• Pain behind or around the patella radiating to the entire knee

Patient Profile

• Female > male or female = male
• 15-25 years old
• No trauma in history

Pathophysiology

Mechanical nociceptive pain with partial inflammatory component in the acute stage. No definitive cause. Irritation due to multiple mechanical factors, causing continuous patellofemoral stress. Increased patellofemoral stress can cause microtrauma in cartilage surfaces leading to degeneration. Damage to cartilage is no direct sign of PFPS though. In the history there is usually a spike in activity/load.

Course

Lengthy course. 60% of patients with patellofemoral pain syndrome have symptoms at a 1 year follow-up and 40% at a 6 year follow-up.

History

Usually short history – patients tend to ignore early symptoms and avoid consulting a healthcare professional. Therapy starts immediately after seeing the PCP. Some patients report a trauma (patella fracture, ACL surgery, ligament lesions). Usually there is no trauma. Patients exercise regularly.

• Local
• Diffuse
• Intense
• Deep aching
• Feeling of instability/giving way

Physical Examination

Inspection
Misalignment: Poor foot and/or knee axis, leg-length difference, side-by-side difference in quadriceps development

Functional Assessment
Squatting; sitting on heels; step-up

Active Examination
Possible weakness of quadriceps, hip abductor and external rotator weakness

Passive Examination
Possible PROM limitations of the patella; possible contraction of m. gastrocnemius, limited hip ROM and lumbar spine mobility  

Differential Diagnosis

1. Knee joint arthritis
2. Ligament lesion
3. Meniscus damage
4. Osteophytes
5. Referred pain from hip or lumbar spine

Strategy

Patient education, passive symptom modification, active exercises for hip and knee muscles

Interventions

Passive: Tape, NSAIDs help in the acute stage, Patient education, Insoles

Active: Address biomechanics of the lower limb, strengthening of quadriceps, hip abductor strengthening, stretching hamstrings/gastrocnemius, gait training

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