Patello Femoral Pain Syndrome – Symptoms, Diagnosis and Treatment

by admin-blog-kh | October 30, 2025 7:38 am

Summary

Patello Femoral Pain Syndrome (PFPS) is one of the conditions that affect the knee joint. It can happen to anybody at any age, however its most common in athletes, sportspersons, and marathoners. The condition is not very serious, and in most cases, home remedies and physiotherapy can solve the problem. In rare cases, minimally invasive surgery is required. In even rarer cases, open or incisional surgery will be required. In this article, we will understand the condition better.

Introduction 

The knee-joint, like any other bone-joint in the body, has a complex anatomy. There are three bones in this joint: femur or thigh-bone, upper end of the tibia or shin bone, and patella or the kneecap. There are 4 ligaments (ACL, PCL, LCL and MCL), and tendons, which fasten the femur and tibia to each other. The 4 ligaments act like ropes and hold the femur and tibia together. Two important tendons – quadriceps tendon and patellar tendon connect the muscles to the bones.

There are several components at the knee-joint which are responsible for the smooth functioning of the joint. Prominent among them are:

• Trochlear groove: This is a groove at the lower end, and on top of – the femur. The patella or kneecap rests in this groove. Whenever we bend, and then straighten up, the patella moves back and forth in the trochlea.
• Articular cartilage: This is a sticky substance present around the ends of the femur, around the trochlear groove, and below the patella. This acts as a lubricant and ensures the three bones slide smoothly against each other as and when we move our leg.
• Synovium—a thin tissue that lines or covers the surface of the knee-joint. A small quantity of liquid produced by the synovium (synovial fluid) also acts as a lubricant for the articular cartilage.
• Fat: There is a small pocket of fat just below the patella, which acts as a padding or cushion and hence a shock-absorber for the patella.

What is PFPS? 

Patello Femoral Pain Syndrome (PFPS) is a condition marked by dull pain under or around the kneecap. It is also called Runner’s knee or jumper’s knee, as it majorly affects runners, sportspersons and athletes who need to run or jump frequently as part of their work. However, it can also affect non-sportspersons, at any age. It can affect either or both the knees. The pain worsens when the person has to sit for long periods of time with the knees bent, as in a theatre or movie hall, social events and a car or flight journey. The pain becomes manageable when the person has rested for some time, or takes breaks from continuous sitting.

Causes and Risk Factors of Patello Femoral Pain Syndrome 

Why some people develop PFPS while some others with a similar profile does not, is not clearly understood. However, there are some risk factors.

• Overuse of the knee joint: People who need to sit, stand or squat repeatedly, throughout the day are at high risk. So also, sportspersons who need to flex their knee constantly, or jump for short heights are at huge risk. This is the largest category of PFPS patients.
• Problems with kneecap alignment: The kneecap may not be properly developed since childhood, or may get misaligned later as a result of accidents, improper sitting and squatting techniques etc. One example of misalignment is a kneecap that sits high on the knee-joint.
• Certain anatomy or body types: Obese people are at high risk because the knee-joint is bearing a lot of body weight above the knee, in addition to enabling constant movement.
• Gender: Women are at high risk. This is because the hips and pelvis are broader in them than men. This makes the angle at which the femur meets the patella, quite large.
• Weak muscles surrounding the knee: Atrophy of the muscles around the knee, due to a sedentary lifestyle or some ailment, or weak quadriceps, can trigger PFPS eventually.

• Muscle imbalance: While sitting, standing up or squatting, the muscles of the hip and knee should move in sync with each other so that the kneecap remains aligned properly. In some people, there can be an imbalance. For example, while squatting, the kneecap may move inwards instead of moving outwards. This can cause PFPS.
• Improper use of sporting-equipment, or poor sports-training techniques: Running, jumping, standing, sitting, flexing the knee, squatting, or straightening up after bending, if done improperly, can trigger PFPS.
• Changes to footwear: Certain footwear that are poorly designed (don’t provide enough cushioning), or very heavy, or tight, or do not complement the natural arch of the feet, can trigger PFPS. Once such footwear is discontinued, PFPS goes away gradually.
• Hard playing surfaces: Playing sports on hard surfaces such a brick and concrete, as against softer ground, grassy fields or astroturf can trigger PFPS.
• Trauma: An injury to the kneecap resulting from falling down on the knees, kneeling repeatedly, a violent collision with another player on the field, or a motor-vehicle accident, can damage the patella and trigger PFPS.
• Surgery: Surgery to repair the ACL[9] which uses the patellar tendon as a graft, can trigger PFPS in some people.
• Arthritis: Older patients with a history of arthritis can develop PFPS.
• Tight hamstring muscles or a tight Achilles tendon can trigger PFPS
• Misaligned feet or walking: In some people, the feet turn inward or face each other while sitting, instead of being aligned with the knee. When these people walk, the feet roll inward while thigh muscles pull the patella outward. This triggers PFPS eventually.

Symptoms of Patello Femoral Pain Syndrome 

• Knee pain after doing activities that require bending of the knee, such as squatting or climbing stairs. The pain increases with more activity and reduces while resting or taking breaks.
• Pain after sitting for long periods of time with knees bent, such as on flights, car journeys, movies/theatres/family functions etc. The pain reduces when one takes breaks or starts walking around.
• Crackling, popping, rubbing or grinding sounds from the knee when standing up, straightening up, or climbing stairs
• Pain that increases when sporting equipment, playing surfaces are changed, or when sporting activity becomes more intense.

Diagnosis of Patello Femoral Pain Syndrome 

Physical Examination

A qualified orthopaedic doctor[10] will ask questions about the person’s vocation, hobbies, lifestyle and history of pain. Then, he/she will ask the patient to walk, jump, jog lightly, sit, stand and squat to observe the level of discomfort. Next, he/she will gently pull on the kneecap or press on the knee-joint and observe the patient’s reaction to understand the level of pain. Finally, to confirm PFPS and rule out any other condition that is causing knee-pain, the orthopaedic doctor will check all of these:

• Whether the kneecap and lower leg are properly aligned with each other while sitting, standing, etc.
• The rotation and range of motion of the hips and knees, as well as stability of the knee
• If there is any tenderness in the kneecap
• The alignment of kneecap with thigh muscles and how firmly are they attached
• The firmness/tautness, flexibility and strength of the quadriceps (frontal thigh muscles), and hamstrings (rear thigh muscles)
• Flexibility and tightness of the feet and heel-cord

Imaging Tests 

• X-rays: An X-ray will show the presence and extent of physical damage to the kneecap.
• MRI scans: This will create a clear picture of the muscles, tendons, ligaments and soft-tissues in and around the knee.

Treatment Options for Patello Femoral Pain Syndrome 

Non-surgical  

• RICE: The first line of treatment for PFPS is a home-remedy called RICE. It involves Resting, using Ice-packs on the knee, tying Compression bandages on the knee, and keeping the knee Elevated from time to time.
• Physical therapy: There are a range of exercises that help stabilize the quadriceps and improve their strength and flexibility. The next set of exercises help improve the endurance, strength and range of movement in the knee joint[11]. Finally, core-strengthening exercises are aimed at strengthening the muscles of the lower back and abdomen.
• Orthotics: These refer to shoe inserts that will help align the foot and ankle as well as stabilize them so that the stress on the lower leg is reduced. While off-the-shelf inserts are available, the doctor may recommend a custom one, sometimes.

Minimally-invasive surgery

This uses an arthroscope which is a short endoscope fitted with a camera at the end. This is gently pushed into the knee-joint after making a small incision in the skin on the joint. The camera relays images to a computer screen which helps guide the doctor’s movements. MIS is done for one of the below reasons:

• Debridement: Some of the articular cartilage which is damaged, is removed from the patella. This reduces the knee-pain.
• Lateral release: In some cases, the lateral retinaculum tendon is so tight that it pulls the patella out of the trochlear groove. In such a case, a procedure called ‘lateral release’ is done to loosen the tissue and realign the patella properly.

Incisional surgery

If the patella is not tracking (moving properly) within the trochlear grove, an open or incisional procedure called Tibial Tubercle Transfer is done.

The tibial tubercle is a bony projection on the top end of the tibia (shin bone). The aim of this procedure is to move the patellar tendon, and some part of the tibial tubercle, so that the kneecap is realigned. To do so, the surgeons detach the tibial tubercle totally or partially, so it now becomes a loose piece. This piece and the patellar tendon are moved towards the inner side of the knee. The loose piece is then re-attached to the tibia using screws. This kind of a transfer achieves better tracking of the patella in the trochlear-groove.

If you’re experiencing persistent knee pain or symptoms of patellofemoral pain syndrome, consult the expert orthopaedic team at Kauvery Hospital[13]. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, Kauvery Hospital offers advanced diagnostics and personalised treatment plans to help you regain comfort and mobility[14].

All You Need to Know About Patellofemoral Pain Syndrome 

What is Patello Femoral Pain Syndrome?

Patello Femoral Pain Syndrome (PFPS), also known as Runner’s Knee, is a condition that causes pain around or behind the kneecap. It often occurs due to overuse, misalignment, or muscle imbalance around the knee joint.

What are the common symptoms of PFPS?

The most common symptoms include dull pain around the kneecap, discomfort while climbing stairs, squatting, or sitting for long periods, and sometimes a grinding or popping sound in the knee.

What causes Patello Femoral Pain Syndrome?

PFPS can be caused by overuse of the knee joint, improper alignment of the kneecap, weak thigh muscles, poor footwear, or repetitive stress from physical activities like running or jumping.

How is Patello Femoral Pain Syndrome diagnosed?

Diagnosis usually includes a physical examination by an orthopaedic specialist, followed by imaging tests such as X-rays or MRI scans to rule out other knee conditions.

What are the treatment options for PFPS?

Most cases are treated with rest, physiotherapy, and strengthening exercises. In rare cases, minimally invasive procedures or surgery may be recommended to correct alignment or relieve pain.

Can Patello Femoral Pain Syndrome be prevented?

Yes. Maintaining proper posture during exercise, strengthening thigh and hip muscles, wearing supportive footwear[15], and avoiding overuse of the knee joint can help prevent PFPS.

When should I consult an orthopaedic specialist?

You should see a doctor if knee pain persists, worsens with activity, or affects your ability to walk, climb stairs, or sit comfortably for long periods.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.

Chennai Alwarpet – 044 4000 6000 • Chennai Radial Road – 044 6111 6111 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011

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