“Runner’s Knee”

Patello-femoral pain syndrome (PFPS) is the broad term used to describe pain at the front of the knee and around the patella, or kneecap. It is typically called Runners knee or Jumpers knee, as it commonly occurs in athletic individuals who participate in sports. This condition, can, however, affect non-athletes as well. The pain and stiffness that it causes can make daily activities, such as climbing stairs, kneeling, and performing other everyday activities.

A number of things can contribute to the development of PFPS, however, the most common things would be abnormal biomechanical loading, mal-alignment of the kneecap or patella, abnormal patella tracking and training loads which are often increased too quickly.

The knee joint is made up of the lower end of the femur, the tibia and patella. Ligaments and tendons connect the femur to the rest of the knee joint. The four major ligaments in the knee joint are the Medial Collateral Ligament (MCL, Lateral Collateral Ligament (LCL), Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). These ligaments help to hold the knee together.

The patella rests in the groove of the femur, called the trochlea groove. Movement of the patella assists in making the movement of the knee joint easier. When you bend or straighten the knee, the patella moves back and forth inside the groove. Articular cartilage is found on the underside of the patella, around the femur and the tibia. This allows for gliding of the bones over each other as you move your leg.

Synovium is also found, which is a thin lining of tissue covering the surface of the joint. This assists in lubrication of the cartilage.

What Is Patello-femoral pain syndrome?

Patellofemoral pain occurs when there is an inflammatory process around the structures of the knee, including the tendons, fat pad and synovial tissue.

In some cases, the articular cartilage behind the kneecap can be softened and eventually lead to breakdown. This is called chondromalaciae patella. The pain from this condition is often due to the inflammatory process surrounding the knee due to the cartilage damage. Cartilage has no nerve supply, so does not directly cause pain.

Causes

  • Overuse
    • Increase in loading exercises involving the knee
      • Jogging
      • Squatting
      • Climbing stairs
    • Use of improper footwear
    • Changes in playing surface
      • In a Cape Town setting, the camber of the roads can often lead to overuse type injuries
  • Patella Maltracking
    • Increased pressure around the knee region due to abnormal tracking which leads to inflammation around the knee region
    • Risk Factors
      • Muscular Imbalances
      • Improper form

Symptoms

  • Pain on activities that requires repeated bending of the knee
  • Pain sitting for long periods of time with the knee bent
  • Popping or crackling in the knee when climbing stairs or after sitting for a long period of time

Management

Conservative Management

  • RICE for acute pain relief
  • Physical therapy
    • Often indicated to improve stability in the knee and strength around the knee joint
  • Orthotics
    • Indicated if the cause of the knee pain is due to abnormal foot shape

Surgical Management

  • Rarely done
  • Non-responsive cases of PFPS
  • Allows for removal of damaged cartilage or release of the tendon to correct cases of patella maltracking