Patellofemoral Syndrome Treatment Options

Nonoperative treatment is usually the first line of approach for PFPS. This treatment option is suited for most patients since PFPS often responds well to conservative management.

The nonoperative approach includes a combination of rest, ice, compression, and elevation (RICE protocol), along with over-the-counter pain relievers like NSAIDs to reduce pain and inflammation. Physical therapy is a crucial component, focusing on exercises to strengthen the muscles around the knee, particularly the quadriceps and hip muscles, to improve kneecap alignment.

Lifestyle Modification

Lifestyle modifications can be an essential part of treating PFPS. The aim is to reduce activities that cause knee pain and introduce lower-impact activities. Modifying athletic activities, including changing running style or footwear, can often make a significant difference. For those with occupations that involve a lot of knee bending, changes in the way work tasks are performed can also be helpful.

Physical Therapy

Physical therapy is typically a mainstay of PFPS treatment. The focus is on strengthening the muscles that affect patellar tracking, including the quadriceps and hip muscles, and improving flexibility. Some patients may also benefit from specific interventions like patellar taping or the use of orthotic shoe inserts to improve patellar alignment.

Bracing or Taping

Patellar braces or tape can help maintain proper patella alignment and improve pain. They can be particularly useful in individuals with malalignment issues contributing to their PFPS. However, they are typically used in combination with other treatments like physical therapy.

Injections

In rare cases, if pain is severe and other conservative treatments have been ineffective, injections of corticosteroids, platelet rich plasma (PRP), or other medications may be considered. However, these provide temporary relief and are not typically the primary treatment for PFPS.

Surgery is typically reserved for severe cases of PFPS that do not respond to conservative treatment options. The goal of surgery is to correct underlying structural abnormalities that contribute to PFPS and treating any cartilage damage. Surgical options include:

Arthroscopic Surgery

This involves the use of a small camera (arthroscope) and tiny instruments to look inside the knee joint and address any issues that might be contributing to PFPS. This could include smoothing rough cartilage, releasing tight ligaments, or removing fragments of damaged tissue.

Cartilage preservation

If there is significant damage to the cartilage, procedures such as autologous chondrocyte implantation (ACI) or osteochondral autograft transplant (OATS) may be considered.

Lateral Release

This procedure involves cutting the ligaments on the outer side of the kneecap to allow it to align properly in the center of the femoral groove.

Medial patellofemoral ligament (MPFL) reconstruction

This procedure is performed to rebuild the ligament that holds the kneecap from moving too far to the outside of your knee, which may cause pain

Tibial Tubercle Osteotomy (TTO)

This procedure is considered if the tibial tubercle—the bony bump on the tibia where the patellar tendon attaches—is too far lateral (outside), contributing to poor patellar tracking. The tibial tubercle is cut and then moved to a more medial (inside) position to improve patellar alignment.

Trochleoplasty

A procedure to reshape the groove of the femur so the patella glides better.

Patellofemoral Replacement

In severe cases, if other treatments fail, a partial knee replacement involving the patella and the trochlea (the groove at the end of the thigh bone) may be considered.

Surgery is generally reserved for those who have not found relief from conservative treatments, and whose pain and functional limitations significantly impact their quality of life. Decisions about when to have surgery should be individualized, taking into account factors such as the person’s age, activity level, overall health, and personal goals and preferences.

Recovery from surgery for anterior knee pain and patellofemoral syndrome depends on the specific procedure performed. Physical therapy will be an essential part of the recovery process, aimed at regaining knee strength and function. Many people are able to return to their normal activities and sports within 3-6 months.