patellofemoral pain syndrome; chondromalacia patella (PFPS)
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Etiology
- pain originating from irritation of the rich innervated subchondral bone & soft tissues around the patella
- risk factors
- developmental anomalies
- overuse
- abnormal patellar tracking
- excessive Q angle
- shallow intercondylar sulcus
- deformed patellar facets
- weakness of the vastus medialis obliquus muscle
- dysfunction of the medial retinaculum or lateral retinaculum
Epidemiology
Clinical manifestations
- vague, dull achy peripatellar (anterior) knee pain
- generally gradual onset
- pain on palpation of the medial articular surface of the patella
- referred pain to the medial joint line & popliteal fossa
- pain climbing stairs[2] (largely during descent)
- knee pain exacerbated by activity or prolonged sitting[2][4][5][6]
- transient pain switching from a sitting to a standing position
- anterior knee pain worse with knee flexion during weight-bearing
- running, climbing stairs, squatting,
- compression of the patella with the knee in extension reproduces the pain
- it may be necessary to move the patella medially & laterally (patellofemoral compression test)[2]
- apprehension &/or quadriceps inhibition against resistance applied to the superior pole of the patella
- positive crepitus test
- positive compression test
- positive shrug test
- anterior knee pain with extension of knee against resistance
- passively stretching knee relieves pain
- absence of edema, erythema or limited range of motion
- no maneuver is sufficiently sensitive or specific to be considered diagnostic[4][5][6]
Radiology
- radiographs are generally not helpful
- patellofemoral osteoarthritis may be confirmed by a radiographs obtained with the knee in a flexed position
- chondromalacia patellae may be associated with softening & erosion of patellar cartilage
- other radiology testing is generally not helpful
Differential diagnosis
- patellar chondromalacia
- older patients
- in association with trauma or malalignment
- patellar subluxation
- giving way, popping or locking of knee with activity
- marked lateral patellar mobility
- apprehension of physical examination
Management
- relative rest
- non-steroidal anti-inflammatory drugs (NSAIDs)
- pain relief in acute cases
- use should not continue more than 2 weeks
- may be useful before & after exercise in patients with periodic exacerbation of symptoms
- physical therapy
- strengthening quadriceps, especially vastus medialis obliquus to offset lateral tracking of patella
- physical therapy should not increase pain
- ice for 15-20 minutes after activity for up to 2-3 months
- knee bracing
- used to correct abnormal patellar tracking
- no well-controlled trials demonstrating benefit
- medial patellar taping
- surgery
- failure of 3-6 months of medical management
- procedures
- releasing lateral retinaculum
- tightening medial retinaculum
- transposing the vastus medialis obliquus tendon
- transferring patellar tendon to a more medial position
- in older patients with chondromalacia, arthroscopic or open debridement may offer relief
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 812-13
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
- ↑ Collado H, Fredericson M. Patellofemoral pain syndrome. Clin Sports Med. 2010 Jul;29(3):379-98 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20610028
- ↑ 4.0 4.1 4.2 Thomee R et al Patellofemoral pain syndrome: a review of current issues. Sports Med 1999 Nov 24; 28:245 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10565551
- ↑ 5.0 5.1 5.2 Bolgla LA and Boling MC. An update for the conservative management of patellofemoral pain syndrome: a systematic review of the literature from 2000 to 2010. Int J Sports Phys Ther 2011 Jun 30; 6:112. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21713229
- ↑ 6.0 6.1 6.2 Cook C et al. Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review. Physiotherapy 2012 Apr 18; 98:93 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22507358
- ↑ Mayo Clinic: Chondromalacia patella http://www.mayoclinic.com/health/chondromalacia-patella/DS00777
- ↑ Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013 Mar;47(4):193-206. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22815424
- ↑ Kamat Y, Prabhakar A, Shetty V, Naik A. Patellofemoral joint degeneration: A review of current management. J Clin Orthop Trauma. 2021 Nov 13;24:101690. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34900577
- ↑ Gaitonde DY et al. Patellofemoral pain syndrome. Am Fam Physician 2019 Jan 15; 99:88. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30633480 Free article https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html
- ↑ Willy RW, Hoglund LT, Barton CJ, et al. Patellofemoral pain. J Orthop Sports Phys Ther. 2019;49:CPG1-CPG95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31475628