July 4, 2010 Runner's Knee (Patellofemoral Pain Syndrome) by Stephen M. Pribut, DPM Description: The knee is a complex joint.

It includes the articulation between the tibia and femur (leg and thigh) and the patella (knee cap) and femur. The most common knee problems in running relate to what is called the "patellofemoral complex". This consists of the quadriceps, knee cap and patellar tendon. What is now called patellofemoral pain syndrome (PFPS) has also been called runner's knee, anterior knee pain, or chondromalacia of the patella. For many years runner's knee was considered to be a direct result of chondromalacia of the patella. This essentially means a softening of the cartilage of the knee cap. The anatomical sources of pain in this area is now considered to be from the richly innervated subchondral bone (bone below the articular cartilage), infrapatellar fat pad, or the medial and lateral retinaculum of the joint. Cartilage does not have the same blood supply that bone does. It relies on intermittent compression to squeeze out waste products and then allow nutrients to enter the cartilage from the ...certain synovial fluid of the joint. During running certain mechanical mechanical conditions may predispose you to a conditions may mistracking knee cap. Portions of the cartilage may then predispose you to a be under either too much or too little pressure and the mistracking knee appropriate intermittent compression that is needed for cap. waste removal and nutrition supply may not be present. This may result in cartilage deterioration, which at the knee usually occurs on the medial aspect or inner part of the knee cap. All patellofemoral pain though may not be caused by this mechanism, although uneven stresses across the joint are believed to play an important role in the development of pain in this area.

Anatomy The symptoms of runners knee include pain near the knee cap usually at the medial (inner) portion and below it. Pain is usually also felt after sitting for a long period of time with the knees bent. Running downhill and sometimes even walking down stairs can be followed by pain. This has been called the "movie theatre sign". The symptoms are aggravated when the knee is bent since (with increased vectors of force) increased pressure exists between the joint surface of the knee cap and the articular surface of the femur (thigh bone). This increase in force over-stresses the injured area and leads to pain. Causes: Factors that increase what is known as the "Q" (Quadriceps) angle increases the chance of having runners knee. The Q angle is an estimate of the effective angle at which the quadriceps averages its pull. It is determined by drawing a line from the Anterior Superior Iliac Spine (bump above and in front of your hip joint) to the center of your knee cap and a second line from the center of your knee cap to the insertion of the patellar tendon (where the tendon below your knee cap inserts). Normal is below 12 degrees, abnormal is usually considered to be above 15 degrees. Many times adding to the strong lateral pull of the bulk of the quadriceps is a weak vastus medialis (VMO). This is the portion of the quadriceps that helps medially stabilize the patella. It runs along the inside portion of the thigh bone to join at the knee cap with the other three muscles making up the quadriceps. Some of the mechanical conditions that may contribute to this include:

Wide Hips (female runners) Knock Knees (Genu Valgum) Subluxating Patella Patella Alta (high patella)