One of the most common things that I see in sports medicine patients is pain in the anterior (front) part of the knee. The medical name for this is “pat-ellofemoral syndrome.”
The patella is the “kneecap;” the femur is the “thigh bone.” The joint where the patella and the femur come together is called the patellofemoral joint. The patella usually sits in a groove on the femur and glides up and down through the groove with range of motion of the knee.
It is very common to get pain in the front part of the knee. It may or may not be coming from the patella itself or the surrounding soft tissues, i.e. the muscles, tendons, joint capsule (casing) and ligaments.
We see it more commonly in females, but it can certainly occur in males. The reason it occurs a little bit more commonly in females is because the structure and anatomy of the female body tends to be a little bit different than the male's. Females tend to have a little bit wider pelvis (for childbearing purposes), and they tend to have more valgus or “knock knees.” The upper part of their tibia (shin bone) tends to be a little bit more bowed (proximal tibial vara). Many of them tend to have flat feet that turn inward (pes planus/pronation). Their patellae seems to point inward as well.
All of this is termed “miserable mal alignment syndrome.” In other words, the actual anatomical alignment of the patient's body can predispose their patella to track or ride a little bit more toward the outer (lateral) part of the patellofemoral joint, i.e. on the outer part of the groove in the femur where the patella sits. This tends to create more pressure on the undersurface of the patella, which tends to lead to pain and sometimes even chondromalacia, which is softening of the cartilage on the undersurface of the patella.
The vast majority of time this is more of an overuse type phenomenon where the muscles are weak and the patient tends to overuse them. Sometimes a patient may increase their exercise or activities too quickly. The weak muscle, coupled with the de-conditioning and the mal alignment, leads to a combination of pain in the front part of the knee.
The good news is that the vast majority of time this can be treated non operatively with physical therapy/exercises as well as other things such as orthotics and certain types of knee braces, which can help the tracking of the patella.
Also, gradually increasing activities to prevent overuse can be helpful. It can be a very nagging problem for some people.
The bad news is that surgery is very unpredictable for this particular problem.
There are certain surgical procedures that can be done, many of which can be done arthroscopically through small incisions. Sometimes we can go in and shave any loose or degenerated chondromalacia cartilage, but unfortunately there is no reliable way yet to replace that cartilage or “retread the tire.”
There are some cartilage replacement/growing techniques, but they are usually only for small areas and notoriously don't do well in the patellofemoral part of the joint. These procedures oftentimes only provide temporary relief.
Sometimes we can release the tissue between the kneecap and the thigh bone on the outer side of the patellofemoral joint to release the pressure on that area and help with the tracking of the patella. That is called a lateral release. Again, this surgery is somewhat unpredictable.
If the person is experiencing instability or their patella is dislocating, that is a different problem, and there is instability surgery that can be done. However, once again, any surgery on the patellofemoral joint is much more unpredictable than other types of surgery. Therefore, the hallmark of treatment is physical therapy and conservative measures.
It is sometimes frustrating for the patient and for the physician when the physician tells the patient that there is not necessarily any “good” surgery for this problem; but, the good news is if the patient is religious with their therapy and then eventually their home exercises, many times they will do very well. It is not just an issue with the knee itself, it is an issue with the entire leg. Subsequently when I send someone to physical therapy for this problem, I prefer that the physical therapist work from the hip/buttock area all the way down to the foot.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained
orthopedic surgeon/sports medicine specialist and is president of
Victory Sports Medicine & Orthopedics in Skaneateles.
It is very common to get pain in the front part of the knee. It may or may not be coming from the patella itself or the surrounding soft tissues, i.e. the muscles, tendons, joint capsule (casing) and ligaments.
We see it more commonly in females, but it can certainly occur in males. The reason it occurs a little bit more commonly in females is because the structure and anatomy of the female body tends to be a little bit different than the male's. Females tend to have a little bit wider pelvis (for childbearing purposes), and they tend to have more valgus or “knock knees.” The upper part of their tibia (shin bone) tends to be a little bit more bowed (proximal tibial vara). Many of them tend to have flat feet that turn inward (pes planus/pronation). Their patellae seems to point inward as well.
All of this is termed “miserable mal alignment syndrome.” In other words, the actual anatomical alignment of the patient's body can predispose their patella to track or ride a little bit more toward the outer (lateral) part of the patellofemoral joint, i.e. on the outer part of the groove in the femur where the patella sits. This tends to create more pressure on the undersurface of the patella, which tends to lead to pain and sometimes even chondromalacia, which is softening of the cartilage on the undersurface of the patella.
The vast majority of time this is more of an overuse type phenomenon where the muscles are weak and the patient tends to overuse them. Sometimes a patient may increase their exercise or activities too quickly. The weak muscle, coupled with the de-conditioning and the mal alignment, leads to a combination of pain in the front part of the knee.
The good news is that the vast majority of time this can be treated non operatively with physical therapy/exercises as well as other things such as orthotics and certain types of knee braces, which can help the tracking of the patella.
Also, gradually increasing activities to prevent overuse can be helpful. It can be a very nagging problem for some people.
The bad news is that surgery is very unpredictable for this particular problem.
There are certain surgical procedures that can be done, many of which can be done arthroscopically through small incisions. Sometimes we can go in and shave any loose or degenerated chondromalacia cartilage, but unfortunately there is no reliable way yet to replace that cartilage or “retread the tire.”
There are some cartilage replacement/growing techniques, but they are usually only for small areas and notoriously don't do well in the patellofemoral part of the joint. These procedures oftentimes only provide temporary relief.
Sometimes we can release the tissue between the kneecap and the thigh bone on the outer side of the patellofemoral joint to release the pressure on that area and help with the tracking of the patella. That is called a lateral release. Again, this surgery is somewhat unpredictable.
If the person is experiencing instability or their patella is dislocating, that is a different problem, and there is instability surgery that can be done. However, once again, any surgery on the patellofemoral joint is much more unpredictable than other types of surgery. Therefore, the hallmark of treatment is physical therapy and conservative measures.
It is sometimes frustrating for the patient and for the physician when the physician tells the patient that there is not necessarily any “good” surgery for this problem; but, the good news is if the patient is religious with their therapy and then eventually their home exercises, many times they will do very well. It is not just an issue with the knee itself, it is an issue with the entire leg. Subsequently when I send someone to physical therapy for this problem, I prefer that the physical therapist work from the hip/buttock area all the way down to the foot.
Dr. Marc P. Pietropaoli is a board certified/fellowship trained
orthopedic surgeon/sports medicine specialist and is president of
Victory Sports Medicine & Orthopedics in Skaneateles.
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