This document discusses patellofemoral pain syndrome (PFPS). PFPS is characterized by anterior knee pain that is most common in young, active populations. It is typically caused by an imbalance of forces across the patellofemoral joint from issues like increased Q-angle, foot overpronation, and weakness of the vastus medialis obliquus muscle. Symptoms include pain around or behind the kneecap that is aggravated by activities involving knee bending like squatting or going up and down stairs. Treatment focuses on reducing pain/inflammation, addressing contributing biomechanical factors, and strengthening exercises for the quadriceps muscles.

1. Patellofemoral Pain Syndrome
2016년 5월 11일
재활의학과
김 종 규

2. Peripatellar pain
• Common causes
• Patellar dislocation or subluxation
• Patellar tendinitis
• Osgood-Schlatter’s disease
• Sinding-Larsen-Johansson disease
• ITB friction syndrome
• Bursitis
• Osteoarthritis
• Patellar fracture
• Quadriceps strain
• Gaut
• Etc.
2016-05-11
2

3. Anterior Knee Pain
• Patellofemoral pain syndrome
• Patellofemoral joint syndrome
• Jumper’s knee
• Chondromalacia patellae
• Peripatellar synovitis
2016-05-11
3

4. Patellofemoral Pain Syndrome
• Anterior knee pain
• Most common cause in young population
• Young female atheletes
• Gradual onset
• Aggravated at
• Squat
• Stair up/down
• Sit to stand
• Knee flexion
2016-05-11
4

5. PFPS
• Sympoms
• Feeling of instability
• Localized pain
• Crepitus
• Edema
• Feeling of muscle weakness
• Cannot squat
• Cannot stair up/down
2016-05-11
5

6. PFPS
• Pain sources
• Peripatellar synovitis without obvious cartilage damage
• Soft tissues such as lateral retinaculum
• Infrapatellar fat pad
• Self limited conditions
• No disability
• Benign neglect
2016-05-11
6

7. Pathophysiology
• Increased tension of patella to lateral side due to
• Overpronation of foot
• Increased Q-angle
• VMO weakness
• Muscle power imbalance
2016-05-11
7

8. 2016-05-11
8

9. Q-angle
2016-05-11
9

10. Q-angle
2016-05-11
10

11. VMO weakness
2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
11

12. 2016-05-11
12

13. 2016-05-11
1. Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following
a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syndrome. JCLB. Elsevier
B.V; 2012 Jul 1;27(6):525–31.
13

14. 2016-05-11
1. Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following
a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syndrome. JCLB. Elsevier
B.V; 2012 Jul 1;27(6):525–31.
14

15. Physical Exam
• Palpation
• Localized edema/tenderness
• Patellar glide test
• Lateral glide, more than 50%
• Patellar tilt test
• Lateral tilt, less than 0 degree
2016-05-11
15

16. 2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
16

17. Treatment
• Reduction pain & inflammation
• Ice, NSAIDs, ultrasound, ultrasound, mobilization
• Address extrinsic contributing factors
• Reduce excessive load to patellofemoral joint
• Address intrinsic contributing factors
• Remote factors: hip muscle retraining, flexibility, foot orthoses
• Local factors: patellar taping, bracing, Q-ceps strengthening
2016-05-11
17

18. Orthoses
• Reduction of foot over-pronation
• Reduction of Q-angle
• Insoles/foot orthoses
• Limited evidences
2016-05-11
18

19. Patellar Taping
2016-05-11
19

20. McConnel Taping
2016-05-11 Modified from http://youtube.com/watch?v=jBRdsK3zRyk
20

21. Patellar Brace
2016-05-11
21

22. Physical Therapy
• Ultrasound
• Laser
• Mobilization
• Manual Therapy
2016-05-11
22

23. Exercise
• Quadriceps Exercise
• Mobilization
• VMO retraining
• Biofeedback
2016-05-11
23

24. VMO Retraining
2016-05-11 Modified from https://www.youtube.com/watch?v=S5BDi8Oj5eM
24

25. Squat vs Leg extension
2016-05-11
Modified from https://www.youtube.com/watch?v=UXJrBgI2RxA and
https://www.youtube.com/watch?v=cfBsnDoQhEk
25

26. Sumo-Squat
2016-05-11 Modified from https://www.youtube.com/watch?v=9ZuXKqRbT9k
26

27. Pharmacological Treatment
• Intra-articular glycosaminoglycan
• NSAIDs, Aspirin
• Corticosteroid
• Botulinum Toxin?
• Surgery – arthroscopic lateral release
2016-05-11
27

28. Cochrane Review (2008)
2016-05-11
Heintjes EM, Berger M, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral
pain syndrome. 2008
28

29. 2016-05-11
29

30. 2016-05-11
30

31. 2016-05-11
31

32. 2016-05-11
32

33. Botulinum Toxin
2016-05-11
1. PG2166. Botulinum Toxin Type A for Nonsurgical Lateral Release in Patellofemoral Pain Syndrome:
A Case Study. 2011 May 19;:1–3.
33

34. 2016-05-11
34

35. Surgery
2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
35

36. Questions
2016-05-11
36
Patellofemoral Pain Syndrome
Chondromalacia Patellae
Patellofemoral OA
?
?

37. 2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
37

38. 2016-05-11
38

39. 2016-05-11
1. Väätäinen U, Lohmander LS, Thonar E, Hongisto T, Ågren U, Rönkkö S, et al. Markers of cartilage
and synovial metabolism in joint fluid and serum of patients with chondromalacia of the patella. Osteoarthritis and
Cartilage. 1998 Mar;6(2):115–24.
39

40. 2016-05-11
40

41. 2016-05-11
1. Naslund JE, Odenbring S, Näslund U-B, Lundeberg T. Diffusely increased bone scintigraphic uptake
in patellofemoral pain syndrome. British Journal of Sports Medicine. BMJ Publishing Group Ltd and British
Association of Sport and Exercise Medicine; 2005 Mar;39(3):162–5.
41

42. Take Home!
• Patellofemoral Pain Syndrome
• Common cause of anterior knee pain
• Biomechanical problems of patella
• Exercise – VMO retraining
• Only Naproxen (VIMOVO) has evidence
2016-05-11
42

43. 감사합니다.
43
2016-05-11