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Practice Practice Pointer

Patellofemoral pain

BMJ 2015; 351 doi: (Published 04 November 2015) Cite this as: BMJ 2015;351:h3939
  1. Kay M Crossley, professor, director of La Trobe Sport and Exercise Medicine Research Centre1,
  2. Michael J Callaghan, research fellow and clinical specialist physiotherapist2,
  3. Robbart van Linschoten, sports medicine physician, assistant professor at Weill Cornell Medical College, Qatar3
  1. 1School of Allied Health, La Trobe University, Melbourne, Vic3086, Australia
  2. 2Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, UK
  3. 3Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to: K M Crossley k.crossley{at}

The bottom line

  • Patellofemoral pain commonly presents as gradual onset of knee pain (behind or around the patella) associated with patellofemoral loaded activities (squatting, climbing stairs, hiking, running)

  • Imaging is rarely indicated

  • Conservative therapies (especially physiotherapist-led exercise, targeted exercises based on the clinical findings, foot orthoses) are effective

  • Accurate diagnosis and explanation of the condition and rationale for the rehabilitation programme, with some indication of timeline for prognosis, improves the likelihood of a successful outcome

Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner’s knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.1 2 While it typically occurs in physically active people aged <40 years, it also affects people of all activity levels and ages.1 2 Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle.

Sources and selection criteria

We undertook a literature review from recent systematic reviews,3 4 5 updated to June 2104. We used the search terms (patell* OR femoropatell* OR femoro-patell* OR retropatell*) AND (pain OR syndrome OR dysfunction) combined with (risk factor OR association OR relative risk) and (rehabilitation OR physi* therapy OR exercise therapy OR ortho* OR electrotherapy OR tap* OR strengthening OR brace OR ortho*). We selected papers that represented the best available evidence, systematic reviews, and randomised controlled trials where possible. The published consensus paper from the 2014 international patellofemoral research retreat6 reviewed the best available evidence on patellofemoral pain and was used when systematic reviews were not available or to confirm systematic review findings. We also included our own personal clinical and research experiences in patellofemoral pain, especially for the sections with limited evidence (such as …

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