Patellofemoral Syndrome
What is the patellofemoral syndrome?
The most common cause of chronic knee pain is the patellofemoral syndrome (PFS). Also informally called "housemaid's knee" or "secretary's knee" and medically termed chondromalacia patella, this condition is named the patellofemoral syndrome because the pain is related to how the kneecap (the patella) slides over the lower end of the thigh bone (the femur).
What are the symptoms of PFS?
The symptoms of PFS are generally a vague discomfort of the inner knee area, aggravated by activity (running, jumping, climbing or descending stairs) or by prolonged sitting with knees in a moderately bent position (the so called "theater sign" of pain upon arising from a desk or theater seat). Some patients may also have a vague sense of "tightness" or "fullness" in the knee area. Occasionally, if chronic symptoms are ignored, the associated loss of quadriceps (thigh) muscle strength may cause the leg to "give out." Besides an obvious reduction in quadriceps muscle mass, mild swelling of the knee area may occur.
What causes PFS?
The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with PFS have abnormal patellar "tracking" toward the lateral (outer) side of the femur. This slightly-off-kilter pathway allows the undersurface of the patella to grate along the femur causing chronic inflammation and pain. Certain individuals are predisposed to develop PFS-females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface.
How is PFS treated?
The primary goal for treatment and rehabilitation of PFS is to create a straighter pathway for the patella to follow during quadriceps contraction. Initial pain management involves avoiding motions which irritate the kneecap. Icing and anti-inflammatory medications (for examples, ibuprofen: Advil/Motrin or naproxen: Aleve) can also be helpful.
Selective strengthening of the inner portion of the quadriceps muscle will help normalize the tracking of the patella. Cardiovascular conditioning can be maintained by stationary bicycling (low resistance but high rpms), pool running, or swimming (flutter kick). Reviewing any changes in training prior to PFS pain as well as examining running shoes for proper biomechanical fit are critical to avoid repeating the painful cycle. Occasionally bracing with patellar centering devices are required.
Stretching and strengthening the quadriceps and hamstring muscle groups is critical for an effective and lasting rehabilitation of PFS. "Quad sets" are the foundation for such a program. Quad sets are done by contraction the thigh muscles while the legs are straight and holding the contraction for a count of ten. Sets of 10 contractions are done between 15-20 times per day.
What is the outlook with PFS?
Under optimal circumstances, the patient should have a rapid recovery and return at full functional level.
Patellofemoral Syndrome (PFS) At A Glance - The patellofemoral syndrome (PFS) is the most common cause of chronic knee pain.
- PFS has also been called "housemaid's knee", "secretary's knee" and chondromalacia patella.
- The pain of PFS is aggravated by activity or prolonged sitting with bent knees.
- Abnormal "tracking" allows the kneecap (patella) to grate over the lower end of the thigh bone (femur) causing chronic inflammation and pain.
- Treatment creates better alignment of the patella during contraction of the quadriceps (thigh) muscle.
Author: William C. Shiel Jr., MD, FACP, FACR
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