Patellofemoral Pain

Patellofemoral pain syndrome also called runner's knee refers to pain under and around your kneecap. Patellofemoral pain is seen in number of medical conditions such as anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella that cause pain around the front of the knee. Patellofemoral pain is a common complaint among runners, jumpers, and other athletes such as skiers, cyclists, and soccer players and therefore is the common name, runner's knee.

Causes

Patellofemoral pain can result from poor alignment of the kneecap, complete or partial dislocation, overuse, tight or weak thigh muscles, flat feet, direct trauma to the knee. Patellofemoral pain often comes from strained tendons and irritation or softening of the cartilage that lines the underside of the kneecap. Pain in the knee may be referred from other parts of the body, such as the back or hip.

Symptoms

The most common symptom includes a dull aching pain underneath the kneecap while walking up or down stairs, squatting, kneeling down, and sitting with your knees bent for long period of time.

Pain usually occurs under or around the front of the kneecap (patella) where it attaches with the lower end of the thighbone (femur). The patella, also called kneecap, is a small flat triangular bone located at the front of the knee joint. The kneecap or patella is a sesamoid bone that is embedded in a tendon that connects the muscles of the thigh to the shin bone (tibia). The function of the patella is to protect the front part of the knee.

Diagnosis

To diagnose patellofemoral pain, your doctor will ask about your symptoms, medical history, any sports participation, and activities that aggravate your knee pain. Your doctor will perform a physical examination of your knee. Diagnostic imaging tests such as X-rays, MRIs, and CT scans, and blood tests may be ordered to check if your pain is due to damage to the structure of the knee or because of the tissues that attach to it.

Treatment

The first treatment step is to avoid activities such as running and jumping, that causes pain. Treatment options include both non-surgical and surgical methods. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Non-steroidal anti-inflammatory medications may be prescribed to reduce pain.

Exercises: Your doctor may recommend exercise program to improve the flexibility and strength of thigh muscles. Cross-training exercises to stretch the lower extremities may also be recommended by your doctor.

Other non-surgical treatments include:

• Knee taping: An adhesive tape is applied over the patella, to alter the kneecap alignment and movement. Taping of the patella may reduce pain.
• Knee brace: A special brace for knee may be used during sports participation which may help reduce pain.
• Orthotics: Special shoe inserts may be prescribed for those with flat feet that may help relieve the pain.

In some cases, you may need surgery that includes arthroscopy and realignment. During arthroscopy, damaged fragments are removed from the kneecap, while realignment moves the kneecap back to its alignment, thus reducing the abnormal pressure on cartilage and supporting structures around the front of the knee.

Prevention

• If you are overweight, you may need to control your weight to avoid overstressing your knees
• Gradually increase the intensity of your workout
• If you have flat feet or other foot problems use shoe inserts
• Avoid running on hard surfaces
• Wear proper fitting good quality running shoes with good shock absorption
• Avoid running straight down hills; instead walk down it or run in a zigzag pattern
• Warm up for 5 minutes before starting any exercise. Also stretch after exercising

Chondromalacia/OCD

The patella, also called the kneecap, is a small bone present on the front of your knee joint. The underside of the patella is covered by cartilage that allows smooth gliding of the knee with movement. Overuse or misalignment of the patella can cause wear and tear of the cartilage.

Chondromalacia patella is a common condition characterized by softening, weakening and damage of the cartilage. The condition is most often seen among young athletes and older adults who have arthritis of the knee. It is especially seen in women.

Causes

There is no explicit reason why the cartilage damage occurs. However, it is associated with improper knee alignment or imbalance in the tightness of the muscles holding it in place. Overuse of the knee in certain sports activities may cause wear and tear of the cartilage. This may cause rubbing or grinding of the kneecap against the bone instead of it smoothly gliding over the knee joint.

Chondromalacia patella may also be caused due to injuries such as fractures or dislocations, or may develop as a part of your ageing process.

Symptoms

Chondromalacia patella is the most common cause of knee pain. Called patellofemoral pain, it is characterized by the following:

Pain in front, around or behind your knee

Pain that gets worse when climbing up or down the stairs, sitting or standing for long periods, or when extreme pressure is applied on the knee

Other symptoms may include:

• Grinding or cracking sensation or noise when you move your knee
• Occasionally, swelling or fluid effusion in your knee joint

Diagnosis

Your doctor will conduct a physical examination by applying pressure on different areas of your knee and moving your leg in different positions. You may be asked to undergo imaging tests including an X-ray, CT scan and MRI scan to obtain detailed images of the bones and soft tissues of the knee.

Treatment

The treatment of chondromalacia patella initially involves simple conservative procedures. You may be asked to rest your knee and avoid any activity that may strain the knee joint. Your doctor may prescribe painkillers and anti-inflammatory drugs to relieve pain and reduce swelling. Physiotherapy may help you to improve the muscle strength, decrease stress on your knee and aid in correcting the misalignment. Wearing support braces and taping around the knee may help you protect your joint, reduce pain and improve alignment. Application of ice on the knee may be recommended after exercise.

When non-surgical treatment does not relieve pain, your doctor may recommend surgical treatment. Surgery may involve:

Arthroscopy: your doctor inserts a device called an arthroscope (thin tube with a camera and light attached) through a small incision. This helps to clearly view the surgical site while other instruments are inserted to remove fragments of the damaged cartilage.

Realignment: your surgeon may operate on your knee to realign the position of your knee cap and release the pressure over the cartilage.

Your doctor will examine your condition and provide you with the best treatment option.