Patellofemoral Pain Syndrome Treatment

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a condition characterised by pain and discomfort at the front of the knee, particularly around the junction of the kneecap (patella) and the thigh bone (femur). This syndrome is commonly referred to as runner’s knee, as it frequently occurs in individuals who participate in activities involving running and jumping. It is prevalent among athletes, adolescents, and young adults and represents a common cause of knee pain in these groups.

PFPS serves as an umbrella term encompassing pain originating from the patellofemoral joint itself or the surrounding tissues. The syndrome is chronic and tends to exacerbate during activities like running, climbing stairs, or sitting​​ for extended periods.

Causes of Patellofemoral Pain Syndrome

Several factors contribute to the development of PFPS:

  • Overuse of the Knee Joint
    Engaging in high-impact activities like running or jumping can place repeated stress on the knee joint, leading to irritation under the kneecap.
  • Kneecap Misalignment
    This occurs when the muscles around the hip and knee do not keep the kneecap properly aligned. Misalignment can exacerbate stress on the patellofemoral joint.
  • Muscle Weakness
    Weakness in the muscles surrounding the joint can contribute to PFPS. This includes the hip and thigh muscles, which help stabilise the kneecap.
  • Structural Abnormalities
    Abnormalities in the structure of the knee, such as an abnormally aligned patella, shaped tibia, or femur, can contribute to the development of PFPS.
  • Previous Knee Injuries or Surgeries
    A history of knee injuries or surgeries, particularly those involving the patellar tendon, can increase the likelihood of developing PFPS.
  • Stress on the Knee Joint
    Using inappropriate footwear or incorrect technique during physical activities can put undue stress on the knee joint.

Symptoms and Signs

PFPS primarily manifests as a dull, aching pain located at the front of the knee. This pain typically intensifies in specific situations:


  • During Physical Activities: Activities that put strain on the knee joint, such as running, kneeling, jumping, and squatting, can aggravate the pain.
  • While Ascending or Descending Stairs: The action of walking up or down stairs can increase discomfort in the knee area.
  • During Extended Periods of Sitting: Keeping the knee in a bent position for long durations can increase the pressure on the patellofemoral joint, exacerbating the pain.

Individuals may also notice crackling or popping sounds in the knee, especially when standing up after sitting for a long time or when climbing stairs​​​​.

Diagnosis

The process of diagnosing PFPS typically involves the following steps:

  • Physical Examination: A knee specialist will conduct a comprehensive physical examination to assess the knee’s condition and identify any signs of PFPS.
  • Medical History Evaluation: The patient’s medical history, including any prior knee injuries or relevant health issues, will be reviewed for an accurate diagnosis.
  • Imaging Tests: While not always necessary, imaging tests such as X-rays or MRIs may be employed to rule out other causes of knee pain, like bone damage.

Non-Surgical Treatment Options

Management of PFPS primarily involves conservative treatment approaches aimed at alleviating pain and addressing underlying causes.

RICE Method

Initially, the knee specialist may recommend a period of rest, followed by ice, compression, and elevation to alleviate pain and reduce swelling. This helps facilitate knee healing and recovery from overuse.

Medication

Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be used to reduce pain and inflammation.

Physical Therapy

Knee specialists may also suggest physical therapy to strengthen the muscles supporting the knees. It focuses on ensuring proper alignment and movement of the knee. This can also include gait retraining for those with biomechanical issues.

Knee Bracing and Taping

Providing support and improving knee alignment through bracing or taping can be beneficial in reducing pain and aiding recovery. For patients with biomechanical issues, the knee specialist may suggest orthotics to help alleviate stress on the knee joint.

Surgical Treatment Options

Surgical intervention for PFPS is generally considered only after conservative treatments have proven ineffective. It is tailored to the patient’s specific needs and is decided on a case-by-case basis.

Knee Arthroscopy

This procedure involves using an arthroscope, a pencil-thin device with a camera lens and light, to view the knee joint. Through small incisions, tools are inserted to repair issues such as patellar malalignment or cartilage damage. If the pain is due to tight or imbalanced soft tissues, a lateral release procedure can be performed to release or lengthen these tissues, providing relief. Arthroscopy is a minimally invasive option and is often preferred for its quicker recovery time.

Open Surgery

In more severe cases, especially those involving structural issues with the knee joint, open surgery might be necessary. This approach allows for more direct access to correct problems such as misalignment of the kneecap or to relieve pressure on the cartilage. Open surgery is generally considered a more extensive procedure and is reserved for cases where other treatments have failed to provide relief.

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Prevention Strategies

Preventing PFPS involves several strategies aimed at reducing the risk of knee injury and maintaining joint health:

  • Maintain a Healthy Weight to Reduce Stress on the Knees - Reducing the stress on the knees by maintaining a healthy weight can be beneficial in preventing PFPS.
  • Prevent Injury with Proper Warm-Ups and Cool-Downs - Engaging in adequate warm-up and cool-down exercises before and after physical activity helps prepare the muscles and joints, reducing the risk of injury.
  • Gradual Increase in Exercise Levels - Gradually increase the intensity and duration of exercises to avoid overexertion of the knee joint.
  • Wear Appropriate Footwear to Avoid Stressing the Knee - Wearing proper footwear during physical activities ensures adequate support and alignment, which can help prevent knee problems.
  • Strengthen the Knee Muscles - Strengthening the muscles around the knee enhances stability and reduces the risk of PFPS. This includes focusing on the hip and thigh muscles.
  • Avoid Excessive Strain on the Knee - Limit excessive strain on the knees by avoiding overtraining.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    How Long Will It Take to Recover from Patellofemoral Pain Syndrome?

    Recovery varies based on factors including the severity of the condition, the chosen treatment approach, and the patient’s overall health. Generally, it ranges from a few weeks to several months. Consult our knee specialist for a recovery timeline based on your condition.

    What Are the Recommended Exercises for Patellofemoral Pain?

    Exercises focusing on strengthening and stabilising the muscles around the knee, especially the quadriceps and hip abductors, can be beneficial. These include straight leg raises and clamshell exercises. Reach out to our knee specialist for a tailored exercise regimen suited to your specific condition.

    What Activities Should You Avoid with Patellofemoral Pain?

    Activities that put excessive strain on the knee, such as running, squatting, and jumping, should be avoided. Movements that involve prolonged bending of the knee should also be minimised.

    How can Patellofemoral Pain be Relieved Quickly?

    Applying the RICE method, along with over-the-counter pain relievers can provide quick relief. Our knee specialist can provide guidance on long-term management strategies.

    Can I Walk with Patellofemoral Pain Syndrome?

    Those with PFPS are usually allowed to walk, but it should be done cautiously to avoid aggravating the condition. If walking causes discomfort, seek guidance from our knee specialist for prompt treatment and effective management.