Surgical Approach to Patellofemoral Pain

Patellofemoral pain is a common complaint encountered by most practicing orthopedic providers. Anterior knee pain can be caused by a variety of different sources, which makes arriving at the proper diagnosis quite challenging. Often, chronic ongoing patellofemoral pain is perpetuated by a disrupted capacity of the patellofemoral joint to accommodate load, creating a cycle of overload-breakdown-pain. Fortunately, most patients with patellofemoral pain improve without surgery. For those that develop persistent pain after appropriate nonsurgical treatment, the caregiver should carefully delineate the underlying source of pain and avoid simply ascribing the pain to a nondescript “patellofemoral syndrome.” Patellofemoral pain is typically derived from the innervated peripatellar soft tissues or subchondral bone. Common causes include focal overload, deficient articular cartilage, and excessive peripatellar retinacular or synovial stress. Surgical treatment of patellofemoral pain should be directed at addressing the appropriate, often overly stressed, pathology. Depending on what drives the pain, surgical treatment can vary from a simple soft tissue release or resection of a localized pain source, to an unloading and/or realignment procedure to reduce focal articular overload. Surgical interventions for patellofemoral pain can be powerful in successfully alleviating symptoms when properly indicated and carefully directed at the source of pain.