Patellofemoral Syndrome

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Anterior knee pain has been variously termed patellofemo-ral syndrome and chondromalacia patellae. When treating anterior knee pain, the physician should identify the specific pathology to initiate targeted treatment. Chondromala-cia patellae, or degenerative changes on the undersurface of the patella, is more common in young females. Pain complaints related to chondromalacia are exacerbated by sitting for an extended period with a flexed knee, doing deep squats, or going up and down stairs. Each of these activities increases the posteriorly directly forces of the patella, directing increased pressure onto the chondral surfaces.

Treatment of these early arthritic changes is typically rehabilitation. Surgical intervention, such as cartilage scraping and debridement, has not been shown to provide long-term relief or benefit. In rare patients who have associated tight lateral retinacular structures and patellar tilt, surgical release of the lateral retinaculum can provide benefit. Conservative treatment of patellofemoral syndrome includes cushioned shoes, rehabilitation focused on the vastus medialis obliquus muscle, reductive taping techniques, hamstring stretches, and NSAIDs. Correction of the foot alignment with orthotic devices is also a treatment option, but supportive evidence is limited. From

Lateral epicondyle

Lateral femoral condyle Intercondylar notch Iliotibial tract

Gerdy's tubercle

Plantaris Gastrocnemius, lateral head

Fibular collateral ligament

Popliteus

Fibular collateral ligament Biceps femoris

Trochlear groove

Adductor tubercle Medial epicondyle

Medial femoral condyle Intercondylar eminence Anterior cruciate ligament Tibial tubercle Patellar tendon

Adductor magnus

Patellar tendon

Sartorius Gracilis

Semitendinosus

Fibular collateral ligament Biceps femoris

Iliotibial band

Patellar tendon

Gastrocnemius, medial head

Iliotibial band

Patellar tendon

Semimembranosus Popliteus

Patellar tendon

Adductor magnus

Semitendinosus

Gastrocnemius, medial head

Gastrocnemius, medial head

Deep medial ligament

Semimembranosus

Superficial medial ligament

Plantaris

Gastrocnemius, lateral head

Soleus

Gastrocnemius, medial head

Deep medial ligament

Semimembranosus

Superficial medial ligament

Plantaris

Gastrocnemius, lateral head

Fibular collateral ligament

Anterior cruciate ligament

Posterior cruciate ligament

Soleus

Figure 30-26 Line drawing shows anatomic sites of bursae around the knee.

70% to 80% of patients will improve with this conservative treatment. Unfortunately, the remaining patients with resistant symptoms can have a frustrating long-term therapeutic course, with guarded prognosis for any surgical intervention. Ultrasound therapy had no clinically important effect on patients with patellofemoral pain syndrome (Brosseau et al., 2001).

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