TREATMENTS
Patellofemoral
syndrome
KNEE PAIN IN FIGURES
women are more likely to suffer a patellar dislocation than men.
%
of physically active adolescents is affected.
%
of cases may persist without adequate treatment.
Patellofemoral pain
Anterior knee pain is very common in women and athletes. It can cause injury to the cartilage of the femur and patella.
DESCRIPTION
What is the patellofemoral joint?
The patellofemoral joint is the region of the knee where the patella (or patella) articulates with the femur. The patella is a sesamoid bone that lies within the quadriceps tendon and plays a crucial role in the mechanics of the knee, facilitating flexion and extension movement, improving the efficiency of quadriceps contraction.
- Femur: Its anterior surface (the femoral trochlea) has a shape that allows articulation with the patella.
- Patella: It is located in the anterior part of the knee, in the quadriceps tendon. Its main function is to act as a lever to enhance the action of the quadriceps muscle.
- Femoral trochlea: This is the depression in the femur where the patella slides. Proper alignment and mobility of the patella in this area is essential to avoid problems such as patellofemoral syndrome.
Diagnosis of patellofemoral pain
Physical examination
You should focus on assessing pain, range of motion, patellar alignment and patellar stability. Key steps include:
Inspection
Observe the posture of the knee in standing position, the alignment of the patella and the presence of swelling. It is important to observe the sign of “squinted kneecaps”, i.e., that these are focused inward on both knees.
Palpation
Palpate the patellofemoral region to identify areas of tenderness, such as the edge of the patella or the patellofemoral groove.
Femoropatellar compression test
It is performed by pressing the patella against the femoral trochlea while the knee is flexed, which may cause pain if there is patellofemoral syndrome.
Patellar mobility test
Assess patellar mobility in all directions (lateral, medial, superior and inferior) to identify potential alignment or instability problems.
Range of motion
Evaluate full knee flexion and extension for restrictions in motion due to pain or instability. The “J-sign” may be observed which translates into malposition of the patella over the femur when positioned medially in full extension.
Complementary tests
Standard knee x-ray
It is performed in two projections, anteroposterior (AP) and lateral, to observe the general alignment of the joint and to detect any bony anomaly or joint wear.
Axial radiography of patellae
Axial radiograph of the patellaThis projection allows a clear view of the position of the patella in relation to the femur and is useful for detecting subluxation or dislocation of the kneecap. It is important to determine the shape of both the femur and the patella in the groove.
Telemetry of lower limbs
It is used to analyze the global alignment of the leg, from the hip to the ankle, and to detect alterations in the knee axis that may be contributing to problems of the patellofemoral joint.
Knee MRI
It is the most detailed test to evaluate the soft tissues (ligaments, tendons, cartilage, meniscus) of the knee. It allows to visualize the state of the femoral trochlea, the cartilage, the quadriceps tendon and the patella, and it is fundamental in the evaluation of patellofemoral pathologies. Generally there is hyperpressure of the patella on its external face on the femur.
Range of motion
Evaluate full knee flexion and extension for restrictions in motion due to pain or instability. The “J-sign” may be observed which translates into malposition of the patella over the femur when positioned medially in full extension.
Knee CT
This test is useful for evaluating bony deformities and alignment of the patella and femur from a three-dimensional perspective. It is particularly useful for studying femoral anteversion, external tibial torsion and patellar angle.
Dynamic CT of the knees
It is a type of test that allows observing the movement of the patella while the knee performs flexion and extension movements. This is useful to identify alterations in the trajectory of patellar motion.
MOST FREQUENT CAUSES
Patellofemoral syndrome
The patella does not slide properly on the femoral trochlea, which can cause pain and wear and tear. Pain and wear and wear on the patellar cartilage. It is usually associated with activities that require repeated flexion of the knee of the knee, like running, bicycle, work in flexion or stair climbing. There is no clear cause.
Conservative treatment
Physiotherapy
Exercises to strengthen the quadriceps and improve patellar control.
Change of activity
Avoid activities that aggravate pain, such as running or jumping.
Use of orthoses
Knee braces or supports to help stabilize the patella.
Anti-inflammatory drugs
To reduce pain and inflammation.
Infiltrations
Infiltrations of hyaluronic acid, PRP or stem cells.
Surgical treatment: Arthroscopy
To remove any fragment of damaged cartilage or to treat cartilage alterations. Sometimes it is associated with the release of the external femoropatellar retinaculum (lateral release).
MOST FREQUENT CAUSES
Patellofemoral syndrome
The patella does not slide properly in the femoral trochlea, which can cause pain and wear on the patellar cartilage. It is generally associated with activities that require repeated knee flexion, such as running, cycling, bending, or climbing stairs. There is no clear cause.
Longitudinal rupture
It extends along the meniscus, parallel to its curvature.
Patellar malalignment
An excessive Q angle or a shallow femoral trochlea can cause the patella to shift easily.
Muscle weakness
Weak vastus medialis cannot stabilize the patella, increasing the risk of dislocation.
Ligamentous laxity
Weak ligaments, such as the medial patellofemoral ligament, may not hold the patella in place. Also in hyperlaxed persons.
Longitudinal breakage
It extends along the meniscus, parallel to its curvature.
Patellar height
The position of the patella with respect to the insertion of the patellar tendon should be looked at, if it is elevated, it is more likely to dislocate laterally.
Bone alterations
Malformations in the femur or tibia (femoral anteversion or excessive external tibial torsion) can affect the alignment and stability of the patella.
Previous injuries
Trauma that alters the stability of the knee.
Conservative treatment
Physiotherapy
Focus on quadriceps strengthening and patellar control.
Use of knee pads
Especially those that stabilize the patella.
Change of activities
Avoid those involving excessive twisting or bending movements.
Infiltrations
Infiltrations of hyaluronic acid, PRP or stem cells.
Surgical treatment
Reconstruction of the medial patellofemoral ligament (MPFL).
Strengthen or reconstruct the medial patellofemoral ligament to improve patellar stability.
Trochleoplasty
Surgical procedure to reshape the femoral trochlea and increase the depth of the trochlea, which helps hold the patella in place.
Osteotomy of the tibia or femur
In severe cases, correction of the patellar angle may require bony correction through de-rotatory or realigning osteotomies of the limb.
RESULTS
Improvement of pain
About 80-90% of patients improve pain with surgical treatment.
Functionality
Recovery of function in 70-80% of patients post-surgery.
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