patello-femoral anterior knee pain

see also:

• knee pain
• http://www.physioworks.com.au/injuries-conditions-1/patellofemoral-kneecap-pain-syndrome

• anterior knee pain is the most common type of knee pains referred to orthopaedic clinics
• most cases are due to mechanical-induced pain within the patello-femoral joint due to overuse or overload, particularly if one embarks on a new activity that involves flexed knees such as walking or running up or down stairs, or, squatting, which, due to the bioechanics of 9x body weight pressure passing into the joint when flexed at 90deg in standing position, can result in pain or damage to the cartilage (chondromalacia patellae), or even osteoarthritis

• patello-femoral pain syndrome (PFPS) or chondromalacia patellae
• Osgood-Schlatter disease
• Bipartite patella
• Patellar misalignment
• Hypermobility syndromes
• Patellar tendinopathy (jumper's knee) / Sinding-Larsen Johannsson disease
• bursitis:
  • Prepatellar bursitis (housemaid's knee)
  • Deep infrapatellar bursitis (parson's knee) - distal to patella and deep to patellar tendon
  • Anserine bursitis (medial pain)
• Patellofemoral osteoarthritis (PFOA)
• traumatic causes:
  • ligamentous strains
  • meniscal tear
  • ACL tear
• septic arthritis
• rarely, tumour
• other causes of arthritis (eg. rheumatoid arthritis)
• referred pain from hip or spine:
  • slipped femoral epiphysis
  • Perthe's disease
  • sciatica
  • etc.

• onset is usual gradual but may initially only occur in high PF stress events such as walking up stairs

• pes planus
• pes cavus
• wide Q angle
• muscular imbalances, tightness or weakness:
  • weak quadriceps
  • tight iliotibial bands
  • tight hamstring muscles
  • weakness or tightness of the hip muscles
  • tight calf muscles

• initial rest +/- ice or non-steroidal anti-inflammatory drugs (NSAIDs) +/- taping of knee
• restore full range of motion
• restore muscle length
  • hamstring/calf/iliotibial band stretches
• restore quadriceps muscle imbalance avoiding exercises that increase PFJ stresses such as flexed knee
• normalise foot and hip biomechanics
  • may require new runners (old runners may make it worse) or orthotics
• normalise movement patterns
  • avoid bad habits - abnormal gaits, jumping, squatting, hyperflexion of knee when sitting
• restore power and agility
• potentially return to sport
  • runners should consider bare foot running which appears to reduce PFJ stress by 12% in mathematical models ¹⁾