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.
- 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:
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.
Now that you have reviewed everything about the diagnosis of patellofemoral pain, test your knowledge by taking the quiz below.
- 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.
- Willy et al. 2019. Patellofemoral Pain Clinical Practice Guidelines Linked to the International Classification of Functioning , Disability and Health From the Academy of Orthopaedic Physical Therapy.
- Cook et al. 2012. Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome: a systematic review.
- Nunes et al. 2013. Clinical test for diagnosis of patellofemoral pain syndrome: systematic review with meta-analysis.
- Collins et al. 2016. Pain during prolonged sitting is a common problem in persons with patellofemoral pain.