Patellofemoral pain: an update on diagnostic and treatment options

Abstract

Patellofemoral pain is a frequent and often challenging clinical problem. It affects females more than males and includes many different pathologic entities that result in pain in the anterior aspect of the knee. Diagnosis of the specific cause of pain can be difficult and requires assessment of lower extremity strength, alignment, and range of motion, as well as specific patella alignment, tracking, and mobility. The treatment for patellofemoral pain is usually conservative with anti-inflammatory medications, activity modification, and a specific physical therapy program focusing on strengthening and flexibility. Infrequently, surgical treatment may be indicated after a non-operative program fails. The outcomes of surgical management may include debridement, lateral release, and realignment of the extensor mechanism to unload the patellofemoral articulation are favorable.

Figures

Fig. 1

Patellofemoral radiographic measurement techniques. a Insall Salvati ratio is calculated by dividing patella length by the patellar tendon length (a/b). A normal ratio is between 0.8 and 1.2. b Modified Insall Salvati ratio is calculated by dividing the patellar articular surface length by the length of the patellar tendon (c/d). Mean normal is 1.25. c Blackburne-Peel ratio is calculated by dividing the patellar articular surface length by the length from the distal pole of the articular surface to a line extending from the tibial plateau (c/e). Normal is between 0.5 and 1.1. d The sulcus angle (b- > a- > c) helps assess femoral dysplasia. Normal is around 140°; dysplasia is indicated when the angle is larger. The congruence angle is measured between the bisector of the sulcus angle and the lowest point on the articular edge of the patella (e- > a- > d). The mean congruence angle is –6°. Medial is (–) and lateral is (+); lateral subluxation has a + angle