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Review
. 2017 Jun 12:8:143-154.
doi: 10.2147/OAJSM.S133406. eCollection 2017.

Patellofemoral pain in athletes

Wolf Petersen  1 , Ingo Rembitzki  2 , Christian Liebau  3
Affiliations
Review

Patellofemoral pain in athletes

Wolf Petersen et al. Open Access J Sports Med. .

Abstract

Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.

Keywords: anterior knee pain; dynamic valgus; hip strength; rearfoot eversion; single leg squat.

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Conflict of interest statement

Disclosure Wolf Petersen, Ingo Rembitzki, and Christian Liebau receive consultant fees from Otto Bock Health Care (Duderstadt, Germany). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Schematic drawing showing the relationship of PFP, PFPS, and PFOA. Abbreviation: PFP, patellofemoral pain; PFPS, patellofemoral pain syndrome; PFOA, patellofemoral osteoarthritis; PF, patellofemoral.
Figure 2
Figure 2
Drawing showing patellar maltracking in PFP patients. Notes: (A) Patients with PFPS have increased lateral shift (arrow). (B) Inpatients with PFOA, lateral maltracking promotes disease progression. Abbreviations: PFPS, patellofemoral pain syndrome; PFOA, patellofemoral osteoarthritis.
Figure 3
Figure 3
Schematic drawing showing the Q angle. Abbreviations: VM, vastus medialis muscle; VL, vastus lateralis muscle; Fq, quadriceps force; Fp, patellar tendon force; R, resultant force.
Figure 4
Figure 4
Drawing showing the dynamic valgus. Notes: This disorder may arise proximally by internal rotation of the femur or distally by internal rotation of the tibia, or both. Internal rotation of the femur might be the result of weakness of the hip muscles. Foot abnormalities might be cause for internal rotation of the tibia (rearfoot eversion or pes pronatus). The valgus malalignement may lead to lateral patella maltracking.
Figure 5
Figure 5
Exercise for hip abductors.
Figure 6
Figure 6
Tape applications for patients with PFP. Notes: (A) Application of a classical McConnell tape. (B) Application of a Kinesio tape.
Figure 7
Figure 7
Example of a patella realignment brace (Agillium Patella pro; Otto Bock, Duderstdt, Germany).
Figure 8
Figure 8
Algorithm for the pathogenesis of PFPS. Notes: Patellar maltracking due to a functional malalignment in the coronal and sagittal planes may be an underlying cause of patellofemoral pain. Possible causes of functional malalignment may be decreased hip muscle strength, low back problems, or foot abnormalities. Secondary consequences include quadriceps imbalance, hamstring tightness, or iliotibial tract tightness. Psychological factors could additionally modify the pain sensation. Abbreviation: PFPS, patellofemoral pain syndrome.
Figure 9
Figure 9
Algorithm for the treatment of PFPS. Abbreviation: PFPS, patellofemoral pain syndrome.
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