What Happens If Patellofemoral Pain Syndrome Goes Untreated
If left untreated, patellofemoral pain syndrome (PFPS) can worsen over time and lead to structural damage in the knee

Patellofemoral pain syndrome (PFPS) typically gets worse over time if left untreated, leading to structural damage in the knee and impaired knee function.

Furthermore, repetitive movements will keep aggravating the patellofemoral joint, causing further injury and more pain and discomfort.

What is patellofemoral pain syndrome?

The knee is made up of two primary joints: the tibiofemoral and patellofemoral joints

The patella or kneecap is a flat triangular bone with curved edges that lies within the femoral groove. The posterior part of the patella (fascies articularis) is covered with cartilage and surrounded by synovial fluid, which facilitates joint movement. Only the fascies articularis patellae and femoralis are in touch with the synovial fluid because the knee capsule is linked completely around the patella.

The collateral ligaments present on either side of the patella help stabilize the joint. Fluid-filled sacs called bursa around the patella include:

  • Prepatellaris: Bursa on the anterior side of the patella between the patellar tendon (which is linked to the patella) and skin. This is generally not in contact with the knee capsule and promotes the gliding of the patellar tendon.
  • Infrapatellaris: Bursa at the level of the tibial tuberosity. 

These bursae may become overactive when the knee is inflamed. 

What causes patellofemoral pain syndrome?

Also called runner’s knee, patellofemoral pain syndrome is a common condition among athletes. 

The condition is caused by constant biomechanical dysfunction, repetitive weight impact on the knee joint, or excessive load on the knee joint over a period of time. This can cause cartilage injury on the edges of the patella, resulting in discomfort and irritation.

Because the patellofemoral joint is complex, its function requires a careful balance of all the soft tissue structures that support the joint. If the muscles that connect to the knee are short and tight or their firing pattern is off, it leads to poor patella tracking and slipping out of the kneecap from its position when the leg bends or straightens, causing pain with movement.

With age, all structures that help with movement in the knee joint can get worn and damaged, resulting in dysfunction. Therefore, it is important to have any knee discomfort appropriately evaluated and treated.

What are different types of patellofemoral pain syndrome?

PFPS is categorized into four groups based on underlying causes:

  • Overuse or overload without impairment: Occurs when a runner or athlete increases the intensity or frequency of stress on the knee joint too soon without sufficient time for recovery
  • Muscle performance deficits: Occurs in people with poor performance in lower-extremity muscles, such as the hips and quadriceps
  • Movement coordination deficits: May be seen in people with internal rotation of the knees (genu valgus), which results in the impaired ability to regulate movement during actions such as jogging or squatting (poor knee alignment or knock knees may be a cause among runners)
  • Mobility impairments: Increased foot mobility or flexibility accompanied deficiencies in other areas such as the hamstrings, quadriceps, calves, or iliotibial band


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What are symptoms of patellofemoral pain syndrome?

Symptoms of patellofemoral pain syndrome may include:

  • Anterior knee discomfort (around the knee and over/under the kneecap)
  • Walking
  • Climbing upstairs
  • Crouching
  • Kneeling
  • Getting up from a chair
  • Jogging
  • Sitting for lengthy periods of time
  • Knee grinding or popping
  • Knee inflammation
  • Buckling of the knees

How is patellofemoral pain syndrome diagnosed?

Your doctor will ask about your history of knee issues and will move your leg and knee joints in various positions to rule out other disorders. Imaging tests may be ordered to confirm a diagnosis:

  • X-rays
    • Ordered to rule out any injury to the bones that make up the knee
    • Good for proper analysis of the bone and not the soft tissues
  • CT scan
    • Provides cross-sectional views of inside structures by combining X-ray images from various angles
    • Can view both bone and soft tissues, but the method uses far more radiation than standard X-rays
  • MRI scan
    • Produces detailed pictures of the soft tissues, such as ligaments, tendons, and muscles by using radio waves and a strong magnetic field
    • May be ordered if your symptoms do not improve with physical therapy and home exercise
    • More costly than X-rays or CT scans

What are the treatment options for patellofemoral pain syndrome?

Nonsurgical treatment

  • Physical activity: Reduce physical activity and avoid high-impact activities (such as running) and switch to low-impact exercises (such as swimming or biking). Avoid bent-knee activities (such as squats) and extensive durations of sitting or kneeling in a bent-knee position.
  • Ice application: Applying ice to the irritated area may help reduce discomfort and swelling.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Aspirin and ibuprofen can help relieve pain and inflammation.
  • Physical therapy: Exercises designed by a skilled physical therapist can help you strengthen and realign the muscles surrounding the knee joint. Many people benefit from strengthening the vastus medialis oblique, which is a quad muscle on the inside of the knee.
  • Knee bracing: Taping or bracing the knee can help to stabilize the kneecap and allow the patella to track correctly during movement.
  • Orthotics: Special footwear can help support the arch and absorb impact.

Surgical treatment

If symptoms do not improve after 6 weeks of conservative therapy, surgery may be considered a last resort.

Surgery is done arthroscopically, with tools entered through small incisions. During the procedure, parts of the injured kneecap cartilage may be removed and the patella is repositioned if necessary during the procedure.


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Medically Reviewed on 10/6/2022
Image Source: iStock image

Patellofemoral Pain Syndrome (PFPS). https://my.clevelandclinic.org/health/diseases/17914-patellofemoral-pain-syndrome-pfps

Patellofemoral Pain Syndrome. https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/

Patellofemoral pain syndrome. https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792