Patellofemoral Arthritis: Symptoms, Diagnosis, Treatment & Recovery

What Is Patellofemoral Arthritis?

Patellofemoral arthritis is wear of the cartilage on the back of the kneecap (patella) and/or the trochlear groove of the femur. It commonly causes pain with stairs, hills, squatting, rising from a chair, and kneeling. The condition may occur in isolation or alongside generalised knee osteoarthritis.

Common Symptoms

• Front-of-knee pain with stairs (especially down), squats, kneeling, and prolonged sitting (“movie-goer’s knee”).
• Grinding/crepitus behind the kneecap when bending/straightening.
• Swelling after activity; occasional Baker’s cyst.
• Stiffness and loss of confidence on uneven ground or slopes.
• Giving way due to pain inhibition or maltracking.

Why Patellofemoral Arthritis Develops — Causes & Risk Factors

• Patellar maltracking or dysplasia (shape differences of the kneecap/groove).
• Prior instability or dislocations stretching soft tissues and damaging cartilage.
• Alignment & load: knock-knee (valgus), rotational differences, or foot mechanics.
• Overuse: repetitive stairs, squats, or kneeling at work/sport.
• Previous injury or surgery including fracture or longstanding patellar tendinopathy.
• General factors: age, genetics, body weight, and systemic inflammatory disease.

How We Diagnose Patellofemoral Arthritis

Diagnosis integrates your history, focused examination, and targeted imaging to define severity, alignment, and tracking.

Clinical assessment

• Patellofemoral compression and tracking tests; crepitus and tenderness behind the kneecap.
• Assessment of VMO/quadriceps control, hip strength, foot posture, and gait.
• Screen for instability (apprehension test) and ligament/meniscal signs.

Imaging

• X-rays (sunrise/merchant and lateral views) to assess joint-space, osteophytes, tilt, and height.
• MRI (selected cases) to map cartilage wear, bone oedema, and maltracking; useful for surgical planning.

Non-Operative Treatment (First-Line)

Many people improve with a structured program targeting pain, tracking, and joint loading. We work closely with our physiotherapy team.

1) Education & activity modification

• Manage stairs, hills, deep squats, and kneeling; use a handrail and shorter step lengths.
• Use cross-training (bike, pool) during flares to maintain fitness with lower joint load.

2) Exercise therapy

• Quadriceps/VMO strengthening and neuromuscular control to improve tracking.
• Hip abductor/external rotator strength to reduce dynamic valgus.
• Mobility for hamstrings, calves, and lateral retinaculum as indicated.
• Progressive functional drills (step-downs, sit-to-stand) with technique cues.

3) Taping, bracing & footwear

• Patellar taping strategies (e.g., McConnell) for short-term pain relief and movement retraining.
• Patellofemoral brace or sleeve for proprioception and tilt control during activities.
• Footwear or orthoses review to address excessive pronation where relevant.

4) Medications & injections

• Short, targeted use of analgesics/anti-inflammatories if appropriate.
• Corticosteroid injection for short-term relief during irritable flares.
• Hyaluronic acid and PRP may be considered in selected patients after discussion of evidence and goals.

Timeline: With consistent rehab and load modification, many patients notice improvement within 6–12 weeks. Severe maltracking or advanced cartilage loss may require surgical discussion.

Surgical Treatment (When Symptoms Persist)

Surgery is tailored to disease pattern, alignment, stability, and goals. We favour joint preservation and anatomy correction in younger patients, and arthroplasty when wear is advanced.

• Patellofemoral joint (PFJ) replacement: resurfaces the kneecap and trochlea in isolated patellofemoral arthritis with good alignment and intact ligaments.
• Total knee replacement: for multi-compartment arthritis or when alignment/ligaments make PFJ replacement unsuitable. See Knee Replacement.
• Tibial tubercle osteotomy (TTO): realigns the kneecap in selected maltracking/instability with focal wear (often younger patients).
• Cartilage restoration (selected): for focal lesions (e.g., MACI/osteochondral graft) when global arthritis is absent.
• Lateral release: rarely in isolation; may be adjunct to realignment when carefully indicated.

Risks & considerations

• Infection, bleeding, clots (rare), stiffness, wound issues.
• Persistent pain if malalignment/instability are not corrected.
• Implant longevity and activity guidance will be discussed in detail.

Recovery & Rehabilitation

Recovery depends on the treatment chosen and your baseline function:

1. Non-operative: progressive strength and mobility over weeks; flare-up strategies to keep you active.
2. After PFJ replacement: immediate walking with aids; many resume day-to-day tasks within 3–6 weeks; strength and endurance continue to improve for months.
3. After TTO/realignment or cartilage procedures: protected weight-bearing and brace early; gradual return to impact over 3–6 months depending on healing and criteria.
4. After total knee replacement: enhanced recovery pathway with functional milestones improving over 6–12 weeks.

Prevention & Self-Care Tips

• Build quadriceps/VMO and hip abductor/external rotator strength.
• Progress loads gradually; manage hills, stairs, and deep kneeling.
• Maintain a healthy weight and choose supportive footwear.
• Use taping/bracing during higher-load phases or sport re-introduction.

When Should I See a Knee Specialist?

Book a review if front-of-knee pain is limiting stairs, kneeling, or daily activities despite diligent rehab. Early, personalised treatment can reduce pain, improve function, and protect your joint.

Patellofemoral Arthritis — FAQs