Patients with patellofemoral pain constitute one of the most common, yet vexing, clinical conditions managed by orthopedic surgeons worldwide. Despite decades of clinical experience and basic science research, there remains a general lack of agreement within the international knee community regarding the etiology and appropriate treatment for such patients. This issue of Sports Medicine and Arthroscopy Review will provide exposure to some new research findings and evolving concepts relative to this challenging clinical problem.
The standard paradigm underlying most orthopedic treatment for anterior knee discomfort is based on a pure structural and biomechanical etiology - namely, that the presence of chondromalacia and/or patellofemoral “malalignment” is the primary cause of pain. This perspective, however, has often led to therapeutic approaches that have actually resulted in worsening of the patient's patellofemoral pain, including aggravating muscle-strengthening exercises “to correct maltracking,” as well as excessive use of surgical procedures such as the lateral release and aggressive chondroplasties.
Over the past decade, an alternative perspective has emerged regarding the genesis of patellofemoral pain that has led to the development of different therapeutic approaches, which appear to be more logical and inherently safer than those based solely on structural and biomechanical factors. This new paradigm de-emphasizes the importance of such factors, and instead conceptualizes the etiology of patellofemoral pain as arising from the often transient loss of homeostasis of a variable mosaic of innervated patellofemoral tissues. Our panel of international experts will offer new ideas and perspectives on various aspects of this important orthopedic problem, beginning with an in-depth historical perspective. Topics to be covered in this symposium also include the latest findings on patellofemoral anatomy and neurosensory characteristics, a current assessment of the value of indicators of malalignment, and the latest thinking on treatment, including physical therapy and surgical procedures. I believe this timely update of a most difficult orthopedic problem will be of value to the practicing orthopedic surgeon and allied health care professionals.