Patellofemoral Syndrome

Patellofemoral pain syndrome, is one of the most common musculoskeletal disorders and has been described as one of the most difficult pathologies to manage. It is often called "runner's or jumper's knee" because it is often found in athletes, especially in women and young people, although it can occur equally in non-athletic patients. The pain and stiffness it causes make it very difficult to climb stairs or bend over the knee or even perform many daily activities. The causes that can contribute to the occurrence of this syndrome are many. Problems involving the alignment of the patella or even overuse of the joint in high-energy sports activities contribute to the development of this syndrome.

Knowledge of the anatomy of the patellofemoral joint is essential for understanding the pathogenesis of the syndrome. The clinical diagnosis is considered multifactorial and is often made after careful evaluation of the causes of pain.

Normally the kneecap is aligned to slide smoothly in the femoral orbit (anatomical structure in the femur). In patients with patellofemoral pain syndrome the patella is usually not properly aligned. Thus the loads on the joint are not distributed in an even manner and pain and dysfunction in the joint is created.

The symptoms are due to alterations of the articular surfaces of the patella and/or the femoral orbit (the friction point between the patella and the femur). It is not always accompanied by pain and often the degree of lesions is not entirely related to the symptoms.

Usually the patient:

• Has pain or burning in front of the knees.

• He / She hears sounds in the knee and more when getting up after sitting for a long time.

• Feels pain when climbing up and down stairs.

• Has difficulty in sitting deeply.

• Reports pain after prolonged sitting with knees bent, difficulty getting up after sitting for a long time.

• Feels pain during sport or intense activity.

The aim of the treatment is to relieve pain and restore the range of motion and strength of the knee. In most cases, patellofemoral pain syndrome is treated conservatively (non-surgically).

Conservative Treatment

The patient should stop all activities that cause pain. At the same time, anti-inflammatory drugs, ice therapy and avoidance of activities that aggravate the condition of the patella are administered.

Along with changing activities and taking NSAIDs, the orthopaedic surgeon may recommend:

• Physiotherapy: Specific supervised exercises help to regain range of motion and strength. In particular, strengthening the quadriceps muscle helps to stabilise the patella.

• Orthotics: Special shoe inserts that help align and stabilize the lower limb, reducing loads on the knee.

Surgical Treatment

Surgical treatment is very rarely used to treat patellofemoral pain syndrome. It concerns cases that have not responded to conservative treatment.

Surgical procedures include:

• Arthroscopy: The surgeon inserts a small camera into the knee through small incisions. With the help of special tools, he can intervene in the various structures of the joint.

• Surgical cleaning: in some cases, removing the damaged articular cartilage from the surface of the kneecap can provide pain relief.

• Lateral Release: The release of the external catheter ligaments relaxes the tissues and allows the patella to slide properly and unobstructed in the orbit.

In some cases, the alignment of the patella is done by moving the tibial tuberosity (osteotomy) and fixing it to the inside of the knee with screws. In this way the patella slides freely and with less friction on the rotation.