& Address: Patellofemoral
by Whitney Lowe
methods of 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
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.