PATELLOFEMORAL PAIN SYNDROME IN YOUNG ADULTS

Abstract

PFPS is very common and a significant source of disability among athletes and young adults. It has a strong association with patellofemoral instability, and it is important to distinguish subluxation from true dislocation. The diagnosis of PFPS can be made by history and physical examination alone. Physical examination should include dynamic assessmentof the knee as well as the hips, feet, and gait. Diagnostic imaging is not necessary but can help to assess patellar alignment and help to rule out other pathology. The etiology of PFPS is multifactorial, and thus treatment selection should be focused according to the patient’s specific pathology. Physical therapy remains the mainstay of treatment, but there are many different ways to treat PFPS with physical therapy. There is no specific regimen on which therapies work best, but it seems that various patients will respond to different treatments based on their underlying pathology. Knee bracing, patellar taping, and foot orthotics may be helpful in some patients. When choosing treatment for patients, it is important to keep in mind that PFPS is also an overuse injury and it should be addressed as part of patient counseling. Surgery should not be considered for pain alone until all other forms of treatment have failed. Furthermore, surgery is only helpful if there is a specific structural problem to address. Patients with lateral patellar compression syndrome may benefit from a lateral retinacular release. Some patients may also require reconstruction of the medial retinaculum. Patients with isolated chondral defects may benefit from local debridement. Others who have significant articular cartilage injury may require a distal realignment procedure, in which the tibial tubercle is moved anteromedially to improve patellar tracking and unloadthe damaged articular cartilage. Patellectomy is rarely indicated, but may be necessary when there is severe articular degeneration.