Link with osteoarthritis

Patellofemoral pain is a musculoskeletal condition with high rates of recurrence and chronicity.1,2 Some studies suggest that the presence and persistence of patellofemoral pain is associated with the development of patellofemoral osteoarthritis in the future,3,4,5,6,7 a condition that leads to pain and disability and is linked to a negative impact on the individual and on the health system.

In this section, you will find detailed information about the possible link between patellofemoral pain and patellofemoral osteoarthritis. Let’s find out more?

The speculation that patellofemoral pain in adolescents and young adults may be a precursor to patellofemoral osteoarthritis in later years is based on two main factors: (i) some preliminary and indirect evidence suggests this possible progression, and (ii) the similarities between conditions.

Some preliminary evidence suggests that patellofemoral pain may progress to patellofemoral osteoarthritis over time.6,7 In a retrospective study6 with 118 people who underwent patellofemoral arthroplasty due to patellofemoral osteoarthritis, about 22% of the sample reported the presence of knee pain since adolescence, compared with only 6% of the control group consisting of 116 people who underwent medial tibiofemoral arthroplasty. Furthermore, in a sample of 84 people with chronic knee pain (no signs of patellofemoral osteoarthritis) evaluated longitudinally, 31% of people developed patellofemoral osteoarthritis at the end of the 7-year follow-up.7

Another factor that reinforces this progression is that both conditions have many similarities to each other, including symptoms and impairments presented by the affected individuals.3 The presence of anterior knee pain during activities that overload the patellofemoral joint, such as the stair ambulation and squatting, is a symptom present in both conditions. Also, reduced quadriceps muscle strength and power, reduced hip abductor muscle strength, and overweight and obesity are impairments shared by both patellofemoral pain and patellofemoral osteoarthritis.8,9,10,11

The main hypothesis is that the altered biomechanics of the lower limbs could lead to abnormal patellofemoral joint overload, which in young people could manifest as patellofemoral pain and, in the long term, could generate structural damage, and consequently progress to patellofemoral osteoarthritis.3

Although the relationship between patellofemoral pain and patellofemoral osteoarthritis has not yet been confirmed or ruled out, it is important to emphasize that adopting effective and evidence-based strategies for both prevention and treatment of patellofemoral pain is important to reduce the odds of chronicity and recurrence of the condition. In addition, several impairments commonly presented by people with patellofemoral pain are considered risk factors for the development of patellofemoral osteoarthritis, such as quadriceps muscle weakness12 and overweight and obesity11,13; therefore, even if there is no direct link, it is important to emphasize that adopting an evidence-based treatment can prevent the worsening and chronicity of patellofemoral pain, and the development of changes that increase the odds of progression to a more disabling condition with greater impact on the individual and for the health system, such as patellofemoral osteoarthritis.


Watch the video below with Dr. Harvi Hart answering the most common questions about this topic [COMING SOON]:

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  1. Lankhorst et al. 2016. Factors that predict a poor outcome 5–8 years after the diagnosis of patellofemoral pain: a multicentre observational analysis.
  2. Nimon et al. 1998. Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management.
  3. Wyndow et al. 2016. Is there a biomechanical link between patellofemoral pain and osteoarthritis? A narrative review.
  4. Crossley et al. 2016. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures.
  5. Crossley. 2014. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain?
  6. Utting et al. 2005. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?
  7. Thorstensson et al. 2009. Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria.
  8. Reid et al. 2015. Muscle power is an independent determinant of pain and quality of life in knee osteoarthritis.
  9. Fok et al. 2013. Patellofemoral joint loading during stair ambulation in people with patellofemoral osteoarthritis.
  10. Ferreira et al. 2021. Impaired isometric, concentric, and eccentric rate of torque development at the hip and knee in patellofemoral pain.
  11. Hart et al. 2017. Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis.
  12. Culvenor et al. 2019. Sex-specific influence of quadriceps weakness on worsening patellofemoral and tibiofemoral cartilage damage: A prospective cohort study.
  13. Hart et al. 2020. Obesity is related to incidence of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee (CHECK) study.