Materiały źródłowe

• #1 Patellofemoral pain syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4169618/

  The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. […] The pathogenesis of PFPS is multifactorial with various functional disorders of the lower extremity to be involved. […] Recent studies, however, show that maltracking of the patella probably plays a key role. […] Pal et al. have demonstrated that patella maltracking in patients with PFPS correlates with a delayed activation of the M. vastus medialis. […] The role of the Q-angle (static measure) as predictor for PFPS is discussed controversially. […] That means that the cause for maltracking of the patella and the imbalance of the vastus medialis and lateralis in some patients with a PFPS may not be part of a structural fault.

• #2

  https://link.springer.com/article/10.1007/s00167-013-2759-6

  The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. […] This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. […] The pathogenesis of PFPS is multifactorial with various functional disorders of the lower extremity to be involved. […] A possible trigger for the patellofemoral pain syndrome may be overload of the patellofemoral joint (e.g. high-intensity training). The combination of overload with dynamic valgus and functional lateralization of the patella may lead to overuse of the structures of the patellofemoral joint. […] Anterior knee pain can be a vicious cycle. By anterior knee pain, the muscle activity of the lower extremity may be further inhibited.

• #3 Patellofemoral Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557657/

  Patellofemoral syndrome (PFS) is one of the most common causes of anterior knee pain. […] The etiology of patellofemoral syndrome is without a clear consensus; however, it is likely multifactorial and secondary to training practices. It is thought to involve 6 anatomic areas, including subchondral bone, synovium, retinaculum, skin, nerve, and muscle. […] Studies point to four major contributing factors: malalignment of the lower extremity and/or patella, muscular imbalance of the lower extremity, overactivity/overload, and trauma. […] Of the four contributing factors, overuse appears to be the most important. […] Many patients with PFS do not demonstrate any signs of malalignment. Instead, during careful interviewing, overload of the patellofemoral joint is often described, which can lead to the development of PFS. […] Direct or indirect injuries to the patellar area can damage structures leading to PFS. […] Though studies have pointed to the above causes or risks of developing patellofemoral syndrome, most will agree its development is rarely secondary to a single component.

• #4 Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/1101/p2012.html

  Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment. Contributing factors include overuse and overload of the patellofemoral joint, biomechanical problems and muscular dysfunction. […] Patellofemoral pain syndrome can be defined as retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. […] Consensus is lacking regarding the cause and treatment of the syndrome. […] Repetitive contact at any of these areas, sometimes combined with maltracking of the patella that is often not detectable by the naked eye, is the likely mechanism of patellofemoral pain syndrome. […] Many theories have been proposed to explain the etiology of patellofemoral pain. These include biomechanical, muscular and overuse theories. In general, the literature and clinical experience suggest that the etiology of patellofemoral pain syndrome is multifactorial.

• #5 Patellofemoral Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/308471-overview

  Patellofemoral syndrome (PFS) is characterized by a group of symptoms that contribute to anterior knee pain. The pain is associated with positions of the knee that result in increased or misdirected mechanical forces between the patella (kneecap) and femur. […] Overall, PFS is thought to be associated with a combination of anatomic, biomechanical, behavioral, and psychological factors. […] While theories regarding the pathophysiology of PFS vary, the prevailing theory is that the syndrome is caused by abnormal tracking and alignment of the patella due to an imbalance of ligamentous and muscle forces as well as malalignment between the joint surfaces. Patellar maltracking leads to irritation of the richly innervated nerve endings within the retinaculum, subchondral bone, Hoffa (infrapatellar) fat pad, and peripatellar synovium. Moreover, load-bearing positions, as assumed in squatting and stair climbing, increase maltracking in patients with PFS. Excessive use of the joint with regard to either frequency or amount of loading also contributes to the symptoms. […] Psychological stress, chronic pain, and central sensitization may play a role in PFS. A systematic review reported that catastrophizing and fear avoidance had strong and consistent associations with pain and function in persons with PFS.

• #6 Patellofemoral Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p88.html

  Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. […] The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. The pain of PFPS often worsens with prolonged sitting or descending stairs. […] Patellar maltracking is believed to play a role in PFPS. Patellar maltracking, or lateral translation, increases with load-bearing positions, such as squatting, in patients with PFPS. Stimulation of nerve endings within the retinacula, Hoffa (infrapatellar) fat pad, and peripatellar synovium may also contribute to the development of PFPS. […] Dynamic valgus is another mechanism associated with PFPS. Dynamic valgus is a body position in which the knee collapses medially from excessive valgus, internal-external rotation, or both. This increases the lateral force on the patella, contributing to maltracking. Dynamic valgus is more common in female athletes, which may account for the higher incidence of PFPS in females.

• #7 Patellofemoral pain syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4169618/

  The exact cause of pain in patients with PFPS is unclear. Most probably the pain develops in the insertions of the extensor mechanism or within the subchondral bone. […] The patellofemoral pain syndrome is a clinical entity which leads to anterior knee pain in patients without any pathological changes at the cartilage of the patellofemoral joint. Patellar maltracking due to a functional malalignment or dynamic valgus may be an underlying cause for this clinical entity. Possible causes for the dynamic valgus may be decreased strength of the hip abductors or a pes pronatus valgus. The functional malalignment is associated with quadriceps dysbalance, hamstring tightness or iliotibial tract tightness.

• #8

  https://link.springer.com/article/10.1007/s00167-013-2759-6

  The exact cause of pain in patients with PFPS is unclear. Most probably the pain develops in the insertions of the extensor mechanism or within the subchondral bone. […] Patellar maltracking due to a functional malalignment or dynamic valgus may be an underlying cause for this clinical entity. Possible causes for the dynamic valgus may be decreased strength of the hip abductors or a pes pronatus valgus. The functional malalignment is associated with quadriceps dysbalance, hamstring tightness or iliotibial tract tightness.

• #9 Patellofemoral Pain Syndrome – WikiSM (Sports Medicine Wiki)

  https://wikism.org/Patellofemoral_Pain_Syndrome

  Patellofemoral Pain Syndrome (PFPS) is a common cause of anterior knee pain. […] The underlying etiology is often considered to be multifactorial. […] Patellar Tracking/ Malalignment: Patella maltracking has long been implicated as a cause. […] The role of the Q-angle as a cause or predictor of PFPS is controversial. […] Multiple studies have demonstrated increased knee abduction, dynamic valgus stressors on the knee joint in PFPS among athletes. […] Psychological factors: Jensen et al: patients with PFPS have higher level of mental distress compared to healthy controls. […] Most pain probably develops in the insertions of the extensor mechanism or within the subchondral bone. […] Increased expression of neurofilament protein, S-100 protein, neural growth factor and substance P in the lateral retinacula of PFPS. […] The medial retinaculum and MPFL. […] Patellar compression of subchondral bone.

• #10 Patellofemoral Pain Syndrome: A Review and Guidelines for Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/1101/p2012.html

  Because bending the knee increases the pressure between the patella and its various points of contact with the femur, patellofemoral pain syndrome is often classified as an overuse injury. […] However, a more appropriate term may be overload, because the syndrome can also affect inactive patients. […] No single biomechanical factor has been identified as a primary cause of patellofemoral pain, although many have been hypothesized. […] Foot pronation causes a compensatory internal rotation of the tibia or femur (femoral anteversion) that upsets the patellofemoral mechanism. […] Weakness of the quadriceps muscles is the most often cited area of concern. However, each potential cause should be evaluated and addressed appropriately to help guide conservative care. […] The potential muscular causes of patellofemoral pain can be divided into weakness and inflexibility categories. […] Although the etiology and treatment of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

• #11 Patellofemoral Pain Syndrome (PFPS) | Kneecap Pain

  https://stretchcoach.com/articles/patellofemoral-pain-syndrome/?srsltid=AfmBOopBUqTV8w-mieADmN1Too1kaHfrKMHCp7bTgmMkzMQGp3h6Llsc

  When looking at biomechanical problems, there has been more than one factor identified as a primary cause of patellofemoral pain. […] Bending the knee increases the pressure between the patella and various point of the femur, hence why patellofemoral pain syndrome is often classified as an overuse injury. However, a more appropriate term may be overload, because the syndrome can also affect inactive people.

• #11 Patellofemoral Pain Syndrome (PFPS) | Kneecap Pain

  https://stretchcoach.com/articles/patellofemoral-pain-syndrome/?srsltid=AfmBOopBUqTV8w-mieADmN1Too1kaHfrKMHCp7bTgmMkzMQGp3h6Llsc

  Patellofemoral pain syndrome (PFPS) is a knee injury that results in pain in the anterior (front) of the Patellofemoral (knee) joint. The pain is usually experienced from the bottom of the quadriceps muscles (thigh) to the top of the patella (kneecap). […] Literature suggests that the etiology of patellofemoral pain syndrome is multifactorial. Many theories have been proposed to explain patellofemoral pain, and these include: Muscular Imbalance and Disfunction, Biomechanical Problems, Overuse. […] The potential muscular causes of patellofemoral pain can be divided into weakness and tightness. Or, lack of strength and lack of flexibility. […] Weakness of the quadriceps muscles is a common area of concern. The quadriceps muscles include the vastus medialis, vastus intermedius, vastus lateralis and the rectus femoris. Weakness of any of these muscles may adversely affect the patellofemoral mechanism.

• #12

  https://link.springer.com/article/10.1007/s40141-014-0044-3

  Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal conditions seen in sports medicine clinics. The pathophysiology of PFPS is multifactorial. […] It is proposed that PFPS arises from a combination of biomechanical factors and tissue imbalances causing improper tracking of the patella in the trochlea of the femur, eventually leading to increased stress at the patellofemoral joint. […] The pathophysiology of PFPS is thought to be multifactorial. It is likely that a combination of biomechanical factors along with muscle and soft tissue imbalances lead to improper tracking of the patella in the trochlea of the femur, eventually leading to increased stress at the patellofemoral joint. Thus, microdamage, inflammation and pain of the cartilage and subchondral bone can arise. […] Patients with PFPS have been found to have increased patellofemoral joint stress, leading to the hypothesis that this in turn leads to increased cartilage and subchondral bone stress, causing damage and pain over time.

• #13 Understanding the patho-anatomy of patellofemoral pain: A crucial foundation for comprehensive management | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/125840-understanding-the-patho-anatomy-of-patellofemoral-pain-a-crucial-foundation-for-comprehensive-management

  As authors try to compare genders possible factors to cause the pain, women have a propensity to a higher Q angle value, dynamic valgus, internal rotation of the hip/femur, an increase in the adduction force of the hip, and pronation of the foot with hypermobility of the patella and ligament laxity. They have a propensity for more weakness in the strength of the quadriceps, external rotators, extensors, and hip abductors. The gluteus maximus has been described as the primary hip extensor and is essential during ambulation and running. If the gluteus maximus weakens, the internal rotation could increase, directly impacting the knee joint. […] The quadriceps promote knee movement, complete the knee extension, and restrict flexion as it is inserted into the proximal pole of the patella. The greater the force exerted during physical activities of daily living, such as going up and down, the more stress the patellar cartilage absorbs up to six times the body weight, irritating the subchondral bone. If the weakness of the abductors and external rotators of the hip and knee are identified, we can assume that the adductors and internal rotators can cause internal rotation and valgus during knee flexion movements, increasing the dynamic Q angle and, in turn, an increase in retro patellar stress.

• #14 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. […] Many things may contribute to the development of PFPS. Problems with the alignment of the kneecap and overuse from vigorous athletics or training are often significant factors. […] Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues. […] Factors that contribute to poor tracking of the kneecap include: Problems with the alignment of the legs between the hips and the ankles, which may result in a kneecap that shifts too far toward the outside or inside of the leg, or one that rides too high in the trochlear groove a condition called patella alta.

• #15 Patellofemoral pain syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4169618/

  Rather a dynamic or functional malalignment is seen in these patients. […] The functional malalignment or dynamic valgus can be visualized clinically with one-legged squats. […] Recent research has shown that functional malalignment does not arise in the knee joint but rather by internal rotation of the femur due to weakness of hip external rotators and abductors. […] An internal rotation of the tibia can also be caused by rear-foot eversion. […] Dynamic valgus may also have influence on the length of the iliotibial tract. […] There is some evidence in the literature that there is not only abnormal frontal plane knee motion in patients with PFPS. […] A possible trigger for the patellofemoral pain syndrome may be overload of the patellofemoral joint (e.g. high-intensity training).

• #16 Patellofemoral pain in athletes | OAJSM

  https://www.dovepress.com/patellofemoral-pain-in-athletes-peer-reviewed-fulltext-article-OAJSM

  There is strong evidence that muscular imbalances play a key role in the pathogenesis of PFP. […] Hip muscle dysfunction is probably an important factor in the pathogenesis of functional valgus malalignment in young patients with PFPS. […] There is strong evidence that, in some patients, foot disorders or deformities such as increased rearfoot eversion or pes pronatus valgus contribute to functional valgus. […] In conclusion, the literature provides evidence that in a subgroup of PFP patients, rearfoot and forefoot abnormalities contribute to the pathogenesis of dynamic valgus. […] The existing evidence regarding the pathogenesis of PFP can be summarized in an algorithm shown in Figure 8. Patellar maltracking owing to a functional malalignment or dynamic valgus may be an underlying cause of PFP.

• #16 Patellofemoral pain in athletes | OAJSM

  https://www.dovepress.com/patellofemoral-pain-in-athletes-peer-reviewed-fulltext-article-OAJSM

  Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. […] A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. […] Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. […] A recent study using 3 T magnetic resonance imaging (MRI) demonstrated that structural abnormalities of the patellofemoral cartilage are not associated with PFP. […] This provides strong scientific evidence that PFP is associated with patellar maltracking. […] In conclusion, patellar maltracking plays a key role in patients with PFP related to PFPS or PFOA. […] Dynamic valgus malalignment influences patellar tracking because the lateralized quadriceps force vector subsequently leads to lateralization of the patella.

• #17 Patellofemoral Pain Syndrome – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/

  Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh and the muscles that externally rotate and move the hip away from your body (this movement is called abduction). When the knee bends and straightens, the quadriceps muscles and tendon help to keep the kneecap centered within the trochlear groove, together with the hip muscles that help control the position of the thigh bone. Weak or imbalanced quadriceps and hip muscles can cause poor tracking of the kneecap within the groove. […] Patellofemoral pain syndrome occurs when nerves sense pain in the soft tissues and bone around the kneecap. These soft tissues include the tendons, the fat pad beneath the patella, and the synovial tissue that lines the knee joint. […] In some cases of patellofemoral pain, a condition called chondromalacia patella is present. Chondromalacia patella is the softening and breakdown of the articular cartilage on the underside of the kneecap. There are no nerves in articular cartilage so damage to the cartilage itself cannot directly cause pain. It can, however, lead to inflammation of the synovium and pain in the underlying bone.

• #18 Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors | Dynamic Medicine | Full Text

  https://dynamic-med.biomedcentral.com/articles/10.1186/1476-5918-7-9

  Patellofemoral Pain Syndrome (PFPS) is a term for a variety of pathologies or anatomical abnormalities leading to a type of anterior knee pain. Knowledge of the anatomy of the patellofemoral (PF) joint is essential to developing an understanding of the pathogenesis of PFPS. Pain may be caused by increased subcondral bone stress attributed to the stress of articulation or from cartilaginous lesions on the patella or distal femur. The pathology of PFPS may be related to decreased pulsatile blood flow in skeletally mature individuals. Tissue ischemia resulting from mechanical forces that reduce genicular arterial flow during passive flexion from 20 to 90 degrees may be a cause or consequence of the pain associated with PFPS. If ischemia is an issue in the pathogenesis of PFPS, an arteriogram or other sophisticated test may detect defects in the collateral flow that could warrant the use surgical or medical revascularization to treat PFPS. Gastrocnemius tightness reduces the amount of dorsiflexion leading to excessive subtalar joint pronation and tibial internal rotation which will cause femoral internal rotation to increase the Q angle. Therefore, one mechanism to PFPS pathogenesis is by increasing Q angle and increased PF joint stresses. Generalized ligamentous laxity is proposed to increase the total patellar mobility which would alter patellar tracking and lead to symptoms. The mechanism behind hamstring strength and pathogenesis of PFPS is not well understood, however overall lower body strength is recommended for a runner’s exercise program. Quadriceps weakness, specifically VMO weakness in comparison to the VL, can lead to lateral displacement of the patella causing the articulating pressure to be on the lateral facet. Excess patellar tilting laterally can lead to patellar medial hypomobility resulting in high stresses between the lateral facet of the patella and the lateral trochlea.

• #19 SciELO Brazil – CLINICAL MUSCULAR EVALUATION IN PATELLOFEMORAL PAIN SYNDROME CLINICAL MUSCULAR EVALUATION IN PATELLOFEMORAL PAIN SYNDROME

  https://www.scielo.br/j/aob/a/GQvYkJXZKpnM7NcfNPYLDLf/

  The etiology of PFPS is multifactorial; notable components include impairment of neuromuscular control of the trunk, pelvis, and legs during functional activities, particularly with regard to the imbalance of forces involved in the musculature around the knee. […] Muscle imbalance is believed to be one of the main factors that increases the risk of PFPS. […] Recent studies have shown that PFPS does not appear in the knee joint, but rather in the decreased amplitude of internal rotation of the femur, due to weakness of the hip abductors (gluteus medius and minimus muscles). […] Weakness of the gluteus medius and minimus muscles causes pelvic instability, and consequently the patient cannot support the pelvis for one minute while standing on the affected leg, thus determining pelvic drop, as reported by Petersen et al.

• #20 SciELO Brazil – CLINICAL MUSCULAR EVALUATION IN PATELLOFEMORAL PAIN SYNDROME CLINICAL MUSCULAR EVALUATION IN PATELLOFEMORAL PAIN SYNDROME

  https://www.scielo.br/j/aob/a/GQvYkJXZKpnM7NcfNPYLDLf/

  Besides pelvic instability, weakness of the hip muscles causes a leg alignment known as dynamic valgus. […] This biomechanical and muscular mechanism may be strongly linked to the pathogenesis of PFPS. […] This assessment pattern (dynamic valgus) was seen to have a strong influence on the pathogenesis of PFPS in our results (0.003).

• #21 Patellofemoral Pain Syndrome (PFPS) | QSP Physiotherapy & Massage.

  https://qsp.physio/patellofemoral-pain-syndrome-pfps/

  Other Potential injury mechanics of PFPS: Tightness in the iliotibial band which places excessive lateral force on the patella and can also externally rotate the tibia, altering the biomechanics of the patellofemoral mechanism. […] Weakness of hip external rotators muscles which results in compensatory foot pronation, again altering the tracking of the patella through changes in the tibias position in relation to the femur. […] PFPS has no set time period for healing. […] The longevity of the condition can often lead to greater levels of degeneration on the affected structures and eventually cause early onset arthritis or require surgical intervention. […] Strengthening of the quadriceps is a key factor of PFPS rehabilitation, in particular increasing the strength of the Vastus Medialis Obliquus has a positive effect on PFPS symptoms by increasing the medial forces projected onto the patella, counteracting the lateral shift of the patella.

• #22 Patellofemoral Pain Syndrome | PPT

  https://www.slideshare.net/slideshow/patellofemoral-pain-syndrome-243357897/243357897

  Patellofemoral Pain Syndrome (PFPS), commonly known as runner’s knee, is a condition characterized by anterior knee pain that is aggravated by activities involving the patellofemoral joint like climbing stairs, sitting with bent knees, or squatting. […] The main cause of PFPS is overuse injuries around in the patellofemoral region because the PF joint is essentially a Soft tissue joint. […] Weakness of the VMO- It allows the patella to track too far laterally. […] Tight IT Band- it places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the PF mechanism. […] Recent research has shown that functional malalignment does not arise in the knee joint but rather by internal rotation of the femur due to weakness of hip external rotators and abductors (M. gluteus medius and minimus).

• #23 The current management of patients with patellofemoral pain from the physical therapist’s perspective – Capin – Annals of Joint

  https://aoj.amegroups.org/article/view/4324/4924

  Throughout the successful management of PFP and especially when symptoms are chronic in nature, rehabilitation specialists must appreciate the complexity of the pain experience. […] Clinicians must recognize the difference between acute (protective) pain and chronic pain, which may limit function and inhibit progress. […] Encouraging regular movement and exercise within the pain-free envelope of function and, when appropriate, such as in the chronic case, even beyond the pain-free range, may be necessary to optimize function in patients with PFP. […] The rehabilitation program should be individually tailored, addressing the patients specific impairments and functional limitations and achieving the patients goals. […] Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFP. […] The persistence of altered movement is a key characteristic of chronic pain, which may be managed in part through emphasis on function over symptoms, graded exposure, patient education, and perhaps referral.

• #24 Patellofemoral pain syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792

  Patellofemoral pain syndrome can have several causes. It’s been linked with: […] Overuse. Running or jumping sports put repeated stress on the knee joint, which can cause irritation under the kneecap. […] Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around the hip and knee don’t keep the kneecap in line. Moving the knee inward during a squat has been linked to patellofemoral pain. […] Injury. Trauma to the kneecap, such as when the kneecap gets out of place or breaks, has been linked to patellofemoral pain syndrome. […] Surgery. Knee surgery can increase the risk of patellofemoral pain. This is especially true of repair to the anterior cruciate ligament using one’s own patellar tendon as a graft.

• #25 Patellofemoral Syndrome

  https://fpnotebook.com/Ortho/Knee/PtlfmrlSyndrm.htm

  Overuse syndrome in athletes […] Patella mal-tracking in the patellofemoral groove […] Degeneration of Patella […] Anatomic variation: Increased Q-Angle […] Anatomic variation: Shallow outer patellofemoral groove

• #26 Patellofemoral pain syndrome – Juzo

  https://www.juzo.com/en/service-knowledge/well-informed/knee-pain/patellofemoral-pain-syndrome

  If the kneecap has an asymmetric shape, the term is patella dysplasia. This malformation is usually congenital and, based on excessive one-sided strain, can cause increased cartilage wear underneath the kneecap. […] In cases of leg misalignment, the knee isnt loaded correctly, resulting in inappropriate stress. This can lead to cartilage wear and joint damage and consequently retropatellar joint pain, i.e. pain behind the kneecap.

• #27 Patellofemoral Pain Syndrome (PFPS) | Evado Studios

  https://evadostudios.com.au/blog/article/patellofemoral-pain-syndrome-pfps

  Patellofemoral Pain Syndrome (PFPS) refers to a multifactorial pathogenesis that leads to pain in and around the patella in the absence of other pathology. […] PFPS is initiated by increased training loads or unaccustomed activity that overloads the patellofemoral joint (PFJ). Increased training loads can occur from changes in training volume, frequency, repetitions, intensity, or training surfaces. […] When the quadriceps are weak, specifically the VMO, the vastus lateralis can exert higher forces resulting in a lateral glide, tilt or rotation of the patella. Therefore, when the knee straightens and bends, the patella wont track correctly in the groove, leading to pain particularly on the lateral facet. […] A tight IT band pulls the patella laterally placing excessive lateral force on the patella.

• #28 Patellofemoral Pain Syndrome (PFPS) | QSP Physiotherapy & Massage.

  https://qsp.physio/patellofemoral-pain-syndrome-pfps/

  Altered tracking of the patella during knee flexion and extension due to biomechanical changes often results in pain around the knee. […] This is due to a change in the directional forces applied to the patella on movement. […] PFPS can occur as a result of trauma to the patella. However, it is more commonly associated with multiple factors including anatomical or biomechanical abnormalities and/or muscular weakness, imbalance and dysfunction. […] The orientation of the patella varies between individuals, it can also vary between left and right limbs in the same individual, which can result in anatomical malalignments that contribute to PFPS. […] A common example of this imbalance is seen between two of the quadricep muscles. […] This results in the Vastus Lateralis exerting a higher force on the patellofemoral joint and causes a lateral glide, tilt or rotation of the patella.

• #29 Patellofemoral Pain Syndrome (PFPS) | Evado Studios

  https://evadostudios.com.au/blog/article/patellofemoral-pain-syndrome-pfps

  Weakness in the hip external rotators (glutes) results in compensatory foot pronation, overloading the knee joint medially. […] Various patella orientations may lead to changes in how the patella tracks and thus, can cause overuse/overload leading to irritation of soft tissues. Similarly, long-term deviation of patella alignment and orientation leads to muscular imbalances or biomechanical abnormalities which further provokes PFPS. […] Foot pronation (foot rolls inwards) causes compensatory internal rotation of the tibia during the weight acceptance phase of walking, which prevents the tibia from fully externally rotating during midstance. This prevents the knee from completely locking and causes the femur to compensate, increasing the contact pressure between the patella and lateral trochlear groove. This increases bone stress and symptoms of PFPS.

• #30 Relationship between muscle activation and sagittal knee joint biomechanics in patients with patellofemoral pain syndrome: a cross-sectional study | Knee Surgery & Related Research | Full Text

  https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-025-00259-4

  Patients with PFPS exhibit elevated muscle activation, particularly in response to changes in the knee extension moment, which is likely a compensatory mechanism to manage knee joint loading during gait. […] These findings reveal significant alterations in muscle activation patterns and KEM adjustments in patients with PFPS, which may serve as compensatory mechanisms to reduce joint load and alleviate pain. […] The specific muscle activation patterns observed in this study are likely influenced by the pathomechanics unique to PFPS.

• #31 Relationship between muscle activation and sagittal knee joint biomechanics in patients with patellofemoral pain syndrome: a cross-sectional study | Knee Surgery & Related Research | Full Text

  https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-025-00259-4

  Patellofemoral pain syndrome (PFPS) is one of the most common conditions affecting the knee joint, yet its pathomechanics remain unclear. […] Despite its high prevalence, the biomechanics and pathomechanics of PFPS remain unclear, which limits effective management strategies. […] It is generally accepted that the pathology of patellofemoral pain is related to elevated patellofemoral joint (PFJ) reaction forces, which is positively correlated with the knee extension moment (KEM) in the sagittal plane. […] On the basis of these results, it has been suggested that subjects with PFPS reduce KEM to decrease pain and PFJ reaction forces. However, the mechanism of how patients reduce KEM remains unclear. […] A recent study has shown that the central nervous system (CNS) modulates muscle activation to reduce the load within the joints in a rat model, leading to our hypothesis that muscle activation changes to reduce the KEM in patients with PFPS.

• #32 Etiology and Exercise Treatment of Patellofemoral Pain Syndrome, Rehabilitation Science, Science Publishing Group

  https://www.sciencepublishinggroup.com/article/10.11648/j.rs.20230802.12

  Objective: As a result of peripatellar pain or anatomical or biomechanical anomalies in the anterior knee, patellofemoral pain syndrome (PFPS) is a knee injury that can be made worse by weight-bearing activities like climbing and descending stairs. […] According to long-term follow-up studies, patellofemoral arthritis may eventually develop in 45% of PFPS patients who do not receive prompt and efficient treatment in the early stages, causing irreparable harm that may significantly impair the patient’s quality of life. […] In order to prevent injuries, enhance daily life activities and athletes’ sporting performance, it is important that we understand the mechanism and exercise treatment of PFPS. […] Its cause is still unknown, and its etiology is complicated, with the main contributing factors being poor lower extremity function, decreased muscle strength, lack of flexibility, and impaired neuromuscular control.

• #33 Patellofemoral Pain Syndrome – Davidson Orthopedics

  https://davidsonorthopedics.com/patellofemoral-pain-syndrome/

  Continuous use without treatment risks further breakdown of the cartilage behind the patella and can eventually lead to arthritis. […] Studies have shown that over 50% of patellar problems can be attributed to patellofemoral malalignment, causing stress and strain on the patella and other surrounding joints. […] Treatment of patellofemoral pain requires a specific, individual diagnosis from a dedicated expert.

• #34 Understanding the patho-anatomy of patellofemoral pain: A crucial foundation for comprehensive management | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/125840-understanding-the-patho-anatomy-of-patellofemoral-pain-a-crucial-foundation-for-comprehensive-management

  Patellofemoral or anterior knee pain is a common cause of medical evaluation around the globe. It is considered a multifactorial disease in which conservative management must focus on the alterations found in the physical exam and radiologic images. The pathophysiology of the condition has been reconsidered, attributing it to inappropriate training and high-demand and periodic physical activities where anatomical and mechanical structures directly impact the functioning of the joint. Numerous studies attempt to link the condition with anatomical and mechanical structures related to the functioning and kinematics of the patellofemoral joint. There are four leading causes: muscular imbalance that alters the biodynamics of the lower extremities, patellar malpositioning that causes compression of the patellar articular facet, impairment of proprioception, and inflammation of soft tissues that could cause the symptomatology.

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