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.
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.
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
Chronic patellofemoral overload and maltracking may predispose to chondromalacia patella
Surgical overcorrection may contribute to maltracking in the opposite direction. For example, overcompensated lateral retinacular release may cause the patella to maltrack medially.
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.
A randomized, controlled trial suggested that gender and the duration of symptom complaints are predictive of which patients with PFS will respond to exercise therapy. The study, which included 131 patients who were randomized to receive exercise therapy or usual care, found that among patients in the exercise group, females and patients who had complained of symptoms for more than 6 months were more likely to report having achieved functional improvement beyond that of the usual-care patients at 3-month follow-up. [26]
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.
