What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome refers to pain that develops between the patella (kneecap) and the femur where they meet at the patellofemoral joint.

When bending or straightening the knee, the patella glides within a groove on the femur called the trochlear groove. If the kneecap tracks improperly or excessive stress is placed on the joint, irritation can occur in:

• The cartilage on the underside of the kneecap
• The surrounding synovial tissue
• Supporting tendons and soft tissues

Articular cartilage covers the ends of the femur and the underside of the patella, helping the bones glide smoothly against each other. The patellofemoral joint is supported by a network of ligaments, tendons and surrounding musculature.

Unlike patellofemoral arthritis, PFPS typically does not involve advanced cartilage breakdown. It is generally considered an overuse or biomechanical condition. While PFPS can be part of a broader spectrum of patellofemoral disorders, most cases improve with conservative treatment.

Anatomy of the Patellofemoral Joint

The knee joint is formed by three bones:

• Femur (thigh bone)
• Tibia (shin bone)
• Patella (kneecap)

The patellofemoral joint is one of three compartments of the knee, along with the medial and lateral compartments.

The patella sits within the trochlear groove of the femur and is stabilized by:

• The quadriceps muscles
• The patellar tendon
• The medial patellofemoral ligament (MPFL)
• Surrounding soft tissues and hip musculature

The menisci cushion the tibia and femur within the main knee joint compartments, while the infrapatellar fat pad provides additional cushioning beneath the kneecap.

When muscle imbalance, alignment issues or repetitive stress alter kneecap tracking, increased pressure develops at the front of the knee.

What Causes Patellofemoral Pain Syndrome?

PFPS is usually caused by a combination of overuse and biomechanical factors.

Overuse and Repetitive Stress

• Running, especially downhill
• Jumping sports
• Squatting or lunging
• Rapid increases in activity level
• High-impact training without adequate recovery

Higher training volume or intensity can increase stress on the patellofemoral joint.

Biomechanical Factors

• Weak quadriceps, particularly the vastus medialis
• Weak hip or core muscles
• Tight hamstrings or iliotibial band
• Flat feet or overpronation
• Increased Q-angle, more common in females
• Patellar tracking abnormalities

Muscle tightness and weakness can increase compressive forces across the patellofemoral joint, contributing to pain.

Injury or Trauma

• Direct blow to the kneecap
• Prior knee surgery
• Previous patellar dislocation

Poor footwear and improper training techniques may also contribute.

Symptoms of Patellofemoral Pain Syndrome

The hallmark symptom is a dull, aching pain in the front of the knee.

Common symptoms include:

• Pain behind or around the kneecap
• Increased pain when climbing or descending stairs
• Pain with squatting, kneeling or lunging
• Pain with prolonged sitting and when standing up from a seated position
• Grinding, popping or clicking sensations
• Tenderness when pressing on the kneecap

Symptoms may affect one knee or both knees. Many patients experience improvement with activity modification and structured rehabilitation.

How Patellofemoral Pain Syndrome Is Diagnosed

Accurate diagnosis is important to distinguish PFPS from other causes of anterior knee pain such as meniscus tears, ligament injuries or patellofemoral arthritis.

At OrthoTexas, evaluation includes:

Comprehensive Clinical Examination

• Detailed symptom history
• Assessment of kneecap tracking
• Evaluation of hip and lower limb alignment
• Strength and flexibility testing
• Functional movement analysis

A thorough physical exam helps identify contributing anatomical or biomechanical factors.

Imaging Studies

• X-rays to assess alignment and rule out structural abnormalities
• MRI if cartilage injury or other internal damage is suspected

PFPS is often diagnosed clinically. Imaging is used selectively to rule out other conditions.

Non-Surgical Treatment for Patellofemoral Pain Syndrome

Most cases improve with conservative treatment. Nonsurgical care is the first line of management.

Activity Modification

• Reduce high-impact activities
• Avoid deep squats and repetitive stair climbing
• Gradually return to sport

Physical Therapy

A structured physical therapy rehabilitation program focuses on:

• Quadriceps strengthening
• Hip abductor and core strengthening
• Stretching tight hamstrings and calf muscles
• Improving patellar tracking
• Correcting movement patterns

Exercise therapy that combines hip and knee strengthening is evidence-based and effective in reducing pain and improving function.

Bracing and Taping

• Patellar stabilizing braces
• Patellar taping techniques
• Shoe inserts or orthotics when needed

These strategies may help improve alignment and reduce stress on the joint when combined with rehabilitation.

Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or naproxen for short-term pain relief

Ice and Inflammation Control

Applying ice after activity can help reduce irritation.

Most patients experience improvement within several weeks to a few months with consistent rehabilitation.

When Is Surgery Considered?

Surgical treatment for patellofemoral pain syndrome is uncommon and reserved for persistent cases that do not respond to a comprehensive course of non-surgical treatment.

Procedures may include:

• Arthroscopy to address cartilage damage
• Lateral release in carefully selected cases
• Tibial tubercle osteotomy to improve alignment
• Removal of loose bodies if present

Surgery is considered only after conservative care has been exhausted.

Prognosis and Long-Term Outlook

The outlook for patellofemoral pain syndrome is generally positive. Most patients experience significant improvement with physical therapy, activity modification and strengthening programs.

Persistent symptoms may occur in some individuals, especially if underlying biomechanical factors are not addressed. Ongoing strengthening, flexibility and proper training techniques are important to prevent recurrence.

Preventing Patellofemoral Pain

Prevention strategies include:

• Gradually increasing activity levels
• Strengthening hip and thigh muscles
• Maintaining flexibility
• Wearing supportive footwear
• Cross-training with low-impact exercise

Early attention to mild symptoms can prevent progression to knee pain.

When to See a Knee Specialist

Schedule an evaluation at OrthoTexas if you experience:

• Persistent front-of-knee pain
• Pain that limits sports or daily activity
• Recurrent symptoms despite rest
• Knee discomfort lasting more than a few weeks
• Instability or mechanical symptoms

Prompt evaluation helps prevent prolonged symptoms and supports an individualized treatment plan.

Comprehensive Care for Runner’s Knee at OrthoTexas

OrthoTexas provides advanced care for patellofemoral pain syndrome, including:

• Advanced diagnostic imaging
• Individualized rehabilitation programs
• Biomechanical assessment
• Bracing and conservative interventions
• Surgical consultation when necessary

Our fellowship-trained orthopedic specialists focus on restoring proper knee mechanics, relieving pain and helping you return to the activities you enjoy.