Quite often individuals present with a dull ache in the front of the knee, worse on standing up from a chair and on negotiating stairs, especially whilst descending. A common source of such pain is the Patellofemoral Joint. Articular cartilage changes (softening or denudation) described as Chondromalacia Patella, could cause such pain. Subtle Malalignments could be the culprit. Patellar Tendinitis (inflammation of the patellar tendon) could be a common cause.
We see a large number of young active individuals in the clinic suffering from such problems. Quite important in managing them is to ascertain the real source of pain.
Well directed physiotherapy works wonders in such patients. Patellar taping, retinacular stretches and selective muscle strengthening are some of the modalities. Static cycling without resistance and swimming often provides a simple cure.
Resistant cases might benefit from Viscosupplement injections. The hypothesised mechanism is increasing the articular cartilage resistance to shear stresses, thereby preventing them from wear and tear.
Patellas with small (upto 3cm square) worn off surfaces can be treated surgically by replacing these defects (the OATS procedure – see Articular Cartilage Restoration).
Larger defects need the Specialised Patellofemoral Replacements. In all cases, treating the underlying reason (most often malalignment) is of utmost importance to prevent recurrence.