Patellofemoral Knee Pain

Patellofemoral pain syndrome (PFPS) knee and around the patella (kneecap) and may also be called “runner’s knee.”

This problem is particularly common in runners and young athletes but can occur in even less active individuals during everyday activities. There are many factors which can contribute to the development of PFPS, for example, patella alignment, overuse and repetitive activities or training errors.


The knee is the largest joint in your body and quite complex. Ligaments and tendons connect the femur (thigh bone) to tibia (lower leg bone). In between the femur and tibia, cartilage and meniscus can be found. The patella is seated within the trochlear groove which is at the end of the femur. The patella glides inside this trochlear groove. Articular cartilage helps the bones glide smoothly during movement.


In some cases of patellofemoral pain, a condition called chondromalacia patella is present. Chondromalacia patella is the softening and breakdown of the articular cartilage on the underside of the kneecap. This condition may also lead to inflammation of the surrounding synovium and pain.


PFPS is commonly due to repeated stress and impact on the knee, particularly with a sudden rise in physical activity. Improper training techniques or programming can worsen these symptoms, as can poor muscle activation techniques.

Patellar Malalignment

Patellofemoral pain syndrome can also be caused by abnormal tracking of the patella in the trochlear groove. Maltracking may result in irritation of the cartilage and surrounding soft tissue.

Factors that contribute to maltracking:

  • Overall lower extremity alignment
  • Muscle imbalance
  • Muscle weakness


The most common symptom of PFPS is a dull, aching pain in the front of the knee. It can occur at rest or with activity. Symptoms of catching and popping can also be present.

Physical Examination

During the physical examination, a COSMO physician will assess your overall lower extremity alignment and patella position, muscle balance and activation, as well as your strength, flexibility and biomechanics with simple movements such as squatting and lunging.


X-rays are performed to assess for degenerative changes of the joint, the position of the patella relative to the trochlear groove and to assess the depth of the trochlear (trochlear dysplasia).
Magnetic resonance imaging (MRI) studies are performed if symptoms persist despite extensive conservative management, or in the setting of concern of significant cartilage injury.


The vast majority of patients with PFPS may be managed without surgery. Strategies of conservative management include rest, ice, patella bracing, anti-inflammatory medication, and correction of muscle imbalances/activation patterns.
An individualized treatment approach is always best and may also include a prescription for shoe orthotics and patella bracing. We hand select physical therapists who will help you achieve your goals.

Surgical Treatment

Surgical treatment for patellofemoral pain is very rarely needed, and primarily is performed in the setting of malalignment of the patella. Additionally, if significant cartilage injury is present, an arthroscopic procedure may be performed. Treatment decisions are performed on an individual basis following examination and imaging.

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