Most often, this type of knee pain resolves with exercises: core + legs + activity modification.
Many people experience knee cap pain (patello-femoral disease) at sometime in their lives. Most often, this type of knee pain resolves over 2-3 months with exercises: core (sit ups, push ups, planks, bridges) + legs + activity modification (not all bodies are meant to run and jump – over and over every day). Knee cap pain people have a normal or mostly normal knee exam, X-rays and MRI. Exercise (physical therapy) and activity modification is the cornerstone of treatment. Additionally knee bracing, shoe orthotics, and tincture of time are used to treat these knees. Try these suggestions, wait a few months or see your primary care physician prior to seeking treatment from a knee specialist.
A small group of patients have more serious knee cap pain because of joint surface damage either behind the knee cap, in the groove the knee cap tracks, or on both surfaces. Typical causes are recurrent patella dislocation, anatomic imperfections (born this way) or repetitive kneeling or jumping activities. Symptoms include pain with stairs, arising from a chair, sitting at a movie, or hiking. People have a feeling of reflex buckling of the knee, catching of the knee and popping as the knee moves from bent to straight. There may have been previous injury with knee cap dislocation. First line treatment is the same as for “normal” patients, as many Knee Cap pain patients are good at tolerating their symptoms.
When non surgical means fail (McConnell taping, bracing, exercising, and activity modification) then one should consider surgical options. Most surgical treatments improve patients but rarely return a person “back to normal”.
MRI and Arthroscopy are important tool for evaluation of the extent of patellofemoral chondral disease.
In Office Arthroscopy combined with PRP (platelet rich plasma) injection may be benificial in patients younger than 50 with patellofemoral chondropathy (localized defect in joint surface).
Fulkerson Osteotomy (AMZ) alters patellofemoral mechanics and is effective for people with an abnormal Q angle and patellar chondral damage in specific locations with the knee otherwise healthy.
Autologous Chondrocyte Implantation (ACI) is used alone or in combination with other strategies for full thickness joint surface damage on the patella or in the trochlear groove.
Patellofemoral Arthroplasty (PFA)
Patellofemoral Arthroplasty (PFA), or replacement of the knee cap joint, is indicated in patients with advanced arthritis localized to the knee cap joint. Typically this is reserved for patients over the age of 45 with severe symptoms and marked abnormalities on physical exam, xray and MRI.
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