Patellofemoral Pain

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Patellofemoral pain is an extremely common disorder, especially in female athletes. There is, however, no true consensus as to the cause and appropriate treatment for patellofemoral pain. This article reviews the epidemiology of patellofemoral pain as well as the proposed etiologies, including quadriceps dysfunction, static alignment disorders, and dynamic alignment disorders. The article also reviews both conservative and surgical treatment of patellofemoral pain.

Section snippets

Epidemiology of patellofemoral pain

Patellofemoral pain syndrome is considered one of the most common disorders of the knee, accounting for 25% of all knee injuries treated in sports medicine clinics [1], [3], [4]. In clinics that manage patients who have musculoskeletal syndromes, patellofemoral pain syndrome accounts for almost 10% of all visits (76 of 814 visits) and for 20% to 40% of all knee problems (76 of 266 visits) [5]. DeHaven and Lintner [6] reported that among patients diagnosed with patellofemoral pain syndrome over

Biomechanical etiology of patellofemoral pain syndrome

In 1968, Hughston [12] wrote that the primary source of anterior knee pain was extensor mechanism malalignment. In 1979, James [13] coined the term “miserable malalignment syndrome” as the cause of anterior knee pain, describing a combination of factors, including femoral anteversion, squinting patella, patella alta, increased quadriceps angle (Q angle), and tibial external rotation (Fig. 1). These early observations form the foundation for research into the etiology of patellofemoral pain

Conservative rehabilitation

In the vast majority of cases, PFPS is treated with conservative rehabilitation. However, studies show varying degrees of success. It has been reported that 70% of patients will be symptomatic again within 1 year following rehabilitation [4]. Many patients have successful short-term outcomes, but poor long-term outcomes. This may indicate that the cause of their symptoms was not adequately addressed. The multifactorial etiology of PFPS makes the task of isolating and treating the cause of the

Limitations of PFPS outcomes research

Although there are many published studies on various aspects of PFPS rehabilitation, few are of high enough quality to provide strong evidence that the interventions are effective. One reason studies often fail to show a specific intervention to be effective is because there are subgroups of PFPS etiologies, which means that some subjects in the study do not have the dysfunction that the intervention is attempting to correct. Other investigators have discussed this notion of subgroups based on

Surgical treatment of patellofemoral pain

Surgery for patellofemoral pain syndrome is indicated in those few patients who have persistent symptoms in spite of appropriate rehabilitation and who have a problem that is genuinely correctable with surgery. Patient selection and postoperative rehabilitation are critical for improving chances of a favorable outcome. Patients whose conservative therapy has failed because of noncompliance with rehabilitation are often not good surgical candidates. The decision to perform surgery for

Summary

Patellofemoral pain is an extremely common disorder with no true consensus as to the cause and appropriate treatment. However, the current standard of care is conservative treatment including physical therapy to address any and all biomechanical issues with quadriceps-based strengthening, iliotibial band stretching, hamstring stretching, and proximally focused exercise programs, as well as orthotic intervention, McConnell taping, and bracing. Surgery for patellofemoral pain syndrome is

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