Diagnosis

In this section, you will find information about the diagnosis criteria for patellofemoral pain.

Recently, a consensus statement from the 4th International Patellofemoral Pain Research Retreat was published defining the most relevant criteria to diagnose patellofemoral pain. Additionally, you will find information about the role of imaging in patellofemoral pain. Should we request MRIs and X rays for every patient with patellofemoral pain? What does imaging tell us about patellofemoral pain?

Diagnosis of patellofemoral pain should be provided by a suitably qualified health professional. Other common terms include chondromalacia patellae, runners knee and knee cap pain.

This infographic does not replace consultation with a physiotherapist or doctor, but it might help understanding the criteria presented by a patellofemoral pain expert panel at the 4th Patellofemoral Pain Research Retreat.

The core criterion required to define patellofemoral pain is pain around or behind the patella, which is aggravated by at least one activity that loads the patellofemoral joint during weight bearing on a flexed knee (eg, squatting, stair ambulation, jogging/ running, hopping/jumping).

Additional criteria (not essential):

A. Crepitus or grinding sensation emanating from the patellofe- moral joint during knee flexion movements.

B. Tenderness on patellar facet palpation.

C. Small effusion.

D. Pain on sitting, rising on sitting, or straightening the knee following sitting.

Important note: People with a history of dislocation, or who report perceptions of subluxation, should not be diagnosed as having patellofemoral pain. Currently, such patients are considered to be a subgroup of people with patellofemoral disorders and/or pain, who may have distinct presentations, biomechanical risk factors and require different treatments approaches.

In the 20th century, it was believed that patellofemoral pain was caused by abnormalities of the patellofemoral joint. However, Kannus and colleagues  (1998) conducted a study using magnetic resonance imaging (MRI) to investigate this assumption. Interestingly, they found that patellofemoral pain was not necessarily related with cartilage defects.

Due to the technological development, today it is possible to detect even very small cartilage defects with the use of high-resolution MRI. Based on this rationale, van der Heijden and colleagues (2017) investigated if structural abnormalities of the pattelofemoral joint is associated with patellofemoral pain. Similarly to Kannus 20 years ago, they concluded that  structural abnormalities of the patellofemoral joint on MRI are not associated with patellofemoral pain. However, a large number of structural abnormalities of the patellofemoral joint on MRI were seen in both people with patellofemoral pain and pain-free.

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