Anterior knee pain

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Nonsurgical care by a specialist in physical medicine and rehabilitation is typically a multifaceted approach, which can include modalities, bracing, medication, injection, proprioceptive techniques, restoration of normal movement patterns, and overall conditioning. There is evidence that physical therapy interventions have significant beneficial effect on pain and function compared with no treatment.

When appropriately indicated, distal realignment procedures can produce consistent clinical results. Indications for distal realignment include lateral patellofemoral instability, anterior knee pain with associated lateral or distal patellofemoral cartilage lesion, and cases with significant lateral patellofemoral overload or tilt. In cases of patellofemoral instability, it is important to determine whether proximal stabilization, distal realignment, or both is needed. If distal realignment is indicated, several anatomic variables must be considered to determine the location and obliquity of the osteotomy when using multiplanar osteotomy techniques...

UNLABELLED: The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment)...

PURPOSE: The current study was performed to characterize the influence of patellar stabilization procedures on patellofemoral and tibiofemoral dynamic motion. METHODS: Six knees were evaluated pre-operatively and 1 year or longer following stabilization via tibial tuberosity realignment, with simultaneous medial patellofemoral ligament reconstruction performed for five knees. Knees were imaged during extension against gravity using a dynamic CT scanner. Models representing each knee at several positions of extension were reconstructed from the images...

Examination of the patellofemoral joint can prove to be challenging. Although certain acute injuries such as patella fracture or tendon rupture can be diagnosed quickly, more chronic injuries such as patellar subluxation and patellofemoral pain syndrome are more difficult to diagnose because of the subtlety of the examination findings. The source of the problem can also vary, and must be identified to direct treatment. Adding to the complexity is that other structures around the knee may present with anterior knee pain and can be mistaken for patellofemoral disorder, which is why the patellofemoral examination should be performed in the context of a complete knee examination...

Treatment of patellofemoral chondral defects is fraught with difficulty because of the generally inferior outcomes and significant biomechanical complexity of the joint. Noyes and Barber-Westin38 performed a systematic review of large (>4 cm2) patellofemoral ACI (11 studies), PFA (5 studies), and osteochondral allografting (2 studies) in patients younger than 50 years. Respectively, failures or poor outcomes were noted in 8% to 60% after ACI, 22% after PFA, and 53% after osteochondral allograft treatment...

Given that the patellofemoral joint is one of the most highly loaded in the human body, the high prevalence of anterior knee pain (AKP) in athletes is unsurprising. Athletes with AKP present a significant diagnostic and therapeutic challenge. A clear understanding of the etiology of patellofemoral pain in this population is essential in guiding a focused history and physical examination, and achieving an appropriate diagnosis and treatment approach. This clinical review provides an assessment framework and a guide for neuromuscular function testing, and an overview of the causes and treatments of AKP in this challenging patient population...

Patellofemoral disorders are common. There is a broad spectrum of disease, ranging from patellofemoral pain and instability to focal cartilage disease and arthritis. Regardless of the specific condition, abnormal anatomy and biomechanics are often the root cause of patellofemoral dysfunction. A thorough understanding of normal patellofemoral anatomy and biomechanics is critical for the treating physician. Recognizing and addressing abnormal anatomy will optimize patellofemoral biomechanics and may ultimately translate into clinical success...