Patellofemoral Pain Syndrome

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Patellofemoral Pain Syndrome
Synonym Runner's knee, retropatellar pain syndrome, lateral facet compression syndrome, idiopathic anterior knee pain. Also chondromalacia patella where there are changes to the patella articular cartilage.
Definition Anterior knee pain where other causes have been excluded.
Epidemiology Very common. More common in women.

Patellofemoral pain is anterior knee pain involving the patella and retinaculum where other causes of anterior knee pain have been excluded.

Clinical Features

Red Flags
  • Fracture or tendon and ligament rupture, osteonecrosis: Major trauma, Sudden onset of pain, Minor trauma with risk factors (age over 50, history of osteoporosis, corticosteroid use)
  • Infection, crystal arthritis: fever, night sweats, signs of inflammation, risk factors for infection (underlying disease process, immunosuppression, penetrating wound)
  • Tumour: past history of malignancy, age >50, failure to improve, weight loss, pain at multiple sites, rest pain, night pain

Differential Diagnosis

Differential Diagnosis

Differential Diagnoses

Anterior, focal or vague




  • Baker's or popliteal cyst
  • Popliteus Tendinopathy
  • Popliteal artery aneurysm
  • Popliteal artery entrapment
  • Posterior capsule tear
  • Posterior cruciate ligament tear
  • Tibiofemoral dislocation

Effusion present without trauma

  • Osteochondral injury
  • Osteoarthritis exacerbation
  • Rheumatological disease (gout, RA, psoriatic arthritis)
  • Septic arthritis


In the acute phase overload is very likely. Runners should reduce their running volume, and in severe cases should stop running entirely. Those with more mild symptoms may only need to reduce more strenuous activities such as hill running. In order to maintain fitness runners can be encouraged to use a stationary bike, upper body cycle, swimming, or other activities that do not cause knee pain.

Hip and knee strengthening is more effective than knee strengthening alone.[1]

There is limited evidence for the use of NSAIDs in the short term, with naproxen being more effective than placebo.[2]

There is no evidence to support the use of ultrasound, iontophoresis, phonophoresis, or electrical stimulation.[2][3][4][5][6]



  1. Nascimento, Lucas R.; Teixeira-Salmela, Luci F.; Souza, Ricardo B.; Resende, Renan A. (2018-01). "Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis". The Journal of Orthopaedic and Sports Physical Therapy. 48 (1): 19–31. doi:10.2519/jospt.2018.7365. ISSN 1938-1344. PMID 29034800. Check date values in: |date= (help)
  2. 2.0 2.1 Heintjes et al.. Pharmacotherapy for patellofemoral pain syndrome. The Cochrane database of systematic reviews 2004. CD003470. PMID: 15266488. DOI. Full Text.
  3. Martimbianco et al.. Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome. The Cochrane database of systematic reviews 2017. 12:CD011289. PMID: 29231243. DOI. Full Text.
  4. Shanks et al.. The effectiveness of therapeutic ultrasound for musculoskeletal conditions of the lower limb: A literature review. Foot (Edinburgh, Scotland) 2010. 20:133-9. PMID: 20961748. DOI.
  5. Bolin. Transdermal approaches to pain in sports injury management. Current sports medicine reports 2003. 2:303-9. PMID: 14583158. DOI.
  6. van der Windt et al.. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 1999. 81:257-271. PMID: 10431713. DOI.

Literature Review