| 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. |
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