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Patellofemoral Pain Syndrome

more about Patellofemoral Pain Syndrome


Housemaid's knee or Chondromalacia patellae



  • Patellofemoral pain syndrome is a term used to describe the pain behind or around the kneecap (patella) resulting from the problems of the patellofemoral joint.  Patellofemoral syndrome is one of the common causes of knee pain.

  • Pain under and around the kneecap
  • Pain can be bilateral or unilateral
  • Pain is aggravated by a prolonged sitting, squatting, kneeling, running, jumping, climbing or walking down stairs.

  • The exact cause is unknown, but many factors may contribute to the development of patellafemoral pain syndrome.  The large group of thigh muscles (quadriceps muscles) attach to the kneecap (patella), allowing it to straighten, thus controlling the movement of patella.  With bending and straightening of the knee, the kneecap glides through the groove in the thighbone (femur), increasing the force of the quadriceps muscles.
  • Overuse and overload -- repeated bending of the knee or other weight bearing activity may increase the pressure between the patella and femur, irritating the undersurface of the patella (articular cartilage), leading to a degeneration of the cartilage, which can cause great pain.  Cartilage degeneration is also referred to as chondromalacia patellae.
  • Sports activities such as running, jumping, swimming and bicycling may increase the risk of patellofemoral pain syndrome, especially in the individuals who have a muscle imbalance or alignment problems of the lower limbs.
  • Alignment problems -- if the alignment of bones in the lower leg is abnormal, it may also cause the abnormal gliding of the patella within the femoral groove when the knee moves.  These include the increased angle between the thighbone (femur) and shinbone (tibia), flat feet, and knock-knees.
  • Abnormal alignment causes the tracking of the patella towards the outside of the femoral groove, leading to the overloading of articulation and damage to the cartilage underneath the patella.
  • Muscle imbalance results from a tightness or weakness of the thigh muscles, which can also cause the abnormal gliding of the patella, leading to eventual inflammation and pain.

  • Pain control -- rest, anti-inflammatory drugs (for example, ibuprofen, aspirin, etc.), and ice packs for acute pain control.
  • Modification of activity levels -- patients should avoid the motions that irritate or overload the kneecap.
  • Non-impact aerobic exercises, such as swimming, do not make the pain worse, and keeps the fitness level high.  If the patients return to the activities before the healing is completed, it may lead to a persistent pain and permanent damage to the kneecap.
  • Stretching exercise of tight muscles (quadriceps, iliotibial band and hamstring)
  • Evaluation of footwear and change of shoes with high quality
  • Arch supports or orthotics may improve lower extremity biomechanics by preventing excessive pronation of the foot.
  • Surgery for chondromalacia or lateral tracking of the patella-surgery can be considered if other treatments do not work.

  • The prognosis is good for the majority of patients.  Most patients recover with relative rest, strengthening and stretching exercises.




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