Runner’s Knee (Patellofemoral Pain)

Runner’s knee, also called patellofemoral pain syndrome (PFPS), refers to pain in the front of the knee and around the patella (kneecap). It can be caused by irritation of any of the structures in the area that contain nerves capable of sensing pain. This includes various ligaments and tendons, the synovial membrane inside the knee joint, the fat pad that lies underneath the patella, the patella itself, and the femur (thighbone). Although runner’s knee is commonly found in runners and other athletes performing similar activities, it can sometimes occur in less active people as well.

Here at YourOrthoSolution, we have some of the top orthopedic surgeons and sports medicine physicians in the country. Our caring team always goes that extra step to make you feel like part of our family. We specialize in knee conditions of this sort and are dedicated to getting you back to the things you love through a customized plan that fits only you. We have extensive experience in treating runner’s knee and want to help you start the healing process as quickly as possible to get you on the path to recovery.

Cause

There are several potential causes of PFPS, but the two main causes are overuse of the knee and patellar malalignment. These are not mutually exclusive. While some people may have PFPS that appears to be due to just one of these causes, both may be important contributing factors in other individuals.

• Overuse – In many people, PFPS is a type of overuse injury caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, jumping, or climbing stairs. A sudden increase in physical activity, use of improper sports training techniques or equipment, use of certain footwear, or running on certain types of surfaces are all factors that may contribute to PFPS.
• Patellar malalignment – In this condition, the patella is pushed off to one side of the trochlear groove when the knee is bent. The trochlear groove (also known as the patellofemoral groove) is the vertical depression in the lower end of the thighbone through which the patella travels when bending and straightening the knee. Normally, the patella stays centered within the groove, but if it is pushed off to the side, excessive pressure will occur between the back of the patella and the thighbone, causing inflammation in the area. Patellar malalignment is more likely to occur in people with weak quadriceps muscles, abnormal angulation between the thighbone and the lower leg bones, or a tight lateral retinaculum tendon. When tight, this tendon tends to pull the patella towards the outside of the knee and out of its groove.

Symptoms

The pain of PFPS often begins gradually and generally feels like a dull, achy pain in the front of the knee. It typically worsens with activities that require repeated bending of the knee. Pain that is affected by changes in activity level or intensity, playing surface, or equipment also suggests the presence of PFPS. The pain may be worse after sitting with your knees bent for a prolonged period of time (such as after a long plane ride).

Stiffness often accompanies the pain. Popping or crackling sounds in your knee when climbing stairs or when standing up after prolonged sitting may also occur if you have PFPS.

Treatments

Nonsurgical

Nonsurgical measures are the main way to treat PFPS. The goals of treatment are to relieve knee pain, increase strength of the muscles around the knee, and reduce knee stiffness (thus restoring normal knee range of motion). Treatments may include:

• Rest – activities that worsen the pain should be avoided until the pain subsides
• Exercise modification – athletes should consider modifying their workout program or switching to a sport that places less stress on the knees (such as swimming). Changing types of shoes or running surfaces may also be helpful.
• Ice or other cold therapy
• Elevation of the knee
• Medications – nonsteroidal anti-inflammatory medications (such as ibuprofen) may reduce pain and inflammation
• Weight loss – this will reduce pressure on the knee
• Physical therapy – especially exercises to strengthen the quadriceps muscles
• Orthotics

Surgical

Although rarely needed, surgery is an option for people with severe PFPS that does not improve with nonsurgical treatment. Some options are:

• Debridement – this involves removing damaged articular cartilage from the back of the patella
• Lateral release – this is performed if a tight lateral retinaculum tendon is pulling the patella out of its trochlear groove. In this procedure, the tendon is cut.
• Tibial Tubercle Transfer – in this procedure, the patella is repositioned so it remains in the groove during knee movements. It requires moving the tibial tubercle, which is the bump at the top of the tibia (shinbone). The patellar tendon lies between the tubercle and the patella, joining the two structures. During the surgery, the tubercle is cut away from the rest of the tibia, then moved to a better location on the tibia, where it is reattached with screws. Because they remain attached to the tubercle, the patellar tendon and patella move with the tubercle.

Most of these surgical procedures can be performed on an outpatient basis in a surgery center setting. There are many advantages to surgery centers, including better outcomes, lower infection rates, no overnight stay, lower costs, and the convenience that comes with a smaller, yet highly skilled, staff.

The debridement and lateral release are performed via minimally invasive arthroscopy. YourOrthoSolution is always keeping you, the patient, in mind and looking for the least-invasive way to repair all injuries. The smaller the incision, the less trauma to the muscle and other tissues. This produces less bleeding and scarring and leads to a quicker recovery.

During the arthroscopic surgery, a small camera (an arthroscope) is inserted into the knee joint through a very small incision. The camera displays images on a high-definition screen, allowing your surgeon to have a detailed view of the area while he or she uses miniature surgical instruments to perform the surgery.

At YourOrthoSolution, all of our doctors and staff are committed to ensuring that you not only receive the best orthopedic care in the area but also have an exceptional experience each time you visit our locations. Our dedicated staff will handle all insurance processes for you. You can expect to be in a friendly atmosphere and receive top orthopedic treatment to help you return to full mobility as quickly as possible.