eMedicine Specialties > Sports Medicine > Knee

Patellofemoral Joint Syndromes: Follow-up

Author: Jane T Servi, MD, Consulting Staff, Northern Colorado Orthopedic Associates
Contributor Information and Disclosures

Updated: Jul 15, 2009

Follow-up

Return to Play

Return to play or previous activity may be resumed when 80% of the strength of the uninjured knee (as measured by isokinetic testing) has been reached in the affected knee. If there has not been a significant loss of strength, the athlete may continue to play as symptoms allow. For those with loss of strength, continued play predisposes to injury secondary to guarding by the athlete.

Prevention

Prevention consists of correcting biomechanical imbalances. The patient should wear arch supports or orthotics for pes cavus or pronation of the foot. Promote flexibility, strengthening, and proprioceptive programs (particularly for the VMO).

Other preventative measures may be sport specific, depending upon the equipment being utilized. For example, with cycling, the seat height should be properly adjusted. For cyclists with femoral anteversion or tibial torsion, floating clips or shims on the pedals may prevent patellofemoral syndromes. For runners, proper shoe maintenance can prevent problems.

Moderation of frequency or intensity of activity can also prevent problems. When a new activity is initiated, it should be done in a slow, progressive manner. Intensity levels should not change drastically over relatively short time periods. Runners, in particular, often follow a 10% rule, in which distance or time is increased by 10% on weekly intervals.

Prognosis

Empiric treatment is successful in 80% of cases of patellofemoral joint syndrome. The treatment goal is to control the symptoms (ie, decrease the pain).

Education

Education consists of the clinician being able to describe the condition anatomically and biomechanically to the patient. Because the problem is primarily one of pain, educate athletes about flexibility, strengthening, and proprioceptive programs, as well as the importance of using the proper equipment.

Miscellaneous

Medicolegal Pitfalls

  • The only medicolegal pitfall is misdiagnosis of the condition.

Special Concerns

  • A special consideration in young patients is that knee pain can be referred from the hip. Those patients who fail to respond to treatment warrant radiography of the hip to rule out Legg-Calvé-Perthes disease or slipped capital femoral epiphysis.
  • Additionally, pain and tenderness to palpation at the inferior pole of the patella may indicate apophysitis (Sinding-Larsen-Johansson disease).

Related eMedicine topics:
Legg-Calve-Perthes Disease
Slipped Capital Femoral Epiphysis

 


More on Patellofemoral Joint Syndromes

Overview: Patellofemoral Joint Syndromes
Differential Diagnoses & Workup: Patellofemoral Joint Syndromes
Treatment & Medication: Patellofemoral Joint Syndromes
Follow-up: Patellofemoral Joint Syndromes
References
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References

  1. Wieting JM, McKeag DB. Anterior knee pain and overuse. In: Sallis RE, Massimino F, eds. ACSM's Essentials of Sports Medicine. St. Louis, Mo: Mosby-Year Book; 1997:421-32.

  2. Scuderi GR, ed. The Patella. New York, NY: Springer-Verlag; 1995:xii-351.

  3. Wertheimer C. Patellofemoral mechanics as a cause of anterior knee pain. Your Patient and Fitness. 1995;9:19-23.

  4. Eilert RE. Adolescent anterior knee pain. Pediatric Orthopedics. Philadelphia, Pa: Lippincott-Raven; 1991:499-515.

  5. Ruffin MT 5th, Kiningham RB. Anterior knee pain: the challenge of patellofemoral syndrome. Am Fam Physician. Jan 1993;47(1):185-94. [Medline].

  6. Pizzutillo PD. Osteochondroses. In: Sullivan JA, Grana WA, eds. The Pediatric Athlete. Park Ridge, Ill: American Academy of Orthopaedic Surgeons; 1990:224.

  7. Walsh WM. Knee injuries. In: Mellion MB, Walsh WM, Shelton GL, eds. The Team Physician's Handbook. Philadelphia, Pa: Hanley & Belfus; 1990:414-39.

  8. Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Man Ther. Feb 28 2008;epub ahead of print. [Medline].

  9. Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. Jan 15 2007;75(2):194-202. [Medline].

  10. Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. Clin J Sport Med. Nov 2002;12(6):339-47. [Medline].

  11. [Best Evidence] Syme G, Rowe P, Martin D, Daly G. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. Man Ther. Jun 2009;14(3):252-63. [Medline].

  12. Earl JE, Vetter CS. Patellofemoral pain. Phys Med Rehabil Clin N Am. Aug 2007;18(3):439-58, viii. [Medline].

  13. LaBotz M. Patellofemoral syndrome: diagnostic pointers and individualized treatment. Phys Sportsmed. July 2004;32(7):22-9. [Full Text].

  14. Weil EK. Pain and pyrexia. Residents' Edition Prescribing Reference. 5th ed. New York, NY: Prescribing Reference, Inc; 1996:164-8.

  15. Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev. Feb 1998;3(1):27-39. [Medline]. [Full Text].

  16. Freeman AJ, Jacobson NA, Fogg QA. Anatomical variations of the plantaris muscle and a potential role in patellofemoral pain syndrome. Clin Anat. Mar 2008;21(2):178-81. [Medline].

  17. Liebensteiner MC, Szubski C, Raschner C, et al. Frontal plane leg alignment and muscular activity during maximum eccentric contractions in individuals with and without patellofemoral pain syndrome. Knee. Feb 21 2008;epub ahead of print. [Medline].

  18. Vicenzino B, Collins N, Crossley K, et al. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC Musculoskelet Disord. Feb 27 2008;9(1):27. [Medline]. [Full Text].

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Further Reading

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Keywords

anterior knee pain, chondromalacia patella, patellalgia, patellar compression syndrome, patellofemoral dysfunction, patellofemoral pain syndrome, PFPS, peripatellar knee pain, retropatellar knee pain, global or generalized knee pain, joint line pain, posterior knee pain, patellar maltracking syndrome, miserable malalignment syndrome

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Contributor Information and Disclosures

Author

Jane T Servi, MD, Consulting Staff, Northern Colorado Orthopedic Associates
Jane T Servi, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Ferring Pharmaceuticals Honoraria Speaking and teaching

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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