[Patellofemoral pain. Diagnosis and treatment]

Abstract

Patellofemoral pain is a frequent complaint among recreational and competitive athletes. Studies from Sweden and Norway among junior and senior high school students showed that every third to fourth student currently suffers, or has previously suffered, from patellofemoral pain. This paper presents current trends in diagnosis and treatment of patellofemoral pain. It describes the clinical examination, and discusses the additional information obtained from tests like radiography, CT and MT. Arthroscopy can establish the degree of cartilage damage and joint articulation, but should not be used as a general diagnostic tool. Treatment of patellofemoral pain should consist of patient education and a carefully designed rehabilitation programme emphasizing eccentric quadriceps exercises, primarily in close chain modes. A knee sleeve with a lateral cushion seems to alleviate symptoms in some patients. If the problems are not reduced by a well executed exercise programme over six months, surgical intervention should be discussed on the basis of a specific diagnosis. The article includes a review of recent studies on patellar shaving, spongialization, lateral release, proximal/distal realignment, tibial tubercle elevation and medialization, and patellectomy.