Patellofemoral Pain Syndrome

 

Am Fam Physician. 2019 Jan 15;99(2):88-94.

  Patient information: See related handout on patellofemoral pain syndrome, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The incidence in the United States is between 3% and 6%. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. The pain of PFPS often worsens with prolonged sitting or descending stairs. The most sensitive physical examination finding is pain with squatting. Examining a patient's gait, posture, and footwear can help identify contributing causes. Plain radiographs of the knee are not necessary for the diagnosis of PFPS but can exclude other diagnoses, such as osteoarthritis, patellar fracture, and osteochondritis. If conservative treatment measures are unsuccessful, plain radiography is recommended. Treatment of PFPS includes rest, a short course of nonsteroidal anti-inflammatory drugs, and physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups. Patellar kinesiotaping may provide additional short-term pain relief; however, evidence is insufficient to support its routine use. Surgery is considered a last resort.

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adolescents and adults younger than 60 years. A retrospective review of an orthopedic database including more than 30 million patients in the United States between 2007 and 2011 estimated the incidence of PFPS to be 1.75 million patients, or about 6%.1 Females accounted for 55% of cases. The highest percentage of cases occurred in the South (42%), and the lowest occurred in the Northeast (14%). In a prospective study of 1,319 healthy, physically active young adults without a previous PFPS diagnosis, 3% developed PFPS during 2.5 years of follow-up, and women were more likely to develop the condition than men.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Exercise therapies are most effective in improving short- and long-term pain in patients with patellofemoral pain syndrome.

A

3

Short courses of nonsteroidal anti-inflammatory drugs improve pain in patients with patellofemoral pain syndrome compared with placebo, but the effect may be limited to one week.

B

28

Patellar kinesiotaping improves patellar maltracking and may reduce short-term pain as an adjunct to exercise.

B

30, 33, 34


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Exercise therapies are most effective in improving short- and long-term pain in patients with patellofemoral pain syndrome.

A

3

Short courses of nonsteroidal anti-inflammatory drugs improve pain in patients with patellofemoral pain syndrome compared with placebo, but the effect may be limited to one week.

B

28

Patellar kinesiotaping improves patellar maltracking and may reduce short-term pain as an adjunct to exercise.

B

30, 33, 34


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Undiagnosed PFPS can cause limitations in daily physical activity and ability to exercise. There is insufficient evidence that undiagnosed PFPS contributes to patellofemoral joint osteoarthritis.35

Definition

A 2016 consensus statement defines PFPS as pain occurring around or behind the patella that is aggravated by at least one activity that loads the patella during weight-bearing on a flexed knee.4 Contributing activities include running, climbing stairs, jumping, and squatting. PFPS is also called runner's knee and anterior knee pain syndrome.4 Although the term PFPS was formerly used interchangeably with chondromalacia patellae, the latter specifically refers to the finding of softened patellofemoral cartilage on plain radiography, magnetic resonance imaging, or knee arthroscopy.6 Conversely, structural defects are absent in PFPS, and imaging is not required for the diagnosis.

Anatomy and Pathophysiology

The patellofemoral joint consists of the patella and the trochlea of the femur and is important in

The Authors

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DAVID Y. GAITONDE, MD, is a core clinical faculty member and chief of endocrinology service at Dwight D. Eisenhower Army Medical Center, Fort Gordon, Ga....

ALEX ERICKSEN, MD, is a second-year resident in the Internal Medicine Residency Program at Dwight D. Eisenhower Army Medical Center.

RACHEL C. ROBBINS, MD, is chief of rheumatology service and associate program director of the Internal Medicine Residency Program at Dwight D. Eisenhower Army Medical Center.

Address correspondence to David Y. Gaitonde, MD, Dwight D. Eisenhower Army Medical Center, 300 E. Hospital Rd., Fort Gordon, GA 30905. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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