Patellofemoral Pain

The patella (kneecap) sits in the anterior aspect of the knee. The patella articulates with the trochlea of the femur. This articulation forms the patellofemoral compartment of the knee. During normal walking, running, and stair climbing the patella is subject to significant stress and loads. Disorders of the patellofemoral compartment are the most common reason for pain in the anterior aspect (front) of the knee.

Symptoms and Causes of Patellofemoral Pain

Many patients present with complaints of pain in the front of the knee. Often the pain is exacerbated by running or stair climbing. The underlying reason for the pain is multifactorial. In many patients there can be chondral (cartilage) injuries of the patella or trochlea. These areas of cartilage wear can lead to chronic discomfort. Many patients have symptoms due to maltracking of the patella. Patellar maltracking occurs when the patella articulates eccentrically in the trochear groove of the femur rather than centrally. This is a common problem in young females. Other causes for patellar pain include cartilage injury, past trauma, and force overload often due to obesity.

Sunrise radiograph of the knee demonstrating eccentric lateral tracking of the patella in the trochlear groove of the femur

Treatment Options

Treatment for patellofemoral pain is most commonly non-operative. Physical therapy, bracing, patellar taping, and other modalities are often successful in relieving pain and disability. Most patients can return to full activities without restrictions.

Tru-Pull brace is one of many braces that can be used in patients with patellofemoral pain due to cartilage wear and patellar maltracking

In cases where patients have persistent symptoms in spite of extensive conservative treatment surgery can be considered. If the underlying problem is wear of the cartilage then cartilage restoration procedures such as microfracture or chondrocyte implantation can be considered. Often the underlying problem is patellar maltracking due to malalignment or past trauma. In these situations the patella must be realigned appropriately into the trochlear groove. Many procedures can be used to accomplish this based on the specific situation. Options include arthroscopic lateral retinacular release, medial patellofemoral ligament reconstruction, and tibial tubercle osteotomy. The choice of what procedure to use is based on patient age, symptoms, and the underlying cause of the maltracking.

23 you female with persistent bilateral knee patellofemoral pain. Note the elevated (patella alta) and lateralized position of each patella

Tibial tubercle osteotomy of the right knee to bring patella inferior and medial led to resolution of patient’s pain. She went on the have the identical procedure performed on the left knee as well, also with excellent results.

 

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