Dr Ronald Grelsamer is an associate clinical professor at the Mount Sinai Hospital in New York.

He has decades of experience in managing problems of the knee related to the patella. In this course he gives a comprehensive overview of those conditions that can cause pain in the patellar region.

Structure of the Course

Patellofemoral anatomy

Important patellofemoral concepts

Differential diagnosis of patellofemoral pain

  • conditions interfering with the mechanics of the knee
  • knee problems not necessarily involving the mechanics of the knee
  • 'Complex Regional Pain Syndrome'
  • 'referred pain', not originating with the knee at all

Conditions interfering with patellofemoral mechanics

  • tight structures around the knee
  • loose structures around the knee
  • factors increasing the Q-angle
  • overuse
  • deformed bones
  • stressed bones

Conditions causing patellofemoral pain but NOT interfering with the mechanics of the knee

  • knee problem but not necessarily involving the extensor mechanism
  • complex regional pain syndrome
  • referred pain from the hip and spine

Symptoms associated with patellofemoral pain

  • the nature of the injury
  • the nature of the discomfort
  • history of swelling
  • noises in the knee
  • pseudolocking, instability, catching

Examination in cases of patellofemoral pain

  • examination standing
  • sitting at the edge of the examination table
  • supine (lying on one's back)
  • prone (lying on one's stomach)
  • decubitus position (lying on one's side)

Imaging and X-rays for patellofemoral pain

Non-operative treatment for patellofemoral pain

  • preventing Overuse
  • mechanical support and improvement of posture
  • releasing tight structures on the lateral side
  • improving muscle balance
  • relieving local inflammation
  • artificial lubricants -Synvisc
  • diet & nutritional supplements

Surgery for Patellar Mal-alignment

  • releasing tight structures on the lateral side
  • tightening incompetent structures on the medial side
  • repositioning of the tibial tubercle

Surgery to slow established patellofemoral arthritis