Patellofemoral Disorders

This chapter summarizes epidemiology, pathophysiology, work-up, and treatment principles for two main patellofemoral disorders—instability and patellofemoral pain. Young age, female gender, anatomic malalignment, and hip weakness are key risk factors for both disorders. A focused history, physical examination, and plain films are typically sufficient for diagnosis, with the help of advanced imaging for characterizing anatomy and ruling out other possible causes of knee pain or instability. The cornerstone of treatment for patellofemoral disorders is activity modification, anti-inflammatories, and physical therapy with a focus on strengthening the quadriceps and posterolateral hip muscles. Surgical management is rarely indicated in the absence of specific anatomic abnormalities. If patients fail to improve after a few months of optimal nonoperative management, further work-up with CT and MRI may be pursued. While counseling patients with patellofemoral disorders, it is important to manage expectations regarding the high rates of treatment failure and chronic knee pain. Finally, as patients with patellofemoral disorders often have concomitant anxiety, chronic pain, or depression, management should be multidisciplinary in nature.