Skip to main content
SpringerLink
Log in

Principles of Prevention and Rehabilitation for the Patellofemoral Joint

  • Chapter
  • First Online:
The Patellofemoral Joint

Abstract

Patellofemoral joint pain is frequently cited as the most common musculoskeletal complaints encountered in medicine among both the general and athlete populations. The anatomy and biomechanics of this joint are inherently complex in nature. A thorough understanding of these topics is essential to properly evaluate and treat these issues.

Located at the anterior knee, the joint has significant freedom. Stability is conferred by both osseous anatomy and several soft tissue structures that serve as both dynamic and static stabilizers. The patellofemoral joint aids in the efficiency of the knee extensor complex. Forces are applied to the joint in both the coronal and sagittal planes. Forces and their vectors change throughout knee range of motion further adding to the complexity. Alterations or imbalances in these forces can alter joint contact pressures ultimately producing pain or result in instability.

Conservative options such as physical therapy are often the first line treatment for patellofemoral disorders. General principles of these therapy regimens include selective muscle strengthening, stretching, proprioception, and functional movement training. The goal of this chapter is to introduce patellofemoral anatomy and biomechanics, as well as to review its rehabilitation principles to better understand its use in treatment of patellofemoral pathology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Devereaux MD, Lachmann SM. Patello-femoral arthralgia in athletes attending a sports injury clinic. Br J Sports Med. 1984;18(1):18–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Heino Brechter J, Powers CM. Patellofemoral stress during walking in persons with and without patellofemoral pain. Med Sci Sports Exerc. 2002;34(10):1582–93.

    Article  PubMed  Google Scholar 

  4. Kannus P, Aho H, Järvinen M, Niittymäki S. Computerized recording of visits to an outpatient sports clinic. Am J Sports Med. 1987;15(1):79–85.

    Article  CAS  PubMed  Google Scholar 

  5. Wood L, Muller S, Peat G. The epidemiology of patellofemoral disorders in adulthood: a review of routine general practice morbidity recording. Prim Health Care Res Dev. 2011;12(2):157–64.

    Article  PubMed  Google Scholar 

  6. Roush JR, Curtis BR. Prevalence of anterior knee pain in 18-35 year-old females. Int J Sports Phys Ther. 2012;7(4):396–401.

    PubMed  PubMed Central  Google Scholar 

  7. Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of patellofemoral pain: a systematic review and meta-analysis. PLoS One. 2018;13(1):e0190892.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Callaghan M, Selfe J. Has the incidence or prevalence of patellofemoral pain in the general population in the United Kingdom been properly evaluated? Phys Ther Sport. 2007;8(1):37–43.

    Article  Google Scholar 

  9. Dutton RA, Khadavi MJ, Fredericson M. Patellofemoral pain. Phys Med Rehabil Clin N Am. 2016;27(1):31–52.

    Article  PubMed  Google Scholar 

  10. Sobotta J. Atlas and text book of human anatomy. London: W.B. Saunders; 1909. 183 p.

    Google Scholar 

  11. Walsh W. Recurrent dislocation of the knee in the adult. In: Delee and Drez’s orthopaedic sports medicine. Philadelphia: Saunders; 2003. p. 1710–49.

    Google Scholar 

  12. Anatomy. Patellofemoral disorders. p. 19–28.

    Google Scholar 

  13. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19–26.

    Article  CAS  PubMed  Google Scholar 

  14. Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology. 2000;216(3):858–64.

    Article  CAS  PubMed  Google Scholar 

  15. Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane. A clinical analysis. Am J Sports Med. 1994;22(1):61–6.

    Article  CAS  PubMed  Google Scholar 

  16. Negrín R, Reyes NO, Iñiguez M, Gaggero N, Sandoval R, Jabes N, et al. Dynamic-anatomical reconstruction of medial patellofemoral ligament in open physis. Arthrosc Tech. 2020;9(7):e1027–32.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003;10(3):215–20.

    Article  CAS  PubMed  Google Scholar 

  18. Khasawneh RR, Allouh MZ, Abu-El-Rub E. Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PLoS One. 2019;14(6):e0218387.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Butler-Manuel PA, Justins D, Heatley FW. Sympathetically mediated anterior knee pain. Scintigraphy and anesthetic blockade in 19 patients. Acta Orthop Scand. 1992;63(1):90–3.

    Article  CAS  PubMed  Google Scholar 

  20. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med. 1998;26(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  21. Meira EP, Brumitt J. Influence of the hip on patients with patellofemoral pain syndrome: a systematic review. Sports Health. 2011;3(5):455–65.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Loudon JK. Biomechanics and pathomechanics of the patellofemoral joint. Int J Sports Phys Ther. 2016;11(6):820–30.

    PubMed  PubMed Central  Google Scholar 

  23. Andrish J. The biomechanics of patellofemoral stability. J Knee Surg. 2004;17(1):35–9.

    Article  PubMed  Google Scholar 

  24. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG. Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther. 2003;33(11):677–85.

    Article  PubMed  Google Scholar 

  25. Hollman JH, Ginos BE, Kozuchowski J, Vaughn AS, Krause DA, Youdas JW. Relationships between knee valgus, hip-muscle strength, and hip-muscle recruitment during a single-limb step-down. J Sport Rehabil. 2009;18(1):104–17.

    Article  PubMed  Google Scholar 

  26. Ford KR, Nguyen AD, Dischiavi SL, Hegedus EJ, Zuk EF, Taylor JB. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus. Open Access J Sports Med. 2015;6:291–303.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51.

    Article  PubMed  Google Scholar 

  28. Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984;66(5):715–24.

    Article  CAS  PubMed  Google Scholar 

  29. Wilson NA, Press JM, Koh JL, Hendrix RW, Zhang LQ. In vivo noninvasive evaluation of abnormal patellar tracking during squatting in patients with patellofemoral pain. J Bone Joint Surg Am. 2009;91(3):558–66.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Werner S. An evaluation of knee extensor and knee flexor torques and EMGs in patients with patellofemoral pain syndrome in comparison with matched controls. Knee Surg Sports Traumatol Arthrosc. 1995;3(2):89–94.

    Article  CAS  PubMed  Google Scholar 

  31. Lack S, Neal B, De Oliveira Silva D, Barton C. How to manage patellofemoral pain—understanding the multifactorial nature and treatment options. Phys Ther Sport. 2018;32:155–66.

    Article  PubMed  Google Scholar 

  32. Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G, Romero-Franco N, Núñez-Nagy S, Pecos-Martín D. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci. 2015;27(7):2387–90.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Witvrouw E, Danneels L, Van Tiggelen D, Willems TM, Cambier D. Open versus closed kinetic chain exercises in patellofemoral pain: a 5-year prospective randomized study. Am J Sports Med. 2004;32(5):1122–30.

    Article  PubMed  Google Scholar 

  34. Werner S. Anterior knee pain: an update of physical therapy. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2286–94.

    Article  PubMed  Google Scholar 

  35. Roush MB, Sevier TL, Wilson JK, Jenkinson DM, Helfst RH, Gehlsen GM, et al. Anterior knee pain: a clinical comparison of rehabilitation methods. Clin J Sport Med. 2000;10(1):22–8.

    Article  CAS  PubMed  Google Scholar 

  36. Smith AD, Stroud L, McQueen C. Flexibility and anterior knee pain in adolescent elite figure skaters. J Pediatr Orthop. 1991;11(1):77–82.

    Article  CAS  PubMed  Google Scholar 

  37. Doucette SA, Goble EM. The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med. 1992;20(4):434–40.

    Article  CAS  PubMed  Google Scholar 

  38. Saltychev M, Dutton RA, Laimi K, Beaupré GS, Virolainen P, Fredericson M. Effectiveness of conservative treatment for patellofemoral pain syndrome: a systematic review and meta-analysis. J Rehabil Med. 2018;50(5):393–401.

    Article  PubMed  Google Scholar 

  39. Collins NJ, Barton CJ, van Middelkoop M, Callaghan MJ, Rathleff MS, Vicenzino BT, et al. 2018 consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th international patellofemoral pain research retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170–8.

    Article  PubMed  Google Scholar 

  40. Willson JD, Dougherty CP, Ireland ML, Davis IM. Core stability and its relationship to lower extremity function and injury. J Am Acad Orthop Surg. 2005;13(5):316–25.

    Article  PubMed  Google Scholar 

  41. Capin JJ, Snyder-Mackler L. The current management of patients with patellofemoral pain from the physical therapist’s perspective. Ann Jt. 2018;3:40.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rabelo ND, Lima B, Reis AC, Bley AS, Yi LC, Fukuda TY, et al. Neuromuscular training and muscle strengthening in patients with patellofemoral pain syndrome: a protocol of randomized controlled trial. BMC Musculoskelet Disord. 2014;15:157.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Motealleh A, Mohamadi M, Moghadam MB, Nejati N, Arjang N, Ebrahimi N. Effects of core neuromuscular training on pain, balance, and functional performance in women with patellofemoral pain syndrome: a clinical trial. J Chiropr Med. 2019;18(1):9–18.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Willy RW, Manal KT, Witvrouw EE, Davis IS. Are mechanics different between male and female runners with patellofemoral pain? Med Sci Sports Exerc. 2012;44(11):2165–71.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Agresta C, Brown A. Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review. J Orthop Sports Phys Ther. 2015;45(8):576–84.

    Article  PubMed  Google Scholar 

  46. Thijs Y, Vingerhoets G, Pattyn E, Rombaut L, Witvrouw E. Does bracing influence brain activity during knee movement: an fMRI study. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1145–9.

    Article  PubMed  Google Scholar 

  47. Worrell T, Ingersoll CD, Bockrath-Pugliese K, Minis P. Effect of patellar taping and bracing on patellar position as determined by MRI in patients with patellofemoral pain. J Athl Train. 1998;33(1):16–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Lun VM, Wiley JP, Meeuwisse WH, Yanagawa TL. Effectiveness of patellar bracing for treatment of patellofemoral pain syndrome. Clin J Sport Med. 2005;15(4):235–40.

    Article  PubMed  Google Scholar 

  49. Petersen W, Ellermann A, Rembitzki IV, Scheffler S, Herbort M, Brüggemann GP, et al. Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial. Arch Orthop Trauma Surg. 2016;136(7):975–82.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Aminaka N, Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. J Athl Train. 2008;43(1):21–8.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Akbaş E, Atay AO, Yüksel I. The effects of additional kinesio taping over exercise in the treatment of patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 2011;45(5):335–41.

    PubMed  Google Scholar 

  52. Chang WD, Chen FC, Lee CL, Lin HY, Lai PT. Effects of Kinesio taping versus McConnell taping for patellofemoral pain syndrome: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:471208.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Leonard Tiger Onsen

  2. Orthopaedic & Spine Institute, Department of Orthopaedic Surgery, Northshore University HealthSystem, Skokie, IL, USA

    Jason L. Koh

Authors
  1. Leonard Tiger Onsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason L. Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. NorthShore Orthopaedic & Spine Institute, NorthShore University HealthSystem, Evanston, IL, USA

    Jason L. Koh

  2. Orthopaedic Surgery, Kobe University Hospital, Kobe, Japan

    Ryosuke Kuroda

  3. Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  4. Bioresearch Foundation, Orthopaedic Arthroscopic Surgery Intl, Milano, Italy

    Alberto Gobbi

Rights and permissions

Reprints and permissions

Copyright information

© 2022 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Onsen, L.T., Koh, J.L. (2022). Principles of Prevention and Rehabilitation for the Patellofemoral Joint. In: Koh, J.L., Kuroda, R., Espregueira-Mendes, J., Gobbi, A. (eds) The Patellofemoral Joint. Springer, Cham. https://doi.org/10.1007/978-3-030-81545-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81545-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81544-8

  • Online ISBN: 978-3-030-81545-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation