Patellofemoral syndrome is characterized by anterior knee pain that is aggravated by activities involving weight bearing on a flexed knee. It is caused by overuse and is diagnosed when other causes have been ruled out. Risk factors include activities like running and squatting, dynamic valgus, foot abnormalities, sudden increases in activity level, patellar instability, and quadriceps weakness. Treatment focuses on activity modification, pain management, muscle stretching and strengthening exercises, orthotics, bracing, and taping. Surgery is generally not effective and the long-term prognosis is usually favorable with most patients experiencing only mild symptoms over time.

1. PATELLOFEMORAL SYNDROME
Onia

2. INTRODUCTION
Patellofemoral Syndrome –
 Anterior knee Pain
 Overuse Disorder
 Aggravated by one or more activities that involve
loading the patellofemoral joint during weight bearing
on a flexed knee
 Diagnosis of exclusion

3. ANATOMY

4. RISK FACTORS
 Activities such as Running, Squatting and climbing
upstairs and downstairs
 Dynamic Valgus (increases valgus maltracking)
 More common in females
 Foot abnormalities(rearfoot eversion and pes
pronatus)
 Overuse or sudden increase in physical activity level
 Patellar Instability
 Quadriceps weakness
 Trauma

5. RISK FACTORS

6. HISTORY
 Gradual or acute onset (trauma)of anterior knee
pain
 Pain area can be peripatellar or retro
patellar(circle sign)
 Pain worsens on squatting, running , prolonged
sitting or when ascending or descending steps
 Knee giving way or buckling
 Exercise history or changes in training
 History of trauma

7. CLINICAL FEATURES

8. EXAMINATION

27. INVESTIGATIONS
Patellofemoral Syndrome is a clinical
diagnosis
Plain films and Sunrise view of knee –
To r/o other causes
CT and MRI to look for other causes

28. TREATMENT
 Activity Modification
 Pain management – NSAIDs
 Ice compression
 Muscle Stretching
 Hip Strengthening exercises
 Quadriceps strengthening- Closed and Open
Kinetic Chain Exercises
Closed Kinetic chain exercises are done with feet
planted to the ground
Like Squat and Leg Press.
Open Chain exercise means the feet change
positions

29. Quadriceps strengthening mainly VMO
 Current evidence suggests that VMO cannot be
exercised in isolation
 Focused exercises targeting VM strengthening—
1. Straight Leg raise while lying down and foot
pointing laterally
2. While lying down and knee flexed , squeeze the
ball between the knees and bridge lift
3. Squat while squeezing a ball between the knees
Link – VMO Strengthening exercises Dr Jo

30. ADJUNCTIVE TREATMENT
 Foot Orthoses- To control over pronation or supination
 Bracing and patellar taping- Various studies- Moderate
evidence of support to control rotation of patella
 Barefoot running and minimalist shoes- 1 study
showing decreased PFS by 12% in running barefoot
 Intraarticular Steroids – very little evidence in favor
 Surgery- Patellar alignment, Resurfacing and
Arthroscopy – Effectiveness in various studies is
unclear

31. COMPLICATIONS
Few long term studies suggest General
prognosis of PFS is favorable
At 2 to 8 years, most patients will
generally complaint of mild symptoms
Not all patients return to sporting activity

32. PREVENTION
 EXERCISE PROGRAM
Isometric hip abduction against a wall
Forward lunges
Single leg step downs
Single Leg Squats
Stretches for Quadriceps, Iliotibial band ,
hamstrings and calves

33. RETURN TO SPORT OR WORK
BASIC GUIDELINES- Patient should
demonstrate motion equal to that of
uninvolved extremity and strength at
least 80% of the unaffected side

34. THANK YOU