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JAMA Patient Page
January 23/30, 2018

Patellofemoral Pain

JAMA. 2018;319(4):418. doi:10.1001/jama.2017.19690

Patellofemoral pain is an injury of the knee involving pain at or around the patella (kneecap).

Patellofemoral pain is one of the most common knee problems in runners and other athletes and after injury or surgery around the knee. Most people with patellofemoral pain describe a pain around or under the kneecap that is worse with squatting, running, prolonged sitting, going up or down stairs, or any other activity involving repeated bending of the knee.

The term patellofemoral pain specifically refers to pain that is not caused by a structural problem with the tendons, ligaments, or cartilage around the knee.

Causes of Patellofemoral Pain

The patella sits on top of the femur and tracks and glides over the knee in various directions as different muscles pull on it. Patellofemoral pain is believed to occur when there is a problem with how the patella tracks over the knee, also known as maltracking of the patella. Maltracking can lead to abnormal contact pressures and mechanics between various parts of the knee. Maltracking can be caused by external factors or internal factors. External factors include overuse, errors in training (for example, too much too soon), or improper shoes. Internal factors include imbalances in the strength of the muscles around the knee as well as the hip, an overly mobile kneecap, or a tight iliotibial band (a band of tissue that runs along the outside of the thigh from the hip to the knee). Most often, patellofemoral pain arises from a combination of these factors.

Diagnosis

Patellofemoral pain is a clinical diagnosis. This means that imaging tests of the knee, such as x-ray or magnetic resonance imaging (MRI), are not needed to make the diagnosis. In fact, x-ray and MRI typically have normal findings in cases of patellofemoral pain. There is no one key finding on clinical examination to diagnose patellofemoral pain. Imaging tests are useful only for ruling out other causes of knee pain.

Treatment

Treatment of patellofemoral pain includes rest, activity modification, and addressing any correctable underlying causes (improper shoes, errors in training). It is recommended to avoid any activity that triggers or worsens the pain. Physical therapy is also a mainstay of treatment. Pain medications such as nonsteroidal anti-inflammatory drugs or acetaminophen can be taken as needed but are not recommended for long-term use. There are no clear data to support the routine use of knee braces, although they have been shown to help with symptoms for some patients. Because patellofemoral pain is a problem with pain and function rather than a structural problem, there are no long-term consequences for the knee joint (such as arthritis).

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Dixit et al. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;75(2):194-202.

Topic: Sports Medicine

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