Clinical Reference Systems: Pediatric Advisor 10.0
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What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is pain behind the kneecap. It has been given many names, including patellofemoral disorder, patellar malalignment, runner's knee, and chondromalacia.

How does it occur?

Patellofemoral pain syndrome can occur from overuse of the knee in sports and activities such as running, walking, jumping, or bicycling.

The kneecap (patella) is attached to the large group of muscles in the thigh called the quadriceps. It is also attached to the shin bone by the patellar tendon. The kneecap fits into grooves in the end of the thigh bone (femur) called the femoral condyle. With repeated bending and straightening of the knee, you can irritate the inside surface of the kneecap and cause pain.

Patellofemoral pain syndrome also may result from the way your hips, legs, knees, or feet are aligned. This alignment problem can be caused by your having wide hips or underdeveloped thigh muscles, being knock-kneed, or having feet with arches that collapse when walking or running (a condition called over-pronation).

What are the symptoms?

The main symptom is pain behind the kneecap. You may have pain when you walk, run, or sit for a long time. The pain is generally worse when walking downhill or down stairs. Your knee may swell at times. You may feel or hear snapping, popping, or grinding in the knee.

How is it treated?

Treatment includes the following:

• Place an ice pack on your knee for 20 to 30 minutes every 3 to 4 hours for the first 2 to 3 days or until the pain goes away
• Elevate your knee by placing a pillow underneath your leg when your knee hurts.
• Take anti-inflammatory medication, such as ibuprofen.
• Do the exercises recommended by your doctor or physical therapist.

Your doctor may recommend that you:

• Wear custom-made arch supports (orthotics) for over- pronation.
• Use an infrapatellar strap, a strap placed beneath the kneecap over the patellar tendon.
• Wear a neoprene knee sleeve, which will give support to your knee and patella.

While you are recovering from your injury, you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to bicycle or swim instead of run. In cases of severe patellofemoral pain syndrome, surgery may be recommended. Your doctor will show you exercises to help decrease the pain behind your kneecap.

How can I prevent patellofemoral pain syndrome?

Patellofemoral pain syndrome can best be prevented by strengthening your thigh muscles, particularly the inside part of this muscle group. It is also important to wear shoes that fit well and that have good arch supports.