What is it ?
Patellofemoral syndrome, also called anterior knee pain, may come from an intra-articular problem (patellar chondropathy, plicae anteromedialis, fat-pad inflammation) or from a functional disorder due to muscular dysbalance.
Patella pathology
Patellofemoral syndrom
Clinical presentation
Anterior knee pain is triggered by going up and down stairs, and increases after sitting for long periods.
When to consult a specialist?
In case of joint locking or knee buckling, and in case of pain that lasts more than 3 months.
Non surgical treatment
Indicated if there is no intra-articular problem and if the pain is due to muscular dysbalance. Physiotherapy and a home training programme will help to stretch the posterior muscular chains in order to reduce the femoropatellar constraints, strengthen the gluteus medius muscle and thus avoid valgus collapse which disrupts the patella’s working axis. Proprioception helps to get a dynamic stabilisation of the patella. Intra-articular infiltration of hyaluronic acid to “lubricate” the femoropatellar joint may help too.
Surgical treatment
Rarely indicated, except in the case of patellar chondral lesions (seen on MRI), which would cause pain resistant to conservative treatment or which would cause joint lockings: depending on the cartilage lesion, an arthroscopy to proceed to chondroplasty or microfractures can be performed, and very rarely an osteochondral graft is necessary and will then be performed by arthrotomy. An hypertrophic plicae anteromedialis (rare) may require an arthroscopic resection.
Postoperative follow-up
The duration of walking with crutches will depend on the procedure performed (e.g. 1 week for a plicae anteromedalis resection, 6 weeks for a chondroplasty); physiotherapy and cycling (cycling) movements are always necessary.
Risks and complications
The most relevant risk is the persistence of pain after surgery, because patients with patellar pain often have a “memory” of the pain which may persist even if the structural problem has been treated by surgery; in case of plicae resection an intra-articular haematoma (haemarthrosis) may occur; in case of chondroplasty, microfractures or osteochondral grafting the main risk is the non-healing of the lesion and this risk is significant in smokers.