Skip to main content

Patellofemoral Pain: An Overview

  • Chapter
  • First Online:
Anterior Knee Pain and Patellar Instability

Abstract

Patellofemoral pain (PFP) or anterior knee pain (AKP) is defined as “pain around or behind the patella, which is aggravated by at least one activity that loads the patellofemoral joint (PFJ) during weight-bearing on a flexed knee (e.g., squatting, stair ambulation, jogging/running, hopping/jumping)”.

That those who know her, know her less, the nearer her they get.

Emily Elizabeth Dickinson

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Crossley KM, Stefanik JJ, Selfe J, et al. Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome m. Br J Sports Med 2016;50:839–843.

    Google Scholar 

  2. Crossley KM, Callaghan MJ, van Linschoten R. Patellofemoral pain. Br J Sports Med. 2016;50(4):247–50.

    Article  PubMed  Google Scholar 

  3. Smith BE, Selfe J, Thacker D, et al. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PLoS ONE. 2018;13(1): e0190892. https://doi.org/10.1371/journal.pone.0190892.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Maselli F, Storari L, Barbari V, et al. Prevalence and incidence of low back pain among runners: a systematic review. BMC Musculoskelet Disord. 2020;21(1):343.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wallace IJ, Worthington S, Felson DT, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci USA. 2017;114(35):9332–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Rathleff MS, Petersen KK, Arendt-Nielsen L, et al. Impaired conditioned pain modulation in young female adults with long-standing patellofemoral pain: a single blinded cross-sectional study. Pain Med. 2016;17(5):980–8.

    PubMed  Google Scholar 

  7. Grelsamer RP. Patellar nomenclature. The tower of babel revisited. Clin Orthop. 2005;436:60–65.

    Google Scholar 

  8. Collins NJ, Bierma-Zeinstra SM, Crossley KM, et al. Prognostic factors for patellofemoral pain: a multicentre observational analysis. Br J Sports Med. 2013;47(4):227–33.

    Article  PubMed  Google Scholar 

  9. Reijnders L, van de Groes SA. The quality of life of patients with patellofemoral pain—a systematic review. Acta Orthop Belg. 2020;86(4):678–87.

    PubMed  Google Scholar 

  10. Tan SS, van Linschoten RL, van Middelkoop M, et al. Cost-utility of exercise therapy in adolescents and young adults suffering from the patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20:568–79.

    Article  CAS  PubMed  Google Scholar 

  11. Sanchis-Alfonso V, Merchant AC. Iatrogenic medial patellar instability: an avoidable injury. Arthroscopy. 2015;31(8):1628–32.

    Article  PubMed  Google Scholar 

  12. van der Heijden RA, de Kanter JL, Bierma-Zeinstra SM, et al. Structural abnormalities on magnetic resonance imaging in patients with patellofemoral pain: A cross-sectional case-control study. Am J Sports Med. 2016. pii: 0363546516646107.

    Google Scholar 

  13. Rathleff MS, Rathleff CR, Olesen JL, et al. Is knee pain during adolescence a self-limiting condition? Prognosis of patellofemoral pain and other types of knee pain. Am J Sports Med. 2016;44(5):1165–71.

    Article  PubMed  Google Scholar 

  14. Powers CM, Bolgla LA, Callaghan MJ, et al. Patellofemoral pain: proximal, distal, and local factors, 2nd International Research Retreat. J Orthop Sports Phys Ther. 2012;42:A1-54.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Conchie H, Clark D, Metcalfe A, et al. Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: A case control study. Knee. 2016. https://doi.org/10.1016/j.knee.2016.04.009.

    Article  PubMed  Google Scholar 

  16. Johnson, LL. van Dyk E, Green JR et al. Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy. 1998;14:347–359.

    Google Scholar 

  17. De Oliveira SD, Barton C, Crossley K, et al. Implications of knee crepitus to the overall clinical presentation of women with and without patellofemoral pain. Phys Ther Sport. 2018;33:89–95.

    Article  Google Scholar 

  18. Robertson CJ, Hurley M, Jones F. People’s beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: a qualitative study. Musculoskelet Sci Pract. 2017;28:59–64.

    Article  PubMed  Google Scholar 

  19. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version 2019.

    Google Scholar 

  20. Levay D. The history of orthopaedics. New Jersey: The Parthenon Publishing Group; 1990.

    Google Scholar 

  21. Budinger K. Üeber ablösung von gelenkteilen und verwandte prozesse. Dtsch Z Chir. 1906;84:311–65.

    Article  Google Scholar 

  22. Budinger K. Üeber traumatische knorpelrisse im kniegelenk. Dtsch Z Chir. 1908;92:510.

    Article  Google Scholar 

  23. Leslie IJ, Bentley G. Arthroscopy in the diagnosis of chondromalacia patellae. Ann Rheum Dis. 1978;37:540–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Royle SG, Noble J, Davies DR, et al. The significance of chondromalacic changes on the patella. Arthroscopy. 1991;7:158–60.

    Article  CAS  PubMed  Google Scholar 

  25. Dye SF, Vaupel GL, Dye CC. Conscious neurosensory mapping of the internal structures of the human knee without intra-articular anesthesia. Am J Sports Med. 1998;26:773–7.

    Article  CAS  PubMed  Google Scholar 

  26. van der Heijden RA, Oei EHG, Bron EE, et al. No difference on quantitative magnetic resonance imaging in patellofemoral cartilage composition between patients with patellofemoral pain and healthy controls. Am J Sports Med. 2015;44(5):1172–8.

    Article  Google Scholar 

  27. Ficat P, Hungerford DS. Disorders of the Patello-Femoral Joint. Baltimore: Williams & Wilkins; 1977.

    Google Scholar 

  28. Grelsamer R. Patellar malalignment: current Concepts Review. J Bone Joint Surg. 2000;82A:1639–50.

    Article  Google Scholar 

  29. Hughston JC. Subluxation of the patella. J Bone Joint Surg. 1968;50-A: 1003–1026.

    Google Scholar 

  30. Merchant AC, Mercer RL, Jacobsen RH et al. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg. 1974; 56-A: 391–1396.

    Google Scholar 

  31. Merchant AC, Mercer RL. Lateral release of the patella: a preliminary report. Clin Orthop. 1974;103:40.

    Article  Google Scholar 

  32. Ficat P, Ficat C, Bailleux A. Syndrome d’hyperpression externe de la rotule (S.H.P.E). Rev Chir Orthop. 1975;61: 39–59.

    Google Scholar 

  33. Insall J. “Chondromalacia Patellae”: Patellar malalignment syndrome. Orthop Clin North Am. 1979;10:117–27.

    Article  CAS  PubMed  Google Scholar 

  34. Insall J, Bullough PG, Burnstein AH. Proximal “tube” realignment of the patella for chondromalacia patellae. Clin Orthop. 1979;144:63–9.

    Google Scholar 

  35. Insall JN, Aglietti P, Tria AJ Jr. Patellar pain and incongruence. II: Clinical application. Clin Orthop. 1983;176:225–232.

    Google Scholar 

  36. Fulkerson JP. The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop. 1983;179:129–33.

    Article  Google Scholar 

  37. Fulkerson JP, Tennant R, Jaivin JS. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment. Clin Orthop. 1985;197:196–205.

    Article  Google Scholar 

  38. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res. 1983;177:176–81.

    Article  Google Scholar 

  39. James, S.L. Chondromalacia of the Patella in the Adolescent. In: Kennedy JC. editor. The Injured Adolescent Knee. Baltimore: The Williams & Wilkins Company, 1979.

    Google Scholar 

  40. Teitge RA. Patellofemoral disorders correction of rotational malalignment of the lower extremity. In: Noyess, knee disorders: surgery, rehabilitation, clinical outcomes, Elsevier, 2017.

    Google Scholar 

  41. Teitge RA. Does lower limb torsion matter? Tech Knee Surg. 2012;11:137–46.

    Article  Google Scholar 

  42. Teitge RA. The power of transverse plane limb mal-alignment in the genesis of anterior knee pain—clinical relevance. Ann Joint. 2018;3:70.

    Article  Google Scholar 

  43. Meister K, James SL. Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity. Am J Orthop (Belle Mead NJ). 1995;24:149–55.

    CAS  PubMed  Google Scholar 

  44. Cooke TD, Price N, Fisher B. The inwardly pointing knee. An unrecognized problem of external rotational malalignment. Clin. Orthop Relat. 1990;56–60.

    Google Scholar 

  45. Sanchis-Alfonso V, Domenech-Fernández J, Ferràs-Tarragó J, et al. The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active adult patients. A Systematic Review with Meta-Analysis. (In press).

    Google Scholar 

  46. Dye SF. The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop. 1996;325:10–8.

    Article  Google Scholar 

  47. Dye SF, Staubli HU, Biedert RM, et al. The mosaic of pathophysiology causing patellofemoral pain: therapeutic implications. Operative Techn Sports Med. 1999;7:46–54.

    Article  Google Scholar 

  48. Davis IS, Powers C. Patellofemoral pain syndrome: proximal, distal, and local factors—an international research retreat: April 30–May 2, 2009, Fells Point, Baltimore. MD J Orthop Sports Phys Ther. 2010;40(3):A1–48.

    Article  PubMed  Google Scholar 

  49. Witvrouw E, Callaghan MJ, Stefanik JJ, et al. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver. Br J Sports Med. 2014;48(6):411–4.

    Article  PubMed  Google Scholar 

  50. Crossley KM, van Middelkoop M, Callaghan MJ, et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). Br J Sports Med. 2016;50(14):844–852.

    Google Scholar 

  51. Powers C, Witvrouw E, Davis IS, et al. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017;51(24):1713–23.

    Article  PubMed  Google Scholar 

  52. Collins NJ, Barton ChJ, van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170–8.

    Article  PubMed  Google Scholar 

  53. Powers CM, Ward SR, Fredericson M, et al. Patellofemoral kinematics during weightbearing and non-weightbearing knee extension in persons with patellar subluxation: A preliminary study. J Orthop Sports Phys Ther. 2003;33:677–85.

    Article  PubMed  Google Scholar 

  54. Souza RB, Draper CE, Fredericson M, et al. Femur rotation and patellofemoral joint kinematics: A weight-bearing MRI analysis. J Orthop Sports Phys Ther. 2010;40:277–85.

    Article  PubMed  Google Scholar 

  55. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33:686–93.

    Article  PubMed  Google Scholar 

  56. Liao TC, Yang N, Ho KY, et al. Femur rotation increases patella cartilage stress in females with patellofemoral pain. Med Sci Sports Exerc. 2015;47(9):1775–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vicente Sanchis-Alfonso .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sanchis-Alfonso, V., Grelsamer, R.P. (2023). Patellofemoral Pain: An Overview. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-09767-6_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics