Patellofemorales

Patellofemorales refers to disorders of the patellofemoral joint, the articulation between the patella (kneecap) and the femoral trochlea. The joint works as the patella tracks within the femoral groove during knee bending and straightening, transmitting large forces especially during activities such as squatting, stairs, or jumping. Patellofemoral conditions can involve soft tissue, cartilage, or bony alignment, and can be influenced by hip and foot mechanics.

The term encompasses several conditions, most notably patellofemoral pain syndrome (PFPS), patellar instability and dislocation, and chondromalacia patellae. PFPS is the most frequent cause of anterior knee pain in adolescents and young adults and is often multifactorial, involving overuse, leg tracking (malalignment), muscle weakness, and faulty movement patterns. Patellar instability ranges from subluxation to true dislocation and is linked to laxity of stabilizing ligaments and maltracking. Chondromalacia patellae describes cartilage softening or damage beneath the patella.

Diagnosis relies on clinical history and examination, with common signs including anterior knee pain aggravated by stair climbing, squatting, or kneeling, patellar maltracking, crepitus, and a positive apprehension or patellar grind test. Imaging such as X-ray (often sunrise/merchant views) helps assess alignment and bone structure, while MRI can evaluate cartilage and soft tissue.

Management is typically conservative initially: activity modification, structured physical therapy focusing on quadriceps and hip-abductor/rotator strength, patellar tracking exercises, and flexibility work; patellar taping or braces and nonsteroidal anti-inflammatory drugs may provide symptomatic relief. When conservative measures fail or in cases of recurrent instability or significant cartilage damage, surgical options include realignment procedures, MPFL reconstruction, distalizing or medializing tibial tubercle transfer, or cartilage restoration. Prognosis varies with underlying factors; prevention emphasizes neuromuscular conditioning and proper training mechanics.