In this section, you will find detailed information about the diagnostic criteria for patellofemoral pain. Let’s find out more?

According to the recommendations of a consensus statement from the 4th International Patellofemoral Pain Research Retreat published in 20161 and of the first clinical guideline on patellofemoral pain recently published in 2019,2 the diagnosis of patellofemoral pain is essentially based on the clinical presentation of patients, associated with the exclusion of other conditions that may cause knee pain.

The main criteria for diagnosis of patellofemoral pain can be divided into: essential criteria, additional criteria, clinical tests and differential diagnosis.1,2

  • Presence of pain pain around or behind the patella
  • Symptoms reproduction during activities that that loads the patellofemoral joint during weight bearing on a flexed knee (e.g., squatting, stair ambulation, jogging/ running, hopping/jumping).

Additional criteria may or may not be present in people with patellofemoral pain and include:

  • Crepitus or grinding sensation emanating from the patellofemoral joint during knee flexion movements
  • Tenderness on patellar facet palpation
  • Small effusion
  • Pain on sitting, rising on sitting, or straightening the knee following sitting


Watch the video below with Dr Danilo de Oliveira Silva explaining more about what crepitus is and how to evaluate it clinically:

Regarding clinical tests for patellofemoral pain, systematic reviews3,4 demonstrate that the majority of clinical tests have poor diagnostic accuracy.

Although there is no “gold standard” clinical test for diagnosing patellofemoral pain, clinicians should use reproduction of retropatellar or peripatellar pain with functional activities loading the patellofemoral joint in a flexed position to complement the diagnosis, especially during squatting: patellofemoral pain is evident in 80% of people who are positive on this test.4

Other functional activities can also be evaluated, as they usually exacerbate the symptoms of people with patellofemoral pain. In a recent study, a large majority of individuals with patellofemoral pain reported at least some difficulty with squatting (93.7%), and also in other functional activities, such as stair negotiation (91.2%), and running (90.8%).5

Also, the tenderness on palpation of the patellar edges test can be used to complement the diagnosis, since that patellofemoral pain is evident in 71–75% of people with this finding.4

Another important component of patellofemoral pain diagnosis is the differential diagnosis. It is necessary to exclude any other possible condition that may cause knee pain, such as patellar tendinopathy, patellar subluxation, Osgood-Schlatter disease and Sinding-Larsen-Johansson disease.2

See the infographic below indicating the main components that should be taken into account during patellofemoral pain diagnosis:

PS: Click on each icon (!) below to learn more about the four steps of patellofemoral pain diagnosis.

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