PatelloFemoral Pain Syndrome (PFPS) is the term given for those suffering from pain in the anterior portion (front) of the knee. One of the causes of PFPS is a degeneration of the cartilage on the undersurface of the kneecap. Often called chondromalacia, this wearing down, roughening and cracking of the articular cartilage often results in knee pain, swelling, and a grinding noise or sensation called crepitus. This condition may occur secondary to the kneecap sliding out of its groove, usually to the lateral side (outside) of the knee.

Symptoms of PFPS

• Pain with kneeling, & squatting
• Pain descending stairs
• Pain after prolonged sitting
• Locking joint
• Giving out
• Pain after or during running

The normal movement of the kneecap is an up and down glide along a groove in the femur (the thigh or upper leg bone). The kneecap slides up in the groove when the knee is straightened and slides down when the knee is bent. When the kneecap slides sideways out of the groove and to the outside of the knee the undersurface of the kneecap grinds against the bony ridges and wears down. The pain that is due to rubbing of the kneecap against the groove and from a stretch that is placed on the inside/medial structures (e.g. joint lining and ligaments). Over time as the kneecap continues to grind, it causes a progressive breakdown of the under surface of the patella.

When your patella gets "off track"

If any of your quadriceps (thigh) muscles pull too hard or not hard enough, your patella gets "off track". That means it is not aligned. It no longer glides easily against the thig hbone. Movement may be painful and hard to do. The patella may also get damaged.

The kneecap can slide out of the groove for several reasons. One is traumatic PFPS caused by a fall or car accident where the knees hit the dashboard. another is muscular weakness of the medial/inside muscles of the quadriceps (also known as the VMO), and/or tightness of the lateral/outside structures of the knee can pull the kneecap out of alignment. A Third over-pronation of the feet (flat feet), or a structural abnormality which exaggerates knock-knee angles, can put stress on the knee allowing the kneecap to slide.

Associated problems related to patella tracking abnormality

• Arthritis
• Dislocation of kneecap
• Subluxation (partial dislocation)
• Patellar Tendinosis (jumpers knee)
• Plica Band Syndrome

Treatment

A traumatic injury is usually corrected by a period of rest and then a gradual exercise program to re-strengthen the injured muscles.

Tightness of the lateral structures and weakness of the medial structures is best corrected with a program of stretching the lateral structures and strengthening the medial muscle groups.

The problem of over-pronation in the foot or a structural abnormality is best corrected with custom-made orthotics. This requires a biomechanical evaluation by a trained professional who will measure and make a cast of your feet.

It is important to begin to build up the weakened muscles around your knee and improve your flexibility.

Along with exercising, it is a good idea to avoid kneeling and deep squatting positions. Try not to sit with the knees bent for too long without stretching or straightening them. Runners may want to decrease their mileage for a while, and avoid running on pavement. Using a brace to help hold the patella (kneecap) in place can help decrease the discomfort while working on strengthening.

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Surgery

Surgery may be indicated if pain severely limits your activities, and a rehab program is just not helping.

In some cases, arthroscopic surgery is required to smooth out the rough cartilage. It may also be necessary to realign the kneecap by performing a lateral release (e.g. cutting the lateral tissue of the knee to reduce the pull on the kneecap). This allows the kneecap to move into its proper place. If the kneecap continues to slide out of the groove, an open realignment procedure may have to be performed. In this procedure transferring the attachment of the patellar tendon balances the pull. Part of the tendon and the underlying bone are moved to the center of the Tibia (leg) bone just below the knee and anchored by screws.

Summary

PFPS is a common malady usually controlled or cured by improving the kneecap and leg anatomic mechanisms through physical therapy rehabilitation, controlling overuse by bracing, proper shoe wear and/or orthotics and avoidance of training errors.