Anterior Knee Pain (Patellofemoral Pain Syndrome)

What is Patellofemoral Pain Syndrome (PFPS)?

PFPS, commonly known as “Runner’s Knee,” is a condition where pain arises from the front of the knee and around the patella (kneecap). It is a common overuse injury seen in athletes and active individuals but can also occur in non-athletes due to muscle imbalances or biomechanical issues.

Causes

  • Overuse: Repetitive stress from activities like running, jumping, or climbing stairs.
  • Muscle Imbalance: Weak quadriceps, especially the vastus medialis oblique (VMO), leading to improper patellar tracking.
  • Malalignment: Misalignment of the patella in the trochlear groove.
  • Foot Mechanics: Flat feet or high arches causing altered biomechanics.
  • Inadequate Footwear: Poor shock absorption contributing to stress on the knees.

Symptoms

  • Dull, aching pain around or behind the kneecap.
  • Pain worsens during activities such as running, squatting, or climbing stairs.
  • Grinding or clicking sensation when moving the knee.
  • Discomfort after prolonged sitting (“theater sign”).

Diagnosis

  1. Physical Examination:
    • Observation of patellar tracking during knee flexion and extension.
    • Tenderness along the patellar edges.
    • Clarke’s Test (patellar grind test): Pain during quadriceps contraction with the patella compressed.
  2. Imaging:
    • X-rays: To rule out other structural issues like arthritis or fractures.
    • MRI: Rarely needed but may reveal cartilage damage or malalignment.

Treatment

  • Non-Surgical Management (First-line)

    1. Activity Modification:
      • Avoid aggravating activities, such as running or squatting, during acute pain.
      • Cross-train with low-impact activities like swimming or cycling.
    2. Physical Therapy:
      • Quadriceps strengthening, particularly VMO.
      • Hamstring and iliotibial (IT) band stretching.
      • Core and gluteal muscle strengthening for improved biomechanics.
    3. Taping or Bracing:
      • Patellar taping (McConnell taping) to improve alignment and reduce pain.
      • Knee braces for added support.
    4. Orthotics and Footwear:
      • Custom orthotics to correct flat feet or overpronation.
      • Well-cushioned shoes for proper shock absorption.
    5. Medications:
      • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

  • Surgical Options (Rarely Needed)

    • Realignment procedures for severe maltracking.
    • Arthroscopic debridement if cartilage damage is present.

Prevention

  • Gradual increase in activity levels to avoid overuse.
  • Strengthening and stretching exercises targeting the knee and surrounding muscles.
  • Use of proper footwear for support and cushioning.