Patellofemoral General Agreement Statement from the PFF/ IPSG Consensus meeting sponsored by DJO International on March 6, 2008
- Focal loading can be a cause of PF pain.
- Overuse or at times cyclical overload of soft tissue or bone areas may explain the unusual and sometimes ill defined nature of anterior knee pain in some patients (Dye theory of envelope of load acceptance) Treatment should establish load reduction.
- Patellofemoral imbalance (including but not limited to malalignment) may cause pain by virtue of cyclical soft tissue and/or bone overload.
- Focal supraphysiological loading can, in some patients, be a cause of PF pain.
- Loss of vascular homeostasis (e.g. hypervascularity, ischemia, osseous hypertension) may be associated with anterior knee pain.
- Structural damage of articular cartilage does not always result in anterior knee pain. However, there is growing evidence that a subset of patients with chondral lesions may have a component of their pain related to that lesion.
There are many alternatives for non-operative PF pain treatment that should be considered some of which may include medications that affect neural pain transmission.
History, exam, imaging and response to treatment (differential injection, specific unloading, medication and multidisciplinary evaluation) should correlate well and be consistent in order to localize pathology and to make a precise diagnosis. Treatment should be developed based on the most precise diagnosis possible. Persistence of pain may be related to inaccurate appraisal of the cause of pain and/or inappropriate treatment decisions, patient non-compliance or complications of surgical treatment.
A patient’s active participation and understanding in his/her treatment is necessary for optimal results.