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PATELLOFEMORAL PAIN SYNDROME TREATMENT

Other common causes of knee pain are knee sprain, arthritis, torn meniscus, or ruptured anterior cruciate ligament. A knee sprain is a painful injury resulting from the application of excessive force to your knee without structural damage; fortunately, you can expect the pain from a sprain to resolve within a few days to weeks. Arthritis is due to progressive damage to the cartilage-covered portion of your knee joint. Knee pain from arthritis gets worse over time, comes on as you get older, and involves the whole knee. A torn meniscus often causes knee noise (popping, clicking, catching, or locking up) and hurts in the center of the knee when you put weight on it and rotate. A torn ACL makes your knee feel unstable, like it’s not safe to walk, in addition to being painful and swollen.

Most cases of patellofemoral syndrome will heal up within six weeks without intervention. If you have knee in the front of your knee that persists for six weeks despite conservative measures like NSAIDs and physical therapy, then see your chiropractor or primary care doctor for an x-ray of the knee. The x-ray will look for arthritis of the knee and stage the process if it is there. If your pain persists despite these measures and the x-ray confirms the underlying problem is not just arthritis, then evaluation by an orthopedic surgeon is the next step.

A board-certified orthopedic surgeon with fellowship training in Sports Medicine is the doctor most specialized to evaluate knee pain due to patellofemoral syndrome. During the orthopedic surgeon’s physical examination of your knee the patellofemoral syndrome will present as tenderness to movement of the kneecap, without signs of anterior cruciate ligament tear (Lachman test), or a meniscus injury (McMurray test), or widespread pain throughout the knee due to arthritis. If a mechanical source of your knee pain is suspected but additional information is required to make a treatment recommendation then the orthopedic surgeon will request magnetic resonance imaging (MRI) of your knee. The patellofemoral syndrome is caused by lesions in the cartilage of the knee between the kneecap and thigh bone. Lesions in the cartilage are called chondromalacia. If your knee pain is caused by patellofemoral syndrome which results from chondromalacia lesions shown on MRI that can be accessed through an arthroscope despite physical therapy and non-steroidal anti-inflammatory drugs with stomach protection then arthroscopic debridement surgery is recommended.

Arthroscopic debridement to remove chondromalacia lesions between the kneecap and thigh bone causing patellofemoral syndrome is done in an ambulatory surgery center (ASC) under either regional or general anesthesia. During the procedure the areas of chondromalacia are debrided, or cleaned out, to reduce the pain and prevent further damage. Think of the cartilage as a layer of smooth pain in the joint. Chondromalacia represents little plaques of chipped pain. Removing the chondromalacia is like peeling paint. The procedure takes around an hour. Cleaning out the damaged areas prevents them from peeling further, and causing additional damage.

You are expected to walk out of the surgery center an hour after surgery without the need for assistance at home. The small incisions in your knee will heal and you should be ready to return to light duty work in a week, moderate duty in three to six week, and heavy duty in twelve. The pain is generally manageable with non-steroidal anti-inflammatory medications.

FAQ

Knee pain in the front of your knee right at the kneecap may be arising from a problem with junction between the kneecap and the leg bone. This condition is called the patellofemoral syndrome. Since the pain is arising from the connection between the kneecap (patella) and thigh bone (femur) the pain is worse when you are active, when walking downhill, sitting with a bent knee, or engaging in sports. The easiest way to confirm patellofemoral syndrome is to gently move your kneecap back and forth. If this maneuver reproduces your usual pain, then you can be confident the problem is coming from the connection between the kneecap and leg bone and that you have patellofemoral syndrome.

The other common causes of knee pain are knee sprain, arthritis, torn meniscus, or ruptured anterior cruciate ligament. A knee sprain is a painful injury resulting from the application of excessive force to your knee without structural damage; fortunately, you can expect the pain from a sprain to resolve within a few days to weeks. Arthritis is due to progressive damage to the cartilage covered portion of your knee joint. Knee pain from arthritis gets worse over time, comes on as you get older, and involves the whole knee. A torn meniscus often causes knee noise (popping, clicking, catching, or locking up) and hurts in the center of the knee when you put weigh ton it and rotate. A torn ACL makes your knee feel unstable in addition to being painful and swollen.

You should suspect you have patellofemoral syndrome if you have pain in the front of your knee that is worse with activity. If you are safe to take non-steroidal anti-inflammatory medications, then you should try those next. We recommend everyone who takes NSAIDs just include a daily Prilosec to prevent acid build up and ulcers. If you have severe pain making it hard to walk, knee noise (popping, clicking, catching, or locking up) and swelling then you should go directly to an orthopedic surgeon after one week. Otherwise, if pain persists despite ice and NSAIDS, then see your chiropractor, physical therapist, or primary care doctor.

Most cases of patellofemoral syndrome will heal up within six weeks without intervention. If you have knee in the front of your knee that persists for six weeks despite conservative measures like NSAIDs and physical therapy, then see your chiropractor or primary care doctor for an x-ray of the knee. The x-ray will look for arthritis of the knee and stage the process if it is there. If your pain persists despite these measures and the x-ray confirms the underlying problem is not just arthritis, then evaluation by an orthopedic surgeon is the next step.

A board-certified orthopedic surgeon with fellowship training in sport’s medicine is the one most qualified to evaluate your knee pain. During their examination patellofemoral syndrome will present as tenderness to movement of the kneecap, without signs of anterior cruciate ligament (ACL) tear, or a meniscus injury, or diffuse pain in the joint due to arthritis.

If your evaluation by a board-certified orthopedic surgeon with fellowship training in sports medicine confirms the diagnosis and all other conservative measures (NSAIDs, physical therapy) have failed and the pain is functionally limiting then arthroscopic surgery is indicated. The surgeon removes injured areas of cartilage to make the knee work more smoothly and try to limit further damage.