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Patellofemoral Joint Pain

Patellofemoral joint pain arises when nerves perceive pain within the bone and soft tissues surrounding the kneecap. The soft tissues consist of the tendons, the fat pad below the patella, and the synovial lining of the knee joint.

Sometimes, patellofemoral pain is associated with chondromalacia patella, a condition where the articular cartilage on the base of the kneecap softens and deteriorates. Since articular cartilage lacks nerves, its damage does not directly trigger pain. Nevertheless, it can cause inflammation in the synovial tissue and discomfort inside the underlying bone.

Symptoms

The primary symptom of patellofemoral joint syndrome is a dull, aching pain that occurs at the front of the knee. This discomfort normally develops gradually and is often triggered by physical activity. It may also affect one or both knees.

Additional common symptoms associated with this condition are:

  • Pain during activities or workouts that involve repeated knee bending, like running, jumping, squatting, or climbing stairs.
  • Discomfort at the front of the knee following prolonged sitting with bent knees, such as in a car, aeroplane, or movie theatre.
  • Pain triggered by alterations in activity level, intensity, and playing tools or surface.
  • Popping or crackling sensations in the knee when standing up after sitting for a long time or while climbing stairs.

Causes

The leading causes of patellofemoral joint pain are:

Overuse:

Patellofemoral joint pain often results from repetitive stress on the knee due to high-impact activities like squatting, jogging, or climbing stairs. It can as well be triggered by abrupt changes in physical activity, such as increasing workout frequency, duration, or intensity (for instance, running longer distances or exercising more days per week).

Other contributing factors include:

  • Using improper sports training methods or tools
  • Footwear or playing surface changes (shifting from natural grass to artificial turf)

Patellar malalignment:

In addition, patellofemoral joint pain can occur due to improper kneecap tracking within the trochlear groove. With this disorder, the patella shifts abnormally to one side when the knee bends, increasing pressure between the patella and the trochlea, which can irritate surrounding soft tissues.

Factors likely to cause poor kneecap tracking involve:

  • Leg alignment issues – Misalignment from the hips to the ankles can cause the kneecap to shift too far inward or outward or ride too high in the trochlear groove (a disorder known as patella alta).
  • Muscle imbalances or weakness – Weakness in the quadriceps (front thigh muscles) or hip muscles responsible for external rotation and abduction (hip movement away from the body) can affect kneecap stability. When bending and straightening the knee, the quadriceps and hip muscles work together in order to maintain the kneecap cantered. The kneecap may not track properly within the groove if these muscles are weak or imbalanced.

Diagnosis

Patellofemoral joint pain can be diagnosed through:

Physical exam

During the examination, your doctor will:

  • Discuss your overall health as well as the symptoms.
  • Ask when the knee pain began, how severe it is, and whether it feels dull or sharp.
  • Identify activities that worsen the pain.
  • Gently press and manipulate the front of your knee and kneecap to locate the source of discomfort.
  • Assess your knee as well as core strength by asking you to jump, squat or lunge.

To determine the reason for your pain and exclude other conditions, your GP may also look at the following:

  • Lower leg alignment and kneecap position.
  • Knee stability, hip rotation, and knees and hips range of motion.
  • The kneecap for tenderness.
  • How the thigh muscles attach to the kneecap.
  • Strength, firmness, flexibility, and tone of the hips, quadriceps, and hamstrings.
  • Heel cord tightness and foot flexibility.
  • Your gait (walking pattern) so as to identify movement issues that may contribute to knee pain.

Imaging tests

  • X-rays: While patellofemoral joint pain is usually diagnosed through a physical exam, an X-ray may be performed to rule out bone damage.
  • Magnetic resonance imaging (MRI): If symptoms persist despite physical therapy and home exercises, an MRI may be ordered to help examine soft tissues like tendons, ligaments, and muscles.

Managing Patellofemoral Joint Pain At Home

Patellofemoral joint pain usually improves with basic at-home care.

Activity modifications:

Avoid activities that trigger knee pain until the discomfort subsides. This may entail:

  • Adjusting your workout routine.
  • Changing to low-impact exercises like swimming, cycling on a stationary bike, or using an elliptical to reduce knee strain.
  • Cutting weight if necessary, as this can decrease pressure on the knee joint.

The RICE technique:

  • Rest: Minimise weight-bearing on the affected knee.
  • Ice: Apply a cold pack for at least 20 minutes at a time, numerous times daily. Use a towel to avoid direct skin contact.
  • Compression: Wrap the knee gently with an elastic bandage and leave space around the kneecap. The wrapping should not be too tight but firm.
  • Elevation: Keep your knee elevated above heart level whenever possible.

Medication:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be useful in relieving pain and reducing swelling. If discomfort persists or mobility becomes more restricted, consult a doctor for further evaluation.

Medical Treatment Options

The goal of medical treatment for patellofemoral joint pain is to reduce pain while restoring strength and flexibility. Most cases can be managed with conservative methods.

Nonsurgical treatment

Along with modifying activities, following the RICE method and using anti-inflammatory medications, the following may also be suggested:

  • Physical therapy: Targeted exercises improve strength, flexibility, and endurance. Strengthening and stretching the quadriceps, along with strengthening hip muscles, helps stabilise the kneecap. Moreover, core exercises may be advisable to support the lower back and abdomen.
  • Orthotics: Footwear inserts can improve foot and ankle alignment, reducing strain on the lower leg. These may be custom-made or store-bought.

Surgical treatment

Surgery to treat patellofemoral joint pain is rarely required. It is only considered in severe situations that do not improve with nonsurgical methods. Possible procedures comprise:

  • Arthroscopy: A small camera (arthroscope) is inserted into the knee joint to display images on a monitor and guide surgical tools.
  • Debridement: Removal of the impaired articular cartilage from the patella’s surface may assist in relieving pain.
  • Lateral release: If a tight lateral retinaculum pulls the kneecap out of alignment or causes tilting, this procedure can be done to loosen the tissue in order to restore proper positioning.
  • Tibial tubercle transfer: Sometimes, the patellar tendon and part of the tibial tubercle (shinbone bump) are repositioned to help reduce strain on impaired cartilage. This procedure requires an open incision, where the bone is partially or fully detached, moved inward, and secured with screws so as to improve kneecap tracking.

Conclusion

Patellofemoral joint pain can often be managed with simple lifestyle adjustments, physical therapy, and home remedies. However, persistent discomfort may require a medical evaluation to prevent more complications. If you’re experiencing ongoing knee pain that interferes with daily activities, seeking professional care is essential.

For a comprehensive assessment and personalised treatment plan, schedule an appointment with our specialists today. Contact us to learn more about effective pain relief options and get back to moving comfortably!