Abstract
CLINICAL PRESENTATION & EXAM: Patellofemoral syndrome is a common cause of knee pain, particularly in young female athletes. Studies suggest that multiple factors contribute to its development, including patellar maltracking, imbalance between the vastus lateralis and vastus medialis, hip instability and weakness, hamstring imbalance and tightness, and rear-foot eversion. Patients typically present with anterior knee pain, especially during weight-bearing activities that involve knee flexion. The condition can also cause knee stiffness after prolonged sitting with the knee flexed and may lead to knee buckling due to quadriceps weakness. Pain often intensifies with squatting. Tight hamstrings have been linked to patellofemoral syndrome, as simultaneous contraction of the hamstrings and quadriceps increases force on the knee joint. Hamstring tightness may be observed during a passive knee extension test. ANATOMY & PATHOLOGY: The patellofemoral joint consists of the patella and the distal trochlea of the femur. The patella plays a crucial role in knee flexion, acting as a lever to enhance the efficiency of the quadriceps. It is connected to the quadriceps tendon and the patellar ligament. The patella is stabilized by surrounding muscles, including the rectus femoris, vastus lateralis, and vastus medialis obliquus. A Q angle exceeding 15-20 degrees is associated with an increased risk of patellofemoral syndrome. DIAGNOSTIC TESTING & CONSIDERATIONS: Diagnosing patellofemoral syndrome is based on a patient’s history and physical examination findings. Among manual maneuvers, the patellar tilt test has the highest likelihood ratio for identifying a true positive result. Additional tests, such as the patellar apprehension test or Clarke’s test, may also aid in evaluation. Gait analysis can reveal signs of patellofemoral syndrome, including exaggerated lumbar lordosis, asymmetric hip height, foot eversion, or quadriceps atrophy. Imaging may be useful for ruling out other conditions, such as osteoarthritis, fractures, or osteochondritis, if these are suspected based on the physical examination. TREATMENT & RETURN TO ACTIVITY: The treatment for patellofemoral syndrome is primarily non-operative, focusing on a conservative approach. Physical therapy is the most studied form of treatment, though no single exercise has been proven to be the most effective. Therapy should be individualized, with an emphasis on strengthening the hip, trunk, and knee muscles. Taping has shown success in addressing lateral patellar maltracking and patellar tilt. When combined with exercise, adhesive taping has demonstrated better results than exercise alone. The most commonly used taping technique is the McConnell method. Additionally, patellar braces can help manage patellar maltracking and pain levels.
Recommended Citation
Dennis, Ava E.; Spindler, Lindsay; and Ruot, Chuck
(2025)
"Patellofemoral Syndrome,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
17, Article 153.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss17/153