Patello-Femoral Pain Syndrome

One of the most common knee injuries we see at our clinic is Patellofemoral pain syndrome (PFPS). PFPS is a condition which usually develops gradually or from overuse and refers to pain around or on the kneecap. PFPS itself is a problem of alignment and muscular dysfunction. However, there are many factors which play on the joint which causes the condition. These include:

PFPS affects the general population but has a higher incidence in young active adolescents, with females affected more than males. According to a recent incidence and prevalence review in the UK, PFPS affects 23% of the general population. Furthermore, in some data it shows that females are twice as likely to get PFPS than males.

Diagnosis:

Currently there is no gold standard diagnostic tool, and imaging is not particularly helpful except to help exclude other diagnoses. Usually a diagnosis is made through a detailed history and objective findings including special tests. Palpation to the patella and knee joint, compression to the patella and loading the knee should be tested to come to a clinical diagnosis of PFPS.

Common symptoms include:

Diffuse pain around/behind or on the kneecap.

Pain when the knee is loaded (e.g squatting, climbing stairs)

Occasionally painful when sitting for long periods of time.

Occasional buckling or giving way.

Around 80% of people who present in clinics with PFPS will have their symptoms reduced by rehabilitation and load management within the first few months.

2/3 of people will remain symptom free after 16 months.

How to fix the problem?

Based off the latest PFPS consensus, there are six recommendations for treating PFPS.

* Exercise-therapy is recommended to reduce pain in the short, medium and long term, and improve function in the medium and long term.

* Combining hip and knee exercises is recommended to reduce pain and improve function in the short, medium and long term, and this combination should be used in preference to knee exercises alone.

* Combined interventions are recommended to reduce pain in adults with patellofemoral pain in the short and medium term.

* Foot orthoses are recommended to reduce pain in the short term.

* Patellofemoral, knee and lumbar mobilisations are not recommended.

* Electrophysical agents are not recommended.

Smith, B. E., Selfe, J., Thacker, D., Hendrick, P., Bateman, M., Moffatt, F., … Logan, P. (2018). Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis.

Halabchi, F., Abolhasani, M., Mirshahi, M., & Alizadeh, Z. (2017). Patellofemoral pain in athletes: clinical perspectives. Open access journal of sports medicine, 8, 189–203.

Collins NJ, Barton CJ, van Middelkoop M, et al 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017 British Journal of Sports Medicine 2018;52:1170-1178.