Dr Harry Papagapiou – Orthopedic Surgeon
MBCHB (WITS) MMED Orth (WITS) FC Orth (SA) Cert Knee Recon
A short review on the common causes & management options for elite & amateur level competitors, casual fitness training and standard daily activity sufferers
Patellofemoral Pain Syndrome (PFPS) also known as :
- Anterior Knee Pain Syndrome
- Chondromalacia Patellae
- “Cinema Goers Knee”
- “Runners Knee”
This is the most common cause of anterior knee pain. I see this condition frequently in my practice. Patients generally have difficulties with activities such as squats, lunges, stair climbing or descending & getting off a chair. These symptoms are usually of gradual onset, and in general patients have been living with this sort of cluster of problems with either activity modification, and apprehension towards certain activities. There is usually audible clicking coming from the knees, and occasionally there is an associated intermittent swelling in the knee that may go unnoticed for some time. Generally by the time a concerned runner, cyclist, gymnast or patient from various other sporting or activity backgrounds has reached my practice, they have had a trial of some sort of conservative management either with a Physiotherapist , Biokineticist or Sports therapist. Conservative management and activity modification transiently is generally the mainstay of treatment and tends to work in a large number of cases, however there is a grading system for chondromalacia patellae. The higher the grade/severity the more likely the condition involves cartilage “cracking” or fissuring that requires mechanical management I.e. surgical intervention. Ofcourse targeting muscle imbalance & patellofemoral tracking, soft tissue releases etc will assist in alleviating symptoms.
There is a higher female to male ratio, and may be seen more frequently in patients with associated generalised joint laxity, femoral retroversion , knock knees etc. BMI or weight does not significantly have a role in this condition. During the consultations the individualised goals are discussed, signs are identified and generally an MRI is requested in order to confirm the diagnosis. If we decide arthroscopic surgery is necessary, the procedure involves a minimal invasive “key hole” technique of stabilising the cartilage using radio frequency instrumentation. The mechanics are optimised, cartilage stabilised and Plicae (Tethering tissue) are released – in essence the PFJ compartment ( ‘knee cap compartment’) is decompressed. This alleviates symptoms, allows successful rehabilitation of
the knee, and allows return to activities/sports.The rehab process is generally between 3 to 6 weeks depending on severity but mobility starts immediately post op. Crutches may be required initially.