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Keeping the Kneecaps on Track
By: Jason M. Tarno, D.O.

<Q: Many athletes and non-athletes suffer from pain in and around the kneecaps. Can you discuss what is causing the pain?

A: Yes. The knee joint is made up of three bones: the thigh bone (femur), the shin bone (tibia), and the kneecap (patella). During flexion and extension of the knee, the patella moves within a groove at the bottom of the femur. This is called the patellafemoral joint. In some people the patella fails to track properly. Tiny nerve endings under the knee cap are believed to be the source of the pain.

Q: Is there a name for this condition?

A: The medical name for this condition is patellafemoral tracking syndrome (PFTS).

Q: What types of activity tend to bring this condition on?

A: Runners commonly suffer from this disorder. In fact, another name for this condition is runner's knee. Going up and down stairs is another activity that brings about pain. Some people complain of "aching pain" under the kneecap simply with sitting for long periods of time.

Q: What is the cause of this disorder?

A: PFTS is really a disorder of biomechanics of the entire lower extremity, from the hips to the feet. Females tend to suffer from this condition more often than males, probably in part because of their wider pelvis. This causes a change in the angle from the hip to the knee by a few degrees, and in turn, a change in the mechanics of the knee. Another cause of this disorder is a weakened inside thigh muscle called the ventral medialis obliquus. The thigh muscle, or quadriceps, is made up of four separate muscles. The VMO is the most medial. When it becomes weak, the knee cap has a lateral pull from the other three muscles, and this causes pain. Still another cause of PFTS is flat feet ( a condition in which the natural arch of the foot is lost - either developmentally, or over time). Again, biomechanics plays out here. When the arch of the foot is lost, the shin, or tibia internally rotates, and the kneecap slides to the outside of the knee. So there really is a lot going on in terms of mechanics at the kneecap.

Q: Can PFTS ever be caused from an injury?

A: Sometimes an injury to the front of the knee can trigger this type of pain, but often no injury occurs. Bone structure is determined by genetics, and some people tend to have a narrow groove for the patella to track in. Some people even experience subluxation of their knee cap, which means that their knee cap moves laterally, out of the natural groove that it usually lives in.

Q: How is this disorder diagnosed?

A: Diagnosis is made on clinical grounds. Although X-rays may show a laterally tilted patella, or kneecap, the physical exam and the history from the patient are really what clues the physician in to what the problem is.

Q: What types of treatments are usually offered?

A: Conservative treatment is the mainstay. The best treatment takes in to account what is causing the problem biomechanically. Therefore, if someone has very flat feet, orthotics usually will provide a great deal of relief. Finding the right shoe with a proper arch support is also helpful.

Q: Are there any exercises that are helpful?

A: Yes. Strengthening the VMO of the quadriceps is critical. Most physicians should be able to outline the correct exercises. If not, referral to a physical therapist is usually beneficial. Exercises for the VMO can be performed during the day at home, and even on the job. In some people, taping of the knee cap proves helpful as well.

Q: Is surgery ever needed?

A: For the typical person with PFTS, the answer is no. However, for individuals that have kneecaps which sublux from the joint, surgery is sometimes an option. This is only after conservative treatment such as physical therapy has failed though. Fortunately, most people are treated conservatively, and can get back to their activities in a rapid manner.

Jason M. Tarno, D.O.
Jason M. Tarno, D.O. is Board Certified in Sports Medicine. He has opened a new Sports Medicine Clinic.