What medications are useful in the Patellofemoral Syndrome?

Non-steroidal anti-inflammatory drugs (NSAID’s), taken in full anti-inflammatory doses, reduce inflammation in the patellofemoral joint. These include aspirin, ibuprofen (Advil), and numerous other prescription drugs (Disalcid, Naprosyn, Feldene, Clinoril, Dolobid, etc.). These medications reduce the inflammatory process by inhibiting prostaglandin synthesis. Prostaglandins are responsible for much of the pain, swelling, and destruction of cartilage. These medications are often quite effective. However, there is a risk of heartburn, gastritis, fluid retention, and other less common side effects. Therefore, these should not be taken without advice of a physician.

What role does physical therapy play?

The most common use of physical therapy is in initiating and advancing an exercise program, the backbone of treatment for the patellofemoral syndrome. In addition, in the acute stage, modalities such as ultrasound and electricity can reduce adhesions behind the patella. Mobilization techniques, often helpful as well, involve the therapist manually “freeing up” the patella so that patellar tracking is improved and symptoms reduced. The use of electrical stimulation and biofeedback has already been discussed. In addition, when other predisposing factors such as malalignment are identified, often the physical therapist can do things to help the patient compensate for the predisposing factors.

What role do orthotics play?

Orthotics are appliances which support, unload, or redistribute forces. In the case of the patellofemoral syndrome, it is often effective to use an elastic knee support with a patellar cut-out (with a horseshoe pad). This knee support results in better distribution of pressure at the patella and in better patellar tracking. This is often a temporary measure until quadriceps strength is sufficient to reduce symptoms. In addition, there is a role for shoe orthotics (inserts). This is primarily useful in people with malalignment. For example, if the patient has flat feet with a consequent increased “Q” angle, orthotics with arch support can reduce the Q angle and, therefore, result in decreased symptoms. Sometimes, taping techniques can be used to reduce symptoms related to patellar tracking.

What is the prognosis in the Patellofemoral Syndrome?

Eighty to eighty-five percent of the people with patello-femoral syndrome are successfully treated with the above measures. Careful evaluation of predisposing factors and a diligent exercise program results in even better statistical success.