Patellofemoral Syndrome and Osteoarthritis

00:01 So, Patellofemoral syndrome, let’s put that on the spotlight because it is really important.

00:06 It is the most common cause of anterior knee pain, both in general and among athletes specifically.

00:12 The classic is that movie sign.

00:15 You’re in a movie for two hours or so.

00:18 You first stand up, it's really stiff, very painful, you walk a little bit, that anterior knee pain gets better.

00:24 Also another one that’s worse with climbing stairs, but unlike the iliotibial band, this is going to be more of a central pain under the patella and kind of hard to describe.

00:33 It's usually a dull pain and kind of vague, but it can be really debilitating as well.

00:38 Doesn't mean it's always so benign or a mild type pain.

00:41 I’ve seen mild to severe patellofemoral syndrome pain as well.

00:46 On exam, one of the interesting things, and this might be on your exam, is the J sign.

00:51 So, as the knee is extended from 90° to full flexion, there will be a lateral patellar tracking.

00:57 There is patellar laxity in a lot of these cases.

00:59 So, you’ll actually see that the patella migrate more laterally.

01:04 And so, of course, you’re going to check for the stability of the patella.

01:08 Patients with patellofemoral syndrome are more likely to have a little bit more laxity in their patella.

01:14 You don't really need x-rays among these patients if you have – particularly when you have these other findings, the symptoms and the signs all suggest patellofemoral syndrome.

01:24 So, again, rest is important.

01:26 And it's important to actually recommend physical therapy for these patients.

01:31 And I was always of the mind, well, it’s always just about quad strengthening.

01:34 Actually sometimes quad strength in these patients is absolutely perfect.

01:39 It's just that they are too tight over that complex of muscles, and so therefore, they actually need more stretching.

01:46 And a physical therapist can be really helpful in determining which particular types of exercises your patient needs.

01:52 There is less evidence, however, for things like knee braces or patellar taping.

01:56 So, physical therapy on the exam would be the right answer if you had a list of potential interventions for patellofemoral syndrome.

02:06 And I have to mention osteoarthritis because among patients who are 50 and over, this is going to be the most common cause of knee pain.

02:12 So, certainly, think about exercise therapy for these individuals as well.

02:16 Generally, weight loss is certainly going to help and exercise therapy can really help to help stabilize the joint and, therefore, reduce pain in everyday activities.

02:27 As I’ve mentioned for other musculoskeletal disorders, acetaminophen has better safety, but is probably slightly less effective than NSAIDs overall, but I still use acetaminophen as my first go-to drug in cases where patients haven't tried anything for it.

02:43 Glucosamine and chondroitin are commonly used.

02:46 They are very much promoted for osteoarthritis.

02:49 They have a pretty mixed record of efficacy overall.

02:53 There's few studies that have shown that they’ve worked.

02:56 And the studies of higher quality tend to show no improvement.

02:59 That said, in my clinical practice, I can say that patients really like glucosamine in particular.

03:03 They think it works great.

03:05 So, that was an introduction to knee pain and some of its common causes.

03:11 I think as you review, just think about those atypical causes.

03:14 Those are going to be the ones that come up on the exam, less so osteoarthritis.

03:18 But iliotibial band syndrome, patellofemoral syndrome, those are things you should know something about and be ready to answer for because you could well see them coming up.

03:28 Thank you.