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Uploaded byFarha Mirza
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Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS), commonly known as runner's knee, is a condition characterized by anterior knee pain that is aggravated by activities involving the patellofemoral joint like climbing stairs, sitting with bent knees, or squatting. It is often caused by overuse injuries and biomechanical faults that cause abnormal tracking of the patella. Examination involves assessing for factors like patellar maltracking, tight muscles, and weakness. Treatment is primarily non-operative and focuses on exercises, bracing, taping, and orthotics to address biomechanical faults and strengthen the quadriceps muscles.

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Patellofemoral Pain Syndrome Represented by Dr.Farha PT Sports Physiotherapist
• Introduction • Clinically relevant anatomy • Function of Patella • Biomechanical faults • Clinical Presentation • Difference diagnosis • Examination • Rehabilitaion
Introduction • Patellofemoral Pain Syndrome (PFPS) is an umbrella term used for pain arising from patellofemoral joint itself, or adjacent soft tissues. • Historically it has been referred to as anterior knee pain but sometime pain can be felt in all aspect of the knee. • The main cause of PFPS is overuse injuries around in the patellofemoral region because the PF joint is essentially a ‘Soft tissue’ joint. • It is sometimes called "runner's knee" . it is common in people who participate in sports—particularly females and young adults—but PFPS can occur in nonathletic, as well. The pain and stiffness caused by PFPS can make it difficult to climb stairs, kneel down, and perform other everyday activities.
Clinically relevant Anatomy • Your knee is the largest joint in your body and one of the most complex. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). • Ligaments and tendons connect the femur to the bones of the lower leg. The four main ligaments in the knee attach to the bones and act like strong ropes to hold the bones together.
Active stabilizers: – Quadriceps • Rectus femoris • Vastus lateralis • Vastus intermedius • Vastus medialis  The VM is divided functionally into two parts: 1.Vastus medialis longus 2.Vastus medialis obliqus (VMO) VMO FUNCTION: Clinically, the function of VMO is producing medialization of patella
Passive stabilizers: – Capsule – IT band – Patellar tendon – Lateral patellofemoral ligament – Patellotibial band – Meniscopatellar ligament – Medial meniscus
Patella • Largest sesamoid bone in body, developed in tendon of quadriceps femoris. – Features- • Base • An apex- Covered by expansion of rectus femoris Separated from skin by prepatellar bursa • 3 borders- Superior, Lateral, Medial • 2 surfaces- Anterior, Posterior- Divided by 2 vertical and 2 transverse lines into 3 pairs of medial and lateral articular facets and one medial strip.
. The tendon of the quadriceps femoris muscle attaches to the base of the patella., with the vastus intermedius muscle attaching to the base itself, and the vastus lateralis and vastus medialis are attached to outer lateral and medial borders of patella respectively.
• The posterior surface of the patella articulates with the femur, and is marked by two facets: – Medial facet – articulates with the medial condyle of the femur. – Lateral facet – articulates with the lateral condyle of the femur.
• Articular areas: – Divided by one vertical ridges : Larger lateral and smaller medial portion. – Another vertical ridge separates a medial strip from medial portion. This strip articulates with medial side of the intercondylar notch of the femur during full flexion. – The rest of the medial and lateral portion of the articular surface are divided by two transverse lines into three pairs of facets. – During different phases of movements of the knee, different portions of the patella articulate with femur.
Pair of facet articulates with femur Action of knee Lower pair Extension Middle pair Beginning of flexion Upper pair Mid flexion Medial strip Full flexion
Function of Patella • Increase the extensor moment of the Quadriceps • Protect the anterior aspect of knee joint from physical trauma • Patella work as a frictionless pulley, in which the force of the patellar tendon equals the force of the quadriceps tendon
Biomechanical faults • Patella maltracking • Weakness of the quadriceps muscles - It may adversely affect the PF mechanism. • Weakness of the VMO- It allows the patella to track too far laterally. • Tight IT Band- it places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the PF mechanism. • Tight Hamstring- It places more posterior force on the knee, causing pressure between the patella and the femur to increase. • Tight calf muscle- It can lead to compensatory foot pronation and can increase the posterior force on the knee.
• Hip stability and hip abductor strength – Recent research has shown that functional malalignment does not arise in the knee joint but rather by internal rotation of the femur due to weakness of hip external rotators and abductors (M. gluteus medius and minimus) • Increase Q angle – Due to increase Q angle knee goes to valgus position. At this time femur and tibia rotate internally. – Internal rotation of the femur might be the result of weakness of hip abductors, internal rotation of tibia might arise from rear foot eversion or pes-pronatus. – Functional valgus may lead to lateral patellar maltracking.
Clinical presentation • Anterior knee pain that is aggravated by activities that increase patellofemoral compressive forces such as: ascending/descending stairs, sitting with knees bent, kneeling, and squatting.
Difference diagnosis • Acute patellar dislocation • Patellar subluxation • Patellar tendinitis • IT Band friction syndrome • Bursitis • Patellar fracture • Quadriceps rupture • Prepatellar bursitis • Patella baja and Patella alta
Examination • Subjective examination: – History – Behavior of symptoms – Contributing factors • Insidious onset- PFPS • Overload event (excessive stairs climbing)-PFPS • Traumatic events – Pattern of Pain • Pain only during activity-Think biomechanics • Pain only after activity-Think inflammatory • Pain that improve with exercise- Think about muscles
• Physical examination: – Observation- Posture – Standing • Posture ant.-post. View • Posture lateral view – Q angle – Leg length measurement – Foot posture – Dynamic movement assessment • Step down test • Lateral step down test • Single leg squat
– Gait – Hypermobility – Seated examination • Passive-active patellar tracking • Strength testing – Hip flexion – Hip rotation – Knee extension
• Supine examination – Palpation – Flexibility test – ROM of knee – Special test • Screening for knee lig. • Screening for meniscus • Neurological exam – Reflexes – Balance
• Side lying examination – Flexibility test- IT Band – Strength test • Hip abd.-add. • Prone examination – Flexibility test - Quadriceps – Strength test- Hip extensors, Knee flexor
Rehabilitation Surgical versus conservative treatment: Kettunen et. al. have demonstrated in a prospective randomized study with PFPS patients that an arthroscopy, in combination with physiotherapy, had no positive effect compared to physiotherapy alone. Therefore, the treatment of PFPS is primarily non-operative. • Pharmacological treatment – NSAID’s
• Tape Aim of classical taping is to modify patella tracking by applying adhesive tape stripe to the skin. The tape should apply a medially directed force to counteract lateral patella maltracking. The most popular application is the Mc Connel tape.
• Patella brace Patella braces are non adhesive devices also applying an external medially directed force which may counteract lateral patella maltracking. • Foot orthosis • Close and open chain exercises – Stretching – Static quadriceps – SLR – Squats – Trunk stabilizer exercises – Proprioceptive exercises
Patellofemoral Pain Syndrome