Patellofemoral Joint Pain
Joint pain caused by the interaction of the femur (thigh bone) and patella (kneecap) has two main causes. One possibility is a breakdown of the cartilage under the kneecap, called chondromalacia patella. A closely linked ailment is pain on the back of the kneecap, called patellofemoral pain syndrome. Related ailments are patellar tendonitis and a torn meniscus.
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Chondromalacia Patella
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Chondromalacia patella is damage to the cartilage that serves as cushion under the kneecap. It can be caused by arthritis, which causes the cartilage to lose its ability to cushion, or from overuse and mal-tracking of the kneecap. If the damage is not caused by arthritis, then it is usually reversible.
Patellofemoral Pain Syndrome
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Patellofemoral pain syndrome is closely linked to chondromalacia patella. The kneecap is encased in tendon. That tendon is supposed to glide smoothly over the cushioning cartilage underneath. If that cartilage is damaged, it may roughen the tendon, causing pain and inflammation.
Because chondromalacia patella and patellofemoral pain syndrome are so strongly linked, their terms are sometimes used interchangeably.
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Mal-tracking
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The main cause of these two conditions is mal-tracking of the patella. Mal-tracking can lead the patellar tendon to press against the underlying cartilage in the wrong way, causing it to damage. This can be due to a muscle imbalance, tight muscles, insufficient foot support, or sometimes a high or low kneecap.
Treatment
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Treatment for mal-tracking consists of orthotic shoe inserts to support the arch, stretching hamstrings and calves, strengthening the hip muscles with leg lifts, strengthening the vastus medialis (inner quadriceps on the lower front of the thigh) with slow, narrow-range leg extensions and protecting knees in the cold. Ice and anti-inflammatories like Advil are used to treat the inflammation; as the former makes the knee brittle, exertion should wait until the knee has warmed again.
Physical therapy should be attempted for 3 to 6 months before surgery is considered, due to the high success rate of physical therapy and rest, and the long recovery period required after surgery.
Differential Diagnosis
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Pain can also arise in the same joint area because of patellar tendonitis or a torn meniscus. Patellar tendonitis usually results from mal-tracking of the patella as well, and therefore benefits from the same muscle imbalance treatment and stretching routines.
The meniscus is the cartilage between the tibia (shinbone) and femur that cushions the pressure between the two. Tears from overexertion or arthritis lead to pain that can be misconstrued as patellofemoral syndrome.
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