Diagnosis of Patellofemoral Pain After Arthroscopic Meniscectomy

Karen Muller, Lynn Snyder-Mackler

Anterior knee pain is a common complaint, occurring in approximately 1 of 4 people; individuals involved in athletics report an even higher incidence. The condition is more common in women than men and most often affects younger persons, with a peak incidence between the ages of 10 and 35 years. Symptoms include the following: pain in the knee when ascending and descending stairs, when squatting, or with prolonged sitting; swelling; a popping or grinding sensation; and incidences of the knee buckling or giving way. Often termed patellofemoral pain syndrome (PFPS), the spectrum of symptoms varies greatly from one individual to another (eg, achy pain after a long run or severe pain when rising from a chair). Many patients with anterior knee pain are eventually referred to rehabilitation. Although PFPS is one of the most common clinical conditions treated by orthopaedic and sports physical therapists, a consensus as to how these patients should be managed does not exist. Subtle variations in symptoms (and the attribution of symptoms to a variety of different causes) deem it unlikely that a generic protocol for treatment or exercise prescription can be developed for the entire scope of individuals experiencing PFPS. Differential diagnosis must consider a range of inflammatory conditions, mechanical problems, and other conditions (eg, tendinitis and bursitis, patellar hypermobility, subluxation and dislocation, posterior cruciate ligament tear, plica, loose bodies, reflex sympathetic dystrophy, osteochondritis dissecans, systemic arthritis, muscle strain, stress fracture, meniscal tear, neuroma, tumor, and iliotibial band syndrome). A variety of techniques have been advocated for treatment of PFPS. Some of these techniques include nonsteroidal anti-inflammatory drugs, ice, quadriceps strengthening, stretching, patella taping or bracing, and orthotics; however, if we simply treat the inflammatory process without treating the underlying cause, the condition will ultimately become chronic or recurrent. Conversely, if we attempt to treat the malalignment without addressing the inflammatory process first, a chronic complaint of pain may result. Any exercise or technique that recreates pain might perpetuate inflammation. A technique that works in one instance may not work in another. The chronicity of the disorder, level of pain and inflammation, activity level, and lower extremity alignment should all be considered when developing a management strategy. Treatment and exercise programs must be based on specific signs and symptoms of each individual. The purpose of this report, therefore, is to illustrate the diagnostic process in the development of a treatment plan for a patient with anterior knee pain after meniscal surgery.

J Orthop Sports Phys Ther. 2000;30(3):138-142.

Key Words: patellofemoral pain syndrome, treatment, malalignment

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