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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
- Patellofemoral Pain Syndrome
- Knee Osteoarthritis
- Patellar Tendinopathy
- Plica Syndrome
- Quadriceps Tendinopathy
- Patellar Instability
- Hoffa's Fat Pad Inflammation
- Prepatellar Bursitis and Infrapatellar Bursitis
- Osgood-Schlatter Disease
- Sinding-Larsen-Johansson Disease
- Referred hip pain
- Avascular necrosis
- Patellar Stress Fractures
- Anterior cruciate ligament tear
- Osteochondral defect
- Posterior cruciate ligament tear
- Tibiofemoral dislocation
- Parameniscal cyst
Medial
- Knee Osteoarthritis
- Medial collateral ligament tear
- Medial meniscal tear
- Medial meniscal cyst
- Bakers cyst
- Medial Plica Syndrome
- Pes anserine bursitis/tendinopathy
- Inflammatory arthritis
- Osteochondral lesion medial femoral condyle (lateral aspect of medial epicondyle most common)
- Saphenous Nerve Entrapment
- Medial friction syndrome
- Medial collateral ligament bursitis
- Osteonecrosis
- Semimembranosus-Tibial Collateral Ligament Bursitis
- Pigmented Villonodular Synovitis
- Synovial Chondromatosis
- Referred Pain - Hip Joint, Lumbosacral spine pathology
- Neoplasm - soft tissue, intraosseous
Lateral
- Lateral meniscus tear
- Posterolateral corner injury
- Patellar dislocation or subluxation
- Lateral collateral ligament tear
- Iliotibial Band Syndrome
- Osteoarthritis exacerbation
- Osteochondral lesion lateral femoral condyle
- Popliteus Tendinopathy
- Biceps Femoris Tendinoapthy
- Semimembranosus Tendinopathy/bursitis
- Fibula head fracture
- Proximal Tibiofibular Joint Instability
- Snapping Biceps Femoris and Popliteus Tendons
- Peroneal Nerve Compression/Neuritis
Posterior
- 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
Treatment
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]
Resources
References
- ↑ 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) - ↑ 2.0 2.1 Heintjes et al.. Pharmacotherapy for patellofemoral pain syndrome. The Cochrane database of systematic reviews 2004. CD003470. PMID: 15266488. DOI. Full Text.
- ↑ 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.
- ↑ 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.
- ↑ Bolin. Transdermal approaches to pain in sports injury management. Current sports medicine reports 2003. 2:303-9. PMID: 14583158. DOI.
- ↑ van der Windt et al.. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 1999. 81:257-271. PMID: 10431713. DOI.
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
