Monday, April 23, 2012

Patellofemoral Pain

Dr. Michael Vella

Your knees carry the weight burden of your body and are subject to the rigors associated with that responsibility.  When combined with the stress of high impact activities such as running, jumping, skiing, and other strenuous activities, a condition referred to as patellofemoral pain syndrome (Runner’s Knee) can develop.  This condition is characterized by pain in the front of the knee which is caused by the irritation of the cartilage (flexible connective tissue connecting bones to bones) located on the back of the kneecap (patella).
Although a number of factors can contribute to this condition, the exact cause is unknown.  Most typically it is caused by:
·    Overuse from high impact activities that cause improper tracking of the patella on the femur (thigh bone)
·    Injury or dislocation (displacement or misalignment) of the kneecap
·    Thigh muscles that are too weak or too tight; inadequate stretching
·    Flat feet
·    Wearing down, roughening or softening of the cartilage under the kneecap
·    Misalignment of the kneecap which can be caused by vigorous activities causing excessive wear and tear on the kneecap cartilage.  The resultant softening and breakdown of the patellar cartilage irritates the joint lining which causes pain.
·   Most common:  a dull aching pain under and around the kneecap where it connects to the femur
·    Pain most frequently occurs when climbing up or down stairs, kneeling, squatting, and sitting for prolonged periods of time with the knee in a flexed position
·    The knee might also “catch”, grind, or pop
·    Maintain a healthy weight and stay in good shape
·    Stretch and sufficiently warm up before participating in any exercise or activity (especially running)
·    Gradually increase your work out or training program over time.  Avoid sudden and intense increases in the intensity of exercise
·    Wear proper running gear and footwear with sufficient shock absorption features and of quality design and materials.  Footwear should fit properly and be changed out frequently when worn
·    Shoe inserts may be necessary if you have flat feet
·    Use proper form when exercising and running.  Running surfaces should be smooth, even, and somewhat resilient.  Avoid running down a steep hill (slow the pace to a brisk walk or use a serpentine pattern when descending)

·    History – your physician will explore your symptoms, exercise/sports participation patterns, and any recent injuries
·    Physical Exam – your physician will want to assess your knee’s strength, motility, and alignment by watching you stand, walk, jump, squat, and will also put your knee and leg through a series of maneuvers to assess the alignment and stability of your lower leg and kneecap
·    Imaging – your physician may order diagnostic imaging studies such as x-ray, MRI, or CT based on the findings of the history and physical exam
Depends on the underlying cause of the knee pain but is generally nonsurgical
            First Aid Treatment: 
·    Immediately cease any activity that causes the knee pain (running or jumping)
·    RICE
o   Rest – avoid putting weight on the painful knee; change to non-weight bearing exercise such as swimming or stationary biking
o   Ice – apply cold packs for 20 minutes several times each day
o   Compression – wrap the area or cover the area with an elastic bandage or elastic knee sleeve that fits snuggly
o   Elevation – keep the knee raised at a level higher than your heart when at rest   
·    Medications such as nonsteroidal anti-inflammatory drugs to relieve pain
·    Consult your physician if the knee pain does not subside or improve with RICE
o   Runner’s knee generally improves with early treatment

Nonsurgical Treatment
Once the knee pain and swelling has subsided, reconditioning is often needed to restore the full range of motion, strength, and agility present prior to the condition’s onset.  Your physician and physical therapist can assist with prescribing an exercise program that will assist with this.  Occasionally interventions such as taping the knee, wearing a brace, or using specialized shoe lifts might be used to relieve the discomfort.

Surgical Treatment
Not frequently necessary except in severe cases but might include
·    Arthroscopy – surgery made through a small incision in which the surgeon removes small fragments of the damaged kneecap through a small tube-like instrument called an arthroscope
·    Realignment – there are many realignment procedures to relieve pain.  Some involve small releases, patellofemoral ligament reconstruction or bony procedures to improve tracking of the patellofemoral joint.  Lastly, in older individuals or most severe cases, there is a limited patellofemoral joint replacement.

Dr. Michael Vella specializes in adult reconstruction of hips and knees, sports medicine including arthroscopy of the knee, shoulder, and ankle,  fracture care, and general orthopedics.  He attended medical school at Upstate Health Science Center, completed two years of general surgery residency at Brown University, and fellowship trained at Harvard.  Dr. Vella has been practicing here since 1989 and participates in the care of many high school, collegiate, and minor professional athletes.  He is a member of several medical societies and is president of Midstate IPA, serving over 1200 health care providers. 



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