Knee - Patella Femoral Syndrome
Description
Patellofemoral pain syndrome is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is common in people who participate in sports—particularly females and young adults—but patellofemoral pain syndrome can occur in nonathletes, as well. The pain and stiffness it causes can make it difficult to climb stairs, kneel down, and perform other everyday activities.
What are the causes?
There are multiple causes of patellofemoral pain syndrome. Malalignment of the kneecap and or overuse from vigorous athletics or training are often contributing factors. Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh can also play a role in patellofemoral pain. When the knee bends and straightens, the quadriceps muscles and quadriceps tendon help to keep the kneecap within the trochlear groove. Weak or imbalanced quadriceps can cause poor tracking of the kneecap within the groove. Change in the frequency of activity, such as increasing the number of days you exercise each week, can also increase pain. Increase in duration or intensity of activity, such as running longer distances, can be a cause of this pain.
What are the symptoms?
Pain is often described as a dull, aching pain in the front of the knee. This pain may be present in one or both knees. Pain can be described more frequently during activities such as climbing stairs, running, jumping, or squatting. Patients also can report a popping or cracking sound in the knee when climbing stairs or standing up from a seated position.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam, which typically includes X-rays. Typically there is no bone abnormality and the area around the patella may be painful with pressure. Your surgeon will evaluate the motion and strength of the muscles around the knee. Some weakness and pain may be noted with resisted knee extension. X-rays are usually normal unless the inflammation is chronic, resulting in calcium formation within the tendon. MRI may be ordered if surgery is possible in the future.
Non-operative
Symptoms are often relieved with conservative treatment, such as changes in activity levels or a therapeutic exercise program. Stop doing the activities that make your knee hurt until your pain is resolved. This may mean changing your training routine or switching to low-impact activities that will place less stress on your knee joint. Biking and swimming are good low-impact options. If you are overweight, losing weight will also help to reduce pressure on your knee. RICE stands for rest, ice, compression, and elevation. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help reduce swelling and relieve pain.
Platelet-rich plasma (PRP) injection is another non operative option for treating pain. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. The goal is to promote an anti-inflammatory effect, reduce pain, and stimulate healing. Although one injection may help, studies support a series of 2 injections, 1 x Week/2 weeks. Not covered by insurance.
Bone Marrow Concentrate "Stem Cell" Injections is another non operative option for treating pain. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate stem cells, which are then re-injected into the joint. The goals are to change the living micro-environment of the joint to a positive one, and to decrease inflammation and cartilage cell death. Not covered by insurance.
Operative
Operative treatment for patellofemoral pain is seldom indicated, as most patients will respond to non-operative treatment. If non-operative treatment fails and operation becomes necessary, Dr. Liu can rebalance the ligaments inside of the knee to take pressure off of the knee cap where it sits in the groove. Following this arthroscopy procedure patients will expect to return to physical therapy for 3-4 months.
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Can I shower after surgery?
If you have a bulky dry dressing you can remove it on postop day #3; you may then shower allowing water to run over steri-strips or sutures; towel pat dry and keep clean; NO soaking or submerging operative body part. If you have a waterproof dressing, please leave it on until you follow up in the office. You can shower over the dressing, no soaking or submerging the shoulder
How long do I need to wear the compression stockings?
Dr. Liu wants you to keep the compression stockings on for 3 weeks. Compression stockings are the best way to help the swelling to go down after surgery.
Should I use ice or heat?
Ice can provide analgesic effects and control swelling for the first 3-5 days; after that we recommend ice after exercises or PT.
How do I use an ice machine or CPM?
if either device is part of your recovery, treat this as an assistance to your recovery. Use either as directed, allowing only the machine to move or do the work. Remember, you should not be doing the work or moving the operative body part on your own.
How do I decrease my pain after surgery?
You may take your pain medication as prescribed; if pain continues, you may add ibuprofen or naproxen in between pain medication doses: (8am pain med, 10am ibuprofen 600-800mg or naproxen 500mg, 12p pain med).
Who schedules my first post operative appointment?
You are responsible for scheduling this appointment. This can be done prior to your surgery or within 1-3 days following. Please call the office, at 702-740-5327, provide your date of surgery, and you will be provided your appointment time and date.
When can I drive?
This depends on your surgery. Please wait until your first post op visit to discuss with your provider.
When can I go swimming?
Please wait at least 4 weeks until you submerge your incision into baths or pools. When your incision is submerged, it can open up and increase risk of infection. We ask that you wait 4 weeks when the incision is healed to soak in tubs or pools.
When do I start Physical Therapy?
Physical Therapy will be discussed at your first postoperative visit 10-14 days after surgery.
I have questions that have not been answered.
Please re-read your postoperative instructions handout. If questions remain, please contact the surgery line that has been provided to you on your post surgical handout.