Traditional methods of treatment
Conservative treatment is generally preferred for addressing PFPS. This is especially true if it is unclear as to which tissues are involved. Conservative treatment includes bracing, activity modification, and quadriceps-strengthening exercises, such as those that emphasize the VMO.

The VMO is the most distal portion of the vastus medialis muscle, whose fibers angle in an oblique direction to offset the lateral pull on the patella. Although the concept is still controversial, there is evidence that the VMO is most active in the last 20 to 30 degrees of knee extension. Since one of its primary functions is to offset the tendency of the other quadriceps to pull the patella in a lateral direction, emphasis might be placed on strengthening in this phase of knee extension.

Another intervention that has met with clinical success is patellar taping. The knee is wrapped with restrictive tape, similar to what athletes use during sports activity. The tape is thought to both encourage proper patellar tracking and influence proprioception in a way that may lead to corrections in faulty biomechanical patterns. Very often it is not one single treatment that is most effective, but a combination of various modalities.

If conservative measures are not successful in alleviating the problem, surgical intervention may be used. One common surgical procedure for this problem is lateral-retinacular release. In this procedure the lateral retinaculum is cut in order to decrease the amount of pulling on the knee’s extensor mechanism in a lateral direction. However, the effectiveness of lateral-release surgery has been questioned recently because severing important soft-tissue restraints around the knee disturbs the optimal biomechanical balance around the joint.

References