Patellofemoral Syndrome - Kneecap Problems 

Introduction

Patellofemoral syndrome is pain in the knee that occurs from poorly aligned knee structures, trauma, or overuse.  It is also called runner’s knee and chondromalacia patellae.  Patellofemoral syndrome results when the cartilage behind the kneecap is overstressed or deteriorates.

Patellofemoral syndrome causes pain and loss of function.  It can be treated with rest, knee bracing, medications, and physical therapy.  In some cases surgery may be necessary to smooth damaged cartilage or realign the kneecap.

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Anatomy
The knee is one of the more complex joints in your body.  Three bones compose your knee.  The femur, your thighbone, is positioned on top of the tibia, your larger leg bone.  The patella, your kneecap, glides in a groove on the end of the femur.  Four main ligaments connect the knee bones together.  Large muscle groups in the thigh provide strength, stability, and motion. 
 
Cartilage located on the end of the bones and underneath the kneecap allows your bones to glide easily during movement.  The synovial membrane that covers the inside of your joint capsule secretes a fluid (synovial fluid) to lubricate the knee joint and nourish the cartilage.  The cartilage and synovial fluid act as a shock absorber when you walk or run. 

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Causes
Patellofemoral syndrome occurs when the cartilage underneath the kneecap softens and degenerates.  This may occur because of overuse, abnormally aligned knee structures, or trauma.  Sports, such as skiing, cycling, running, and soccer, is associated with patellofemoral syndrome.  Arthritic changes in the kneecap can occur from chronic patellofemoral syndrome.

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Symptoms
Patellofemoral syndrome can cause dull knee pain, swelling, and tenderness.  Your pain may increase after you have been seated for a long period of time or during certain activities, such as using stairs, kneeling, squatting, or getting out of a chair.  You may notice that your knee grinds when you straighten it.

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Diagnosis
Your doctor can diagnose patellofemoral syndrome by reviewing your medical history and examining your knee and entire leg.  X-rays will be taken to check knee alignment and to evaluate for arthritic changes.  In some cases, additional imaging tests may be ordered.  CAT and MRI scans are often uses to evaluate the tracking of the patella and to better see the cartilage surfaces.

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Surgery
Surgery may be necessary to correct knee malalignments.  Realignment surgery is used to correct the position of the kneecap.  Arthroscopic surgery can be used to realign the patella in some cases, and to remove damaged cartilage. 
 
With arthroscopic technology, your surgeon will not need to open your joint.  Arthroscopic surgery uses an arthroscope and narrow surgical instruments that are inserted through small incisions.  An arthroscope contains a lens and lighting system that allow a surgeon to view inside of a joint.  The arthroscope is attached to a miniature camera.  The camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape.  Arthroscopic surgery is associated with shorter recovery times and less pain and bleeding than open procedures.
 
Sometimes the kneecap malalignment is not treatable arthroscopically, and in such cases there are open surgical techniques that are indicated.  Your doctor will discuss which type of surgery is best for your particular problem.

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Treatment
The goal of treatment is to relieve pain while restoring motion and function of the knee.  This may be achieved in several ways.  You should rest and avoid strenuous activities until your pain resolves.  Your doctor may recommend ice packs or non-steroidal anti-inflammatory medications to relieve pain and swelling. 
 
Some people may not require surgery but will be referred to a physical therapist for rehabilitation.  You may need to wear a knee brace or custom-made shoe inserts for support during activities.  Your physical therapist will teach you exercises to strengthen the muscles around your knee and to improve your flexibility.  As you get stronger, you may advance to exercising on gym equipment, such as a treadmill or stationary bike.  Eventually, your physical therapist will provide you with a home exercise program.
 
If you require surgery, you will participate in physical therapy immediately after your surgery.  It is important to move and exercise the knee to improve circulation, reduce swelling, increase flexibility, and increase strength.  Your physical therapist will initially teach you exercises to do in bed and while sitting on the edge of the bed.  Your physical therapist will help you stand and walk.  You may need to use crutches or a walker to help maintain your balance at first.  It is very important to get up and moving.
 
As you heal, your physical therapist will upgrade your exercise program to help you continue to increase your strength, balance, flexibility, and endurance.  You may advance to using gym exercise equipment, such as a treadmill or stationary bike.  When your incisions heal, you may perform physical therapy exercises in a heated therapeutic pool.  The heat may help to relieve pain and stiffness, while the water provides you with support while exercising your joints.  Eventually, you physical therapist will provide you with a home exercise program.

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Recovery
Recovery from patellofemoral syndrome is individualized and depends on many factors, including the cause and the treatment method you receive.  Your doctor will let you know what to expect.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.