Mechanism of Injury:

Results from trauma to the anterior aspect of the knee, postoperative or generalized muscle deconditioning, or from repetitive activities on incline surfaces.

Subjective Symptoms:

Anterior knee pain especially while walking on stairs and inclines. Patients may also complain of "giving way," crepitus, locking and swelling. Often, symptoms are bilateral. Patients complain of stiffness and a poorly localized dull ache with prolonged sitting ("movie sign").

Objective Signs:

Abnormal quadriceps muscle contraction with weakness of the vastus medialis obliquus. Often associated with tightness of the hamstrings and lateral soft tissue restraints of the knee. May have underlying patellofemoral instability and abnormal extensor mechanism alignment (i.e., increased quadriceps or 'Q' angle).

Natural History:

Without intervention, symptoms often persist or progress leading to further limitations in activity.

Nonsurgical:

Nonsurgical treatment is nearly always the mainstay of treatment. Emphasis is on a formal patellofemoral program with reduction of inflammation, improved flexibility and strengthening of the muscle groups responsible for patellar tracking. McConnell taping and bracing may be useful in some instances.

Surgical:

Rarely, with long standing patellar tilt or subluxation, arthroscopy and lateral release can be curative. Patellar femoral instability and localized arthritis may require a formal extensor mechanism realignment procedure that includes a tibial tubercle osteotomy (i.e., Fulkerson procedure).

Nonsurgical:

6-8 weeks

Avoid climbing and inclines

Surgical:

12-16 weeks

Procedure dependent