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St. Mary's Center for Orthopaedics

Patellofemoral Pain Syndrome (Runner’s Knee)

What is runner’s knee?

Runner’s knee, also known as patellofemoral pain syndrome, is a condition characterized by dull pain around the front of the knee (patella), where it connects with the lower end of the thigh bone (femur).

What causes runner’s knee?

Runner’s knee may be caused by a structural defect, or a certain way of walking or running. Other causes may include the following:

  • a kneecap that is located too high in the knee joint
  • weak thigh muscles
  • tight hamstrings
  • tight Achilles tendons
  • poor foot support
  • walking or running with the feet rolling in, while the thigh muscles pull the kneecap outward
  • excessive training or overuse
  • injury

What are the symptoms of runner’s knee?

The following are the most common symptoms of runner’s knee. However, each individual may experience symptoms differently. Symptoms may include:

  • pain in and around the kneecap that may be felt with activity, or even after prolonged sitting with the knees bent, occasionally resulting in weakness or feelings of instability
  • rubbing, grinding, or clicking sound of the kneecap that can be heard at times when the knee is bent and straightened
  • kneecap is tender to the touch

The symptoms of runner’s knee may resemble other conditions and medical problems. Always consult your physician for a diagnosis.

How is Runner’s Knee Diagnosed?

Diagnosis of a runner’s usually is confirmed with a complete medical history and a physical examination.

Physical Examination
To assess your knee’s strength, mobility and alignment, the doctor may ask you to stand, walk, jump, squat, sit, and lie down.

The physical examination will include a check of the alignment of your lower leg, kneecap, and quadriceps; knee stability, hip rotation, and range of motion of knees and hips; under the kneecap for signs of tenderness; the attachment of thigh muscles to the kneecap; strength, flexibility, firmness, tone, and circumference of quadriceps and hamstring muscles; tightness of the heel cord and flexibility of the feet.

Imaging
The doctor may order diagnostic imaging studies, such as X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scans, and blood tests to rule out damage to the structure of the knee and the tissues that connect to it.

What is the Treatment for Runner’s Knee?

Specific treatment for runner’s knee will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the injury
  • your tolerance for specific medications, procedures, surgeries, or therapies
  • expectations for the course of the injury
  • your opinion or preference

The best course of treatment for runner’s knee is to stop running until running can resume without pain. Other treatment may include:

  • cold packs, compression, and elevation
  • medications such as ibuprofen
  • stretch exercises
  • strengthening exercises
  • arch support in shoes

Surgical Treatment
When needed, surgical treatments include:

  • Arthroscopy. The surgeon removes fragments of damaged kneecap cartilage through a small incision, using a pencil-sized instrument called an arthroscope.
  • Realignment: The surgeon opens the knee structure and realigns the kneecap, reducing the abnormal pressure on cartilage and supporting structures around the front of the knee.