eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Patellofemoral Syndrome: Follow-up

Author: Patrick J Potter, BSc, MD, FRCP(C), Associate Professor, Physical Medicine and Rehabilitation, The University of Western Ontario; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre
Coauthor(s): Keith AJ Sequeira, MD, Associate Director of Spinal Cord Medicine, Assistant Professor, Department of Physical Medicine and Rehabilitation, Parkwood Hospital, University of Western Ontario
Contributor Information and Disclosures

Updated: Jul 15, 2009

Follow-up

Further Inpatient Care

  • The standard procedure for treatment of individuals with patellofemoral syndrome is performed on an outpatient basis. Inpatient care generally is not indicated.

Further Outpatient Care

  • Allow time for conservative measures (eg, exercise) to have a therapeutic effect in patients with patellofemoral syndrome. A period of 4-6 weeks usually is adequate for some resolution of symptoms. Longer delays before follow-up often result in reduced compliance with treatment recommendations. Reinforcement of treatment goals and strategies is important.

Inpatient & Outpatient Medications

  • Outpatient medications for individuals with patellofemoral syndrome include common analgesics or NSAIDs (see Medication). Most individuals manage without medication once initial symptoms have been controlled.

Deterrence

  • Prevention of patellofemoral syndrome (PFS) is accomplished by following exercise recommendations and making changes in activity, as described in previous sections. In female athletes, decreased hamstring-to-quadriceps strength ratios have been associated with an increased prevalence of overuse injuries, suggesting that maintaining adequate hamstring strength may act as a preventative strategy. Braces have been tried on asymptomatic subjects undergoing rigorous basic military training, with a subsequent decrease in the incidence of PFS compared with the subject population that did not use the braces.

Complications

  • Complications in patients with patellofemoral syndrome may result secondary to the effects of NSAID use. Occasional dermatologic reactions occur due to the brace material. Prescribed exercises rarely result in aggravation of symptoms. If a specific activity is determined to be associated with aggravation of symptoms, then accordingly modify the frequency, duration, and intensity of the activity

Prognosis

  • The prognosis for full functional recovery in cases of patellofemoral syndrome is very good. In general, this syndrome is successfully treated with conservative measures. Because the prognosis is so good, refractory cases should be closely reviewed with regard to compliance and understanding of treatment recommendations.

Patient Education

  • Educate the patient so that he/she understands which activities aggravate patellofemoral syndrome. In addition, emphasize the need for extended adherence to the exercise regimen. The patient's physical therapist should educate the patient about a home exercise program, making sure the patient has a good understanding of the exercises.
  • For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center, Arthritis Center, and Osteoporosis and Bone Health Center. Also, see eMedicine's patient education article Knee Pain.

Miscellaneous

Medicolegal Pitfalls

  • The most common medical/legal aspects related to patellofemoral syndrome are defining the nature of the syndrome, its effect on usual activities, and the prognosis in cases in which onset has occurred as a result of trauma (eg, a work-related injury, an automobile-related injury). More specifically, cases in which a direct blow has resulted in an impairment of the cartilage surface may not respond in the same manner as tracking problems. Contusion secondary to dashboard contact, termed dashboard knee, remains a common cause of ongoing knee pain after trauma resulting from a motor vehicle accident.

Special Concerns

  • The primary significant concern associated with patellofemoral syndrome is that the patient remain active and continue to interact with peers. This goal can be accomplished by making sure the affected youth understands the aggravating and alleviating factors associated with participation in sports and other physical activities. If some athletic activities must be curtailed, ideally there should be an attempt to engage the patient in alternative activities to maintain conditioning (eg, swimming). Long-term goals should include resumption of the patient's preferred activities when this is feasible.
 


More on Patellofemoral Syndrome

Overview: Patellofemoral Syndrome
Differential Diagnoses & Workup: Patellofemoral Syndrome
Treatment & Medication: Patellofemoral Syndrome
Follow-up: Patellofemoral Syndrome
References
Further Reading
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References

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  4. Naslund JE, Odenbring S, Naslund UB, et al. Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome. Br J Sports Med. Mar 2005;39(3):162-5. [Medline]. [Full Text].

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Keywords

patellofemoral syndrome, knee pain, patella, patellofemoral, knee cartilage, patellofemoral pain syndrome, pain behind knee, patellofemoral joint, kneecap pain, patella femoral, patella pain, patella femoral syndrome, PFPS, anterior knee pain, chondromalacia patella

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Contributor Information and Disclosures

Author

Patrick J Potter, BSc, MD, FRCP(C), Associate Professor, Physical Medicine and Rehabilitation, The University of Western Ontario; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre
Patrick J Potter, BSc, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Keith AJ Sequeira, MD, Associate Director of Spinal Cord Medicine, Assistant Professor, Department of Physical Medicine and Rehabilitation, Parkwood Hospital, University of Western Ontario
Disclosure: Nothing to disclose.

Medical Editor

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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