What is a Patello-Femoral Problem?

Patello-Femoral problems occur when the patella doesn't glide smoothly in the patello-femoral groove. When this occurs, the cartilage which "coats" the end of the femur and the underside of the patella (articular cartilage) begins to degenerate, leading to irritation, pain and inflammation.

What Causes Patello-Femoral Problems?

Patello-Femoral problems can occur as a result of muscle imbalance in the quadriceps muscles or because of anatomic variations (differences in how the bones in the knee are shaped). Anatomic variations occur in all people, because all people are unique. However, some people are born with bones which do not accomodate proper movement of the patella. When the quadriceps muscles are stronger on one side than they are on the other, the force of the stronger muscles cause the patella to shift more to that side. The patella then essentially "grinds" on the articular cartilage. Two types of anatomic variations occur most often. Some people are born with a greater angle between the femur and tibia. Women tend to have a greater angle here than men. The patella sits at the center of this angle and when the quadriceps muscles contract, this force attempts to straighten this angle, forcing the patella laterally (to the outside of the knee). Another case of anatomic variation occurs when one side of the patellar groove is lower than normal. This makes the groove too shallow. In this case, the patella may actually slip out of the groove, causing a patellar dislocation.

What are the symptoms I should look for?

Many people may have these conditions, yet never be bothered by them. Other people may find they experience pain when walking down stairs or down hills or when sitting for long periods of time. The knee may grind or "crunch" when getting up from a seated position. In more advanced cases, there may be a feeling of clicking or popping when the knee is bent. The knee may become inflamed (or swell) and become stiff or tight with heavy use.

How are these problems diagnosed?

A complete history of your knee problem(s) will help your orthopedist begin the diagnosis. X-rays are also very useful in determining the cause of patello-femoral problems because they will show the alignment of the patella in the patellar groove. Several X-rays may be taken with your knee in different bent positions so your orthopedist can see how your patella moves as your knee bends and straightens. Many of the symptoms are similar to those of other knee problems, so your doctor may have you undergo an MRI scan. This way other knee problems or causes of pain can be identified or ruled out.

How are patello-femoral problems treated?

Your doctor may first recommend or prescribe anti-inflammatory medications (such as ibuprofen) as well as rest and ice to help reduce swelling and pain. Physical therapy will be prescribed in the early stages to help increase flexibility, strength, alignment and muscle balance in the knee. If these steps do not improve the condition the doctor may suggest surgical correction. The surgeon can see exactly how the patella moves in the patellar groove by looking at the wear of the articular cartilage within the joint. If the condition is caused by a rough patellar surface, this can usually be corrected by smoothing the surface, or shaving the patella. If the patella problems appear to be caused by a malalignment problem, the surgeon may suggest a procedure called a lateral release. In this procedure, the tight ligaments on the outside (lateral side) of the patella are released to allow the patella to slide back into the proper groove. The released ligaments heal with time and the patella should remain in proper alignment. In cases involving these simple surgical procedures, rehabilitation will begin shortly after surgery and the patient should be feeling better in no time. However, one must remember that all people are different and recovery time will vary.