Patellofemoral pain syndrome is a generalised term used to indicate pain around the front of the knee in young adults.
The causes for this type of pain are overuse or patella maltracking
The treatment for this type of condition is rest, rehabilitation and a progressive return back to sport and other activities.
The assessment should include identification of foot deformities, abnormal shoe wear patterns, altered hip rotation, weakness in core strength and Gluteus medius. Knee effusion is classically absent. MRI scans are not indicated here once the diagnosis has been made by careful examination.
- Shoe modification or orthotics
- Rest from intensive repetitive activities
- Muscle strengthening programme (abdomen, back, muscles around the hip, Qadriceps and calf muscles)
- Stretches to IT band and lateral structures
- Arthroscopy is seldom necessary for this condition
Patellofemoral Chondral damage and Patellofemoral Arthritis
Damage to the articular cartilage of the PF joint as a result of injuries, overuse, dysplasia or maltracking. Patella chondral pathology is identified in a significant number of arthroscopies in young sportsmen.
The patellofemoral contact area gradually increases unto 90 degrees of flexion and reduces again with deeper flexion. Due to this reduced area of contact patella chondral damage happens frequently
Examination is performed to assess tenderness and crepitus at patellofemoral joint. The whole assessment of patella tracking is also performed. Effusion often indicates underlying chondral pathology. Pain is often reproduced with a mini squat.
X-rays and MRI scans are useful to assess dysplasia, alignment issues and chondral pathology. TT-TG distance can aid in the treatment planning.
Nonsurgical management with Physiotherapy, orthotics, weight management and activity modifications should be tried and would help most patients.
Surgical options are based on the severity of cartilage damage and the presence of maltracking. Often any cartilage repair procedure is performed in combination with a tibial tuberosity anteromedialisation (AMZ). AMZ can have a role as a sole procedure. Patello-femoral replacement is a treatment for severe chondral damage to the PF joint when other compartments are normal.The alternative is a total knee replacement.
Picture shows failed cartilage repair in the patella (X-rays) now having a patellofemoral replacement(AVON)