Patellofemoral Pain Syndrome (PFPS)
Patellofemoral pain syndrome (PFPS) is a common condition that limits athletes. A growing body of evidence has gained popularity in recent years that suggests hip dysfunction to be a major contributing factor to PFPS.
Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, Beverly Hills, CA, and surrounding locations.
PFPS and Hip Pain
Biomechanical and anatomic factors for PFPS have been interpreted through numerous studies. Clinical and research practice have recently reported an imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VO) to be the lead cause of increased lateral stress in the patellofemoral joint.
PFPS is also known to occur because of an abnormal patellar tracking. This is only secondary to an imbalance in the performance of quadriceps muscles. Nonoperative procedures are primarily focused on developing balance and strength in the VMO and other quadriceps muscles. While quadriceps exercise is the most prescribed intervention and it does result in a reduction in dysfunction and pain, it is not a complete resolution.
PFPS, in recent years, has also been related to deficits in core endurance and hip musculature. Patients with PFPS, as per biomechanical studies, demonstrate excessive hip adduction and internal rotation. Patients also have weak external rotators, hip abductors, and hip extensors as compared to patients that don’t have any pain.
According to a 2018 systemic review, knee and hip strengthening provides for effective and more superior results compared to knee strengthening on its own in patients with patellofemoral pain.
What is Patellar Malalignment?
Abnormal tracking of the kneecap in the trochlear groove may also be a cause for patellofemoral pain syndrome. The patella gets pushed to one side of the groove while bending the knee in this condition. This abnormality can result in increased pressure between the trochlea and the back of the patella, which may irritate soft tissues.
These are a few factors that can result in poor tracking of the kneecap:
- Alignment issues in the legs between the ankles and the hips: The kneecap may shift too far towards one side or ride too high within the trochlear groove because of alignment problems in a condition called patella alta.
- Muscular weakness or imbalance in the front of thigh: The quadriceps tendon and muscles work to keep the kneecap within the trochlear groove when the knee is used. You may experience poor tracking of the knee cap with imbalanced or weak quadriceps.
Diagnosis
Your doctor may check the following to help diagnose the cause of your pain and for ruling out any other physical concerns:
- Position of the kneecap
- Alignment of the lower leg
- Hip rotation, knee stability, and range of motion in the hips and knees
- Signs of tenderness in the kneecaps
- Thigh muscles attachment with the kneecap
- Flexibility, strength, tone, and firmness of the hips, hamstrings, and quadriceps
Imaging Studies
- Xray – Xray is required to rule out any damage to the bones
- MRI – This is ordered when the symptoms don’t improve with home exercise or physical therapy
Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, Beverly Hills, CA, and nearby areas for orthopedic surgery.
Contact the Southern California Hip Institute
Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:
Century City / Los Angeles: 310.595.1030
Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.
Also visit http://www.drgorthopedics.com/
