for Treatment:

Knee pain believed to be musculoskeletal in origin, primarily from muscle imbalances and/or poor biomechanics. Patients report symptoms as general knee pain or ache surrounding the patella.

 

Contraindications / Precautions for Treatment:

Avoid activities that cause excessive patellofemoral joint reaction forces.

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Interventions most commonly used for this case type/diagnosis. – Stretching, strengthening, patella joint mobilization, electrical stimulation, biofeedback, and patella taping. It is important to work within a pain free ROM or the vastus medialis oblique will be inhibited. The VMO is important for improved patella tracking.

 

Strengthening – Strengthening the gluteus maximus and medius, quadriceps, and hamstrings are needed. Specifically strengthening hip external rotators eccentrically will help with gait and stability. Strengthening of the quadriceps needs to be in a pain free ROM. This can be done with lateral step-ups and limited ROM squats.

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Stretching of tight structures – Iliotibial band, Lateral retinaculum.

Stretching of shortened muscles – Hamstrings, quadriceps, hip flexors, and gastroc soleus complex.

Stabilization – Stabilization/balance/proprioceptive exercises for the hip and knee. Frequency & Duration 2-3x/wk for 8-12 wks

Patient / family education – HEP, flexibility trg, strength trg, footwear, and patella taping.

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Re-evaluation / assessment

Standard Time Frame – At least once every 30 days.

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Commonly expected outcomes at discharge – Improved or normalized muscle length, normal patella mobility, normal VMO density, normalized muscle imbalances at the hip and knee, and correct shoe wear.

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Patient’s discharge instructions – Continue with stretching, strengthening, patella mobilizations, and patella taping if needed.