Patellofemoral Syndrome (Runner’s Knee)

Introduction

Patellofemoral Syndrome comes from poorly aligned knee joints, trauma, or overuse and can cause an abundance of pain in the knee. Patellofemoral Syndrome is more commonly known as Runner’s Knee or Chondromalacia Patellae. Runner’s Knee can cause pain and loss of function, if not treated properly. Once you have been diagnosed with Runner’s Knee, however, it can be treated with rest, knee bracing, medications, and physical therapy. In certain situations, surgery may be necessary.

Knee Anatomy

Bones in the Knee

The knee is one of the more structurally complex areas of the body. The knee is composed of three bones:

  • Tibia, or shinbone
  • Femur, or thighbone, sits on top of the tibia, the larger leg bone.
  • Patella, or kneecap, glides in a groove on the end of the femur.

Muscles in the Thigh

Large muscle groupings in the thigh give the knee its strength and stability:

  • The quadriceps muscles-group of muscles on the front of the thigh that straighten and rotate the leg.
  • The hamstring muscles- located on the back of the thigh and bend or flex the knee.

Ligaments Surrounding the Knee

Ligaments are strong tissues that provide stability and allow the leg to move. They also enable flexibility while maintaining balance. Four ligaments connect our knee bones together:

  • The medial collateral is located on the inside of the knee, and the lateral collateral is at the outer side of the knee. These two ligaments help the joint to resist side to side stress.
  • The anterior cruciate ligament and the posterior cruciate ligament cross each other inside of the knee joint. These ligaments help to keep the joint aligned. They also counteract forward and backward forces and keep the bones in place. They also control rotation of the tibia.

Cartilage, Synovium, and Nerve Fibers

Two cartilage disks, Menisci, are located on the end of the tibia. This cartilage forms a smooth surface, allowing the bones to glide easily during motion. The menisci act as shock absorbers when we walk or run.

A smooth tissue capsule covers the bones in our knee, and a thin synovial membrane lines this capsule. The synovium secretes a liquid known as synovial fluid. The synovial fluid acts as a cushion and lubricant between the joints, which allows the knee to move painlessly. Proprioceptive nerve fibers are inside in the ligaments and joint capsules, sending signals throughout the body.

Patellofemoral Syndrome Causes

Over time or due to trauma, the cartilage underneath you kneecap begins to soften and degenerates. Degeneration occurs because of overuse, abnormally aligned knee structures, or trauma. Many sports are associated with Patellofemoral syndrome. Patellofemoral syndrome can cause arthritic changes.

Patellofemoral Syndrome Symptoms

Common symptoms of Patellofemoral syndrome include dull knee pain, swelling, and tenderness. After long periods of inactivity, the pain in the knee may increase. Your pain may increase after you have been seated for a long period of time. You may also notice an increase in pain during certain activities, such as using stairs, kneeling, or squatting. Patients often complain that their knee “grinds” when they straighten it.

Patellofemoral Syndrome Diagnosis

Your doctor will more than likely order an X-ray to check knee alignment and evaluate arthritic changes.  In some cases, your doctor may order a CAT scan or MRI to evaluate the tracking of the patella or to better see the cartilage surfaces.

Patellofemoral Syndrome Treatment

With Patellofemoral Syndrome treatments, the ultimate goal is to relieve pain. Another goal is to  restore motion and function of the knee. Your doctor has a variety of options in order to achieve these goals. You need to rest and avoid harsh activities until your knee heals. Most doctors tell their patients to use the RICE (rest, ice, compression, elevation) to help these times of tears. The doctor may also recommend physical therapy as it can help strengthen the muscles that move the knee joint.  Your doctor may recommend a knee brace for sports or custom shoe inserts to support the arch of the foot.

Patellofemoral Syndrome Surgery

Your doctor may recommend surgery if your knee has a malalignment. This surgery corrects the position of the kneecap. In most cases, your doctor will recommend arthroscopic surgery, as it can be used to realign the patella in some cases, and to remove damaged cartilage.

The majority of medical professionals prefer Arthroscopic surgery because it is less invasive. It’s also associated with a lot less pain, swelling, infection, and bleeding. This type of surgery also has a faster recovery time than open surgery.

However, in some cases, the kneecap cannot be realigned via arthroscopic surgery. Your doctor will come up with a game plan and discuss which type of surgery is best for your knee.

Patellofemoral Syndrome Recovery

Like most accidents and surgeries, the recovery from Patellofemoral Syndrome varies depending on the individual and on a variety of factors, including the cause and the treatment method you receive. Your doctor will let you know what to expect.

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