Do you have Kneecap cartilage problems? It’s a very common complaint, but one for which there are few good solutions offered by traditional Orthopedics — mostly because it’s seen as an individual problem, rather than signaling a problem within a larger system.
How is Patellofemoral Syndrome Treated in Orthopedics?
Patellofemoral Syndrome is when the kneecap doesn’t track properly in the groove. The Orthopedic Surgical Solution to this issue is often a lateral release surgery where the fascia and ligaments around the outside of knee cap are surgically cut to try and better align the knee cap in it’s grove. The problem with lateral release surgery is that in our experience, it rarely works. We have seen many patients through the years who are very dissatisfied with the results of their surgery and who are still in as much pain, or have more pain.
Are There Other Solutions to Kneecap Tracking Problems?
There are many nonivasive treatment approaches to Patellofemoral Syndrome as seen on the Infographic at right. There are also several studies demonstrating the biomechanical issues which are causative, and how that should inform treatment. I’ve blogged before that the hip bone is connected to the knee bone in looking at how patients get patellofemoral pain and cartilage loss. That study suggested weak butt muscles were to blame in patients with knee cap arthritis. Another blog post on a kneecap pain study showed that strengthening the hip adductors helped the VMO muscle recruit better (weakness in this inside quadriceps muscle is thought to lead to bad kneecap tracking and cartilage loss). Yet another blog showed that kneecap braces didn’t seem to work. Finally, yet another reviewed studies with conflicting evidence that orthotics could help pain in the kneecap.
In that complex context of information comes yet another study that investigated the biomechanical origins of patelllofemoral pain in women. This study used sophisticated movement tracking devices to check on the movement of the knee and hip when women with and without patellofemoral syndrome were stepping up and down at various knee angles (higher or lower steps). What did they find? The study findings are a difficult read, but basically that there was a greater likelihood for the knee or hip to move inward (knee and hip adduction) in women with patellofemoral pain. In fact, a greater tendency for the body to cave in toward that side. This makes some sense, as these movements allow the kneecap to track to the outside of it’s groove and put more stress on the outside of the patella in it’s groove.
The upshot? Weakness in the hip muscles (gluteals) seems to be a common theme in kneecap pain syndromes. While kneecap taping can often help symptoms, these studies would suggest that working on strengthening and restoring normal biomechanics in the hip muscles may be time well spent.