Patellofemoral stress syndrome. Current concepts.

Patellofemoral stress syndrome is a condition of peripatellar pain without anatomic malalignment, history of trauma, patellar instability or clinical evidence of patellofemoral crepitus. These patients demonstrate lateral retinacular and iliotibial band tightness. Frequently, the patient's pain occurs when sitting for prolonged periods of time with the knee flexed, and most commonly with sporting events. A complete history and physical evaluation is necessary for an accurate diagnosis. This evaluation should include the following radiographs: anterior-posterior, lateral, and most importantly, the tangential views. Once diagnosed, patellofemoral stress syndrome is usually treated conservatively. Studies indicate that 60 to 80% of knees will respond favourably to conservative treatment. The exercise programme should include iliotibial band stretching, hamstring stretching, gastrocnemius stretching, progressive resistance straight leg raising and hip adduction strengthening. These exercises should be performed 2 times/day until symptoms subside and then 3 times/week as long as the patient is active in sports. If the conservative programme fails, surgical management may be considered. A lateral retinacular release or possibly lateral retinacular lengthening are surgical procedures recommended as reliable solutions in the majority of patients. These procedures require continuation of the exercise programme to be successful.