Christian Lattermann : Update: How to Make Patellofemoral Pain

Christian Lattermann : Update: How to Make Patellofemoral Pain Less Painful
Saturday, July 12, 2014 12:44pm - 12:52pm
How to make anterior knee pain less painful for the patient and the surgeon:
This lecture will provide an overview of how to approach patients with anterior
knee pain such that it is less painful for patient and physician
Pain in the front of the knee is multicausal:
п‚· Overload (muscle imbalance)
п‚· Overload (envelope vs activity profile)
п‚· Impingement (lateral or medial)
п‚· Alignment
п‚· Tendinitis
п‚· PF OA
п‚· Traumatic
Evaluate the knee carefully and obtain an adequate and inclusive history of the
activity level, activities that cause pain and those that will relief the pain:
п‚· Sports
п‚· Work related activities
п‚· Repetitive versus non-repetitive in nature
п‚· Chronic overload situations:
o Standing in one spot in one position for long times
o Lack of movement
o Environmental issues
o Overexertion (long distance running, down hill running)
п‚· Sudden changes in loading (i.e. weekend warrior lacking training, warm up)
Physical exam is important in order to detect nuances:
п‚· Tracking
п‚· Patella tilt
п‚· J-sign
п‚· Quad strength and girth, activation
п‚· Apprehension
п‚· Lateral / medial recess pain
 Gait anomalies (i.e. internally rotated “squinting” patella while ambulating)
Physical Therapy and non-operative options almost always will be effective, only
few patients will require any form of operative treatment. Issues such as gait,
muscle activation, necessary activity modifications etc will need to be addressed.
Only if non-operative treatment failed , operative solutions may help.
Beware of the patient who :
 Says they have done “all that” but cannot demonstrate a single exercise he
/she has done”
п‚· c/o anterior knee pain with highest level of activities only
п‚· c/o 10/10 pain
п‚· MRI findings showing chondromalacia