Part 3 of a course on Patellofemoral Pain by Dr Ronald Grelsamer of Mount Sinai Hospital in New York.

Pain around the knee cap (patella) will not develop without a cause. Although you may have been told that you have “chondromalacia” or that you suffer from “patellofemoral syndrome”, these terms actually encompass a wide variety of conditions. In this Part of the course I will run briefly through the list of some of these conditions.

A. Conditions interfering with the mechanics of the knee

Tight structures around the knee

• Tight lateral retinaculum (patellar tilt and/or lateral displacement)
• Tight ilio-tibial band
• Tight hamstrings
• Tight quads
• Tight calf muscles
• Patellar arthrofibrosis & patella baja

 

Loose structures around the knee

• constitutional laxity (hypermobility syndromes)
• patella alta (high knee caps)

 

Factors increasing the Q angle

• Flat feet
• Knock knees (valgus deformity)
• Poorly positioned tibial tubercle
• Tibial rotation (’miserable malalignment’)

 

Irritation of soft tissues inside the knee

• Plica syndrome
• Fat pad syndrome
• Pre-patellar & infra-patellar bursitis
• Synovial impingement
• Neuroma in the lateral retinaculum
• Early rheumatological conditions

 

Overuse

• Unusual exercise
• Patellar tendinopathy
• Quadriceps tendinopathy

 

Deformed bones

• Trochlear dysplasia
• Patellar dysplasia
• Bipartite patella
• Dorsal defect

 

Stressed bones

• Stress fracture of patella
• Traumatic fracture of patella
• Osgood Schlatters’ disease & Sinding-Larsen-Johansson syndrome

B. Knee problems not necessarily involving the mechanics of the knee

• Neuroma under the skin
• Osteochondritis dissecans
• Tumors
• Infection

C. 'Complex Regional Pain Syndrome'

I will go into this in more detail later.

D. 'Referred Pain', not originating with the knee at all

• Hip problem, e.g. slipped capital epiphysis
• Spine problem

This list is for reference and completes this part of the course. I’ll explain all the terms as we go along - don’t worry!