Patello-Femoral Syndrome

What is the patello-femoral syndrome?

Patello-Femoral Syndrome is the most common cause of chronic knee pain. patello-femoral syndrome results from poor alignment of the kneecap (patella) as it slides over the lower end of the thigh bone (femur). patello-femoral syndrome is also informally called "housemaid's knee" or "secretary's knee."

What are the symptoms of patello-femoral syndrome?

The symptoms of patello-femoral syndrome 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 patello-femoral syndrome?

The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with patello-femoral syndrome 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 patello-femoral syndrome: females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface.

How is patello-femoral syndrome treated?

The primary goal for treatment and rehabilitation of patello-femoral syndrome 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 patello-femoral syndrome pain, as well as examining running shoes for proper biomechanical fit are critical to avoid repeating the painful cycle. Generally, full squat exercises with weights are avoided. 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 patello-femoral syndrome. "Quad sets" are the foundation of 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 patello-femoral syndrome?

Under optimal circumstances, the patient should have a rapid recovery and return at full functional level.