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Patello-Femoral Pain (Anterior Knee Pain; Chondromalacia Patella)

This term is most often associated with the knee, but can also be associated with any joint that has articular cartilage. "Chondromalacia" is a Latin word meaning "cartilage softening" . "Chondromalacia" is a surgical determination, not a clinical one. Two common types of cartilage are: hyaline/articular and fibrocartilage. The former is a glistening, near friction-free surface that covers the ends of bones, allowing for smooth movement. The latter is a tougher type of cartilage, like the meniscus of the knee, which helps in stabilizing the joint. Chondromalacia is graded from I to IV, the latter implicating "bone on bone" wearing. A recent study (1) proved that one can have as much as a Grade III wearing without pain. So, pain is variable. The source of chondromalacia pain (2) is not the articular cartilage itself, but the thinning of it, which transfers loads onto the underlying subchondral bone, which is pain-sensitive.

Patello-Femoral pain is the most common of knee problems. This involves the joint between the knee cap(patella) and the thigh bone(femur). It is chronic, but usually only episodically painful. There is often no one trauma associated with it, just a sense of discomfort with fluctuations of pain over time. It is often associated with sub-optimal biomechanics around the knee cap and lower limb, but not always. When biomechanics are good, but there is PF pain, this may be due to a predisposition towards soft articular cartilage, which is poorly understood. Direct trauma to the knee cap can instigate PF pain and softening of the cartilage over time. Biomechanics are unalterable conservatively, but can be influenced by selective muscle stretching and strengthening exercises around the knee, pelvis, hip and foot. This helps to reduce the abnormal vector forces influencing the patella.
PF Pain is characterized by a poorly localized, deep aching under the patella, which often refers towards the front and inner aspects of the knee. Aggravating factors are: prolonged sitting, descending/ascending stairs or hills, and squatting. There is only rarely very mild swelling.
The treatment of PF Pain is conservative. This means seeking the advice of a Physical Therapist who will identify selective exercises to optimize lower limb mechanics. McConnell PF taping may also be indicated. Occasionally, modalities such as Ultrasound and Biofeedback may be helpful. The prescribed exercises are a life-long commitment, like brushing your teeth.
If conservative care of PF Pain fails, and the pain is significant, then the advice of a surgeon should be sought. But surgery is the last resort.
Other conditions such as patellar subluxation(partial dislocation) or dislocation often cause PF pain.

Patellar Subluxation and Dislocation

Due to multifactorial reasons, some patellae (knee caps) are prone to either partially dislocate (sublux) off the femur (thigh bone) in an outward direction or fully do so episodically. After such an event, the patella usually snaps back into place spontaneously. Less commonly, a traumatic incident can dislocate a non-predisposed patella. Some biomechanical factors may be involved: a somewhat flat patella undersurface gliding on a shallow groove on the femur; inward rotation of the femur which places the patella in a position to outwardly sublux/dislocate; weak quads or gluts muscles; and hypermobility ("double-jointed"). Since one cannot alter one's own skeletal makeup, it is crucial to emphasize what can be influenced: soft tissue. Optimizing the quads and gluts; selective stretching to decrease the pull of tissue on the outer side of the patella; and McConnell Patello-Femoral taping are important among othertreatment principles. It is important to seek the advice of a physical therapist to help develop an Independent Exercise Program. Like any other chronic condition, one must remain diligent with these exercises throughout life, just like brushing teeth.

Patellar Tendonitis

Please refer to Tendinitis for general information. Patellar tendonitis more likely involves a micro-degeneration process of the quads tendon below the patella(knee cap). It is often associated with jumping sports or repetitive knee activities. The diagnosis is clinical. Rarely is MRI needed and only if conservative treatement fails to eliminate the pain, and surgery(very rarely) is being considered. Treatment comprises identifying and eliminating the causative factors. Then, performing selective exercises and icing over a consistent period of several weeks will hopefully help. A Physical Therapist should be consulted if pain persists.

Plantar fasciitis