Patellofemoral syndrome

Patellofemoral syndrome is a condition causing dull, aching pain at the front of the knee, typically caused by exercises like running, jumping, and climbing stairs or hills.

Your knee joint includes the patella, or kneecap, and joins the lower leg to the thighbone, or femur. Patellofemoral pain is caused by stress on the connective tissues and muscles around the knee, including the quadriceps muscles and vastus medialis, and early softening of the cartilage on the kneecap. We commonly treat this condition in athletes of all levels.

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Don't ignore your knee pain

The anterior knee pain often increases when you run, walk up or down stairs, sit for long periods, or squat.

If left untreated, this condition can sometimes cause damage to the structures in knee joint. It can shift the patella, affect muscles and tendons, and lead to cartilage damage, called chondromalacia patella.

Getting the right treatment

Simple non-surgical treatments will commonly relieve patellofemoral pain, but in serious cases surgery is necessary.

If you’re experiencing pain at the front of your knee, see a UCHealth provider for an evaluation of your patellofemoral joint and possible referral to an orthopedic or sports medicine specialist. We’ll work with you on a personalized treatment plan for your case that will relieve your pain and get you back to the activity level you want.

Causes and symptoms of patellofemoral syndrome

Contributing factors

We still have not found one definitive cause for patellafemoral syndrome, but we do know that several things can contribute:

  • A fall or blow to the knee joint.
  • Impact activities that put repeated stress on the knee joint.
  • Overtraining or poor form at a sport.
  • Variations in patient anatomy that cause the patella to track improperly.
  • Weakness or muscle imbalances in the hip or thigh muscles.

Common symptoms

Your UCHealth provider will conduct a physical exam to properly diagnose patellofemoral syndrome, looking for these common symptoms:

  • Pain at the front of the knee, and sometimes around the patella. Typically occurs when running, sitting for a long time, and walking up or down stairs.
  • The knee feels like it’s catching or locking.
  • You hear a grinding or crackling noise in your knee, called crepitus.
  • Your provider may also perform imaging tests as part of your diagnosis.

Senior couple jogging together

Treatment options

Your treatment plan

Patellofemoral syndrome pain won’t go away without treatment. Your orthopedic provider will develop a personalized treatment plan for you that will reduce pain and prevent further injury, which can include:

  • Cold packs or ice. Helps reduce pain.
  • Elastic tape or a supportive brace. Stabilizes your knee.
  • Knee-friendly sports. Bicycling, swimming and yoga are low-impact on knees and will help you recover.
  • Orthotics. A shoe insert can make your knee more stable.
  • Physical therapy. A physical therapist will teach you exercises that improve balance, flexibility, strength and maintain range of motion.
  • Prescription or over-the-counter (OTC) medicines. Help reduce inflammation, swelling, and pain. NSAIDs (nonsteroidal anti-inflammatory drugs) are the most common that we recommend.
  • Rest. Gives your knee time to recover. You may need to stop certain activities in the short term, such as not running for several weeks.

Surgery is sometimes called for

If these steps aren’t working, your doctor might suggest a surgical procedure:

  • Arthroscopy. Your surgeon inserts a thin tube fitted with a camera and surgical tools, called an arthroscope, through a tiny incision and removes fragments of damaged cartilage and smoothes the cartilage surface.
  • Realignment. Your surgeon realigns the angle of your kneecap to relieve pressure on the cartilage.

If arthroscopy or relalignment surgery fail, or if there is severe cartilage loss under the kneecap, you may be a candidate for a partial knee replacement.

Woman walking with her dog

Recovery and return to sports

Getting back to what you love

With proper treatment and a commitment to physical therapy, you can expect to fully heal in four to five months.

The pain of “runner’s knee” won’t hold you back from reaching your goals any more.

Orthoinfo: American Academy of Orthopaedic Surgeons. Patellofemoral Pain Syndrome (https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Patellofemoral Syndrome (https://www.ncbi.nlm.nih.gov/books/NBK557657/)

American Academy of Family Physicians. Patellofemoral Pain Syndrome (https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html)