What is patellofemoral pain syndrome

Patellofemoral pain syndrome is pain in the joint between the kneecap and the thigh bone. It is usually not cartilage damage but overload: the joint gets more load than it can cope with, for example after a sudden increase in running, jumping or squatting.

Weak hip and thigh muscles, foot posture and movement technique also play a part. If MRI shows softening of the kneecap cartilage, this is called chondromalacia; the two often overlap, but pain does not always match the findings on images.

Symptoms

A dull ache around or behind the kneecap.
Pain gets worse with squatting, going down stairs, running and jumping.
The knee hurts after sitting for a long time with bent knees (“cinema sign”).
Sometimes painless crunching — this is not dangerous in itself.
There is usually no swelling or locking; if there is, the cause is probably something else.

Diagnosis

The diagnosis is based on symptoms and an examination: the doctor checks pain on squatting, the position of the kneecap and muscle strength. X-ray or MRI is used to rule out other causes — a meniscus tear, patellar tendinopathy and, in teenagers, Osgood-Schlatter disease.

Patellofemoral pain: treatment options

The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.

Option	What to expect	How well studied
Exercise therapy and physiotherapy	Reduces pain, strengthens muscles, improves function; the basis of treatment	Well studied, recommended
Braces, splints, insoles	Offload and stabilise, reduce pain under load	Moderate evidence
Load management, weight loss	Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain	Moderate evidence
Painkillers and NSAIDs	Ease pain during flare-ups; long-term use is limited by side effects	Limited or conflicting evidence
Corticosteroid injection	Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable	Little data
PRP / CGF	Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown	Little data
Surgery	Only for a structural cause: patellar instability or malalignment	When indicated — the doctor decides

We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.

When surgery is needed

Surgery is usually not needed for patellofemoral pain. Arthroscopic “clean-up” of the joint is not recommended. Surgery is only discussed when there is a structural cause — recurrent dislocation of the kneecap, marked malalignment or a large cartilage defect — and several months of exercise have not helped.

Timeline and outlook

Exercise usually brings noticeable improvement within 6–12 weeks. Load is reduced but not stopped completely: running and jumping are brought back gradually, guided by pain. In some people symptoms last a long time or come back, so it is worth continuing the exercises after things improve.

What to prepare for a free review

Images: MRI, ultrasound or X-ray (DICOM files or photos of the screen) and their reports.
When and how the pain started, where exactly it hurts, what makes it worse or better.
Treatment so far: injections, physiotherapy, surgery — and how it helped.
Other conditions and medications, especially blood thinners.

With this information, a partner-clinic physician can say whether further tests are needed and which treatment options suit you.

When to see a doctor urgently

The knee swells after an injury or locks.
The joint is hot and red, or you have a fever.
Pain at night and at rest, unrelated to activity.

Contraindications to injection treatment: active infection, active cancer, clotting disorders, pregnancy. Possible risks of injections are a temporary pain flare and swelling for 1–3 days and, rarely, infection; the treatment may also not work.

Scientific evidence

International consensus statements and a Cochrane review on treating patellofemoral pain:

Crossley KM et al. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions. Br J Sports Med, 2016.
Collins NJ et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain. Br J Sports Med, 2018.
van der Heijden RA et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev, 2015.

Frequently asked questions about patellofemoral pain

Can I run with patellofemoral pain?

Usually yes, but less: reduce distance and pace, avoid downhill running and let pain guide you. At the same time do exercises for the hip and thigh muscles.

Which exercises help?

Strengthening the quadriceps and the hip and gluteal muscles is the best-studied treatment. It is best to plan the programme with a physiotherapist.

Do taping and orthotic insoles help?

They can reduce pain in the first weeks when combined with exercise. They cannot replace exercise.

Do I need injections?

Usually not. Steroid and PRP injections have been little studied for patellofemoral pain and are not part of standard treatment.

How can RegenPAS help?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

Pain at the front of your knee? Send your images — we reply within 24 hours

Send your MRI or ultrasound and describe where and when it hurts. The coordinator replies within 24 hours; a clinic physician gives an opinion in 1–3 business days.

Send images

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