Updated: 12/28/2021

Patellofemoral Syndrome

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  • Snapshot
    • A 27-year-old female presents with knee pain. Her pain worsens when she is running downhill or climbing up the stairs. She describes the pain as "achy" and being behind the knee. When sitting for long periods of time, she reports her knees feeling stiff. She denies any recent history of trauma and has never had surgery. She has tried multiple over-the-counter analgesics but were not effective. She is a high school teacher and an avid runner who is preparing for a marathon. A full knee examination is performed.
  • Introduction
    • Overuse of patellofemoral area involving the knee and the retinaculum
      • usually presents as anterior knee pain
      • aggravated by weight bearing activity (e.g., running)
  • Epidemiology
    • More common in women
    • Commonly seen in runners or cyclists
  • Etiology
    • Overuse (most common)
      • malalignment and trauma are also risk factors
    • May be secondary to patellofemoral joint overload
  • Presentation
    • Physical symptoms
      • anterior knee pain
        • worsened with ascending or descending stairs, running, and squatting
  • STUDIES
    • Patellofemoral compression test
      • pain elicited with compression of the patella
  • Differential
    • Chondromalacia
    • Patellofemoral osteoarthritis
    • Iliotibial band syndrome
    • Prepatellar bursitis
  • DIAGNOSIS
    • Clinical diagnosis
      • no pathognomonic findings
  • Treatment
    • Physiotherapy (first-line) of the quadriceps
      • decreasing exercise intensity
      • activity modification
      • strengthening and stretching movements
    • Pain management
      • foot elevation, ice, and compression
      • little evidence supporting effectiveness of NSAIDs and acetaminophen
        • may be used if pain not relieved by ice or if pain with daily activities
  • Complications
    • May have to limit sports activities
  • Prognosis
    • Favorable prognosis
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(M2.OR.17.4751) A 24-year-old female presents to her primary care physician with right knee pain for the last week. She states that she first noticed it after a long flight on her way back to the United States from Russia, where she had run a marathon along a mountain trail. The patient describes the pain as dull, aching, and localized to the front of her kneecap, and it worsens with sitting but improves with standing. Aspirin has not provided significant relief. The patient has a history of a torn anterior cruciate ligament (ACL) on the right side from a soccer injury three years ago. In addition, she was treated for gonorrhea last month after having intercourse with a new partner. At this visit, the patient’s temperature is 98.5°F (36.9°C), blood pressure is 112/63 mmHg, pulse is 75/min, and respirations are 14/min. Which of the following is most likely to establish the diagnosis?

QID: 108785

Plain radiograph of the knee

12%

(19/162)

MRI of the knee

23%

(37/162)

Ballotable patella test

9%

(15/162)

Patellar compression with extended knee

49%

(80/162)

Anterior drawer test

4%

(7/162)

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