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Patellofemoral Syndrome

Patellofemoral syndrome, also known as chondromalacia patella, is a painful knee condition caused by a degeneration of the cartilage in the kneecap, which may be caused by overuse, injury, obesity or malalignment of the kneecap. While this condition can affect anyone, it is most common in athletes and people who put heavy stress on their knees.

Symptoms of Patellofemoral Syndrome

Individuals with patellofemoral syndrome experience knee pain that gets worse when the knee is bent, during activities that may include:

  • Kneeling
  • Walking up or down stairs
  • Squatting
  • Sitting
  • Jumping

Some individuals also experience a buckling or popping sensation within the knee, as well as feelings of tightness or fullness.

Diagnosis of Patellofemoral Syndrome

Patellofemoral syndrome is diagnosed through a physical examination of the knee and leg. Imaging tests may include X-rays, MRI scans or CT scans to visualize the tissue within the knee and rule out structural damage as the cause of pain.

Treatment of Patellofemoral Syndrome

While patellofemoral syndrome may be a chronic condition, there are several basic treatment options available to relieve symptoms, most of which focus on avoiding activities that may cause pain. Additional treatment may include:

  • Anti-inflammatory pain medications
  • Rest
  • Icing the affecting area
  • Supportive braces
  • Physical Therapy

Customized physical therapy exercises, including stretching of the hip, knee, and ankle to improve flexibility and relieve tightness, may also be effective for treating patellofemoral syndrome. Strengthening of the quadriceps and hamstrings is also important to ensure muscle balance about the knee joint. Weakness and stiffness are two common causes of patellofemoral syndrome that is amenable to rehabilitation.

More Information

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.