Welcome to the ICRS Patient & Public Education Site

If you suffer from joint pain, you’re not alone. Each year, more than 50 million people visit their doctors because of joint pain — half of them with a damage of the articular cartilage.

On this website, you can find useful, updated information on specific cartilage-related conditions and possible treatments options, written by world-renowned experts in this field, helpful patient information to read and download, and other useful resources

The choice of procedures depends on the size and location of cartilage defect. Larger defects are typically treated with autologous chondrocyte transplantation, osteochondral allograft transplantation, or newer synthetic or natural scaffolds which may require open incisions. Smaller defects in specific locations may be treated with enhanced bone marrow stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer which may be completed through the arthroscope. There is also a chapter for conservative treatments options and rehabilitation after cartilage repair.

Intended Audience for this Website

People of all ages can suffer from cartilage complications, whether due to ‘wear and tear’ or injury. While the former is much more common in middle-aged patients, and even more so in women, injuries to the joints, such as trauma or accidents during active sports, can affect any age group or gender. Careers requiring repetitive or intense motion can increase the risk of developing cartilage problems, but there are several other risk factors, including age, weight and genetic predisposition.

What is Cartilage Repair?

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities – abnormalities a person is born with (for instance misalignment) – that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans (OCD). There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

What is not covered in this Website?

There are several types of bone and joint pain, each with many potential sources or etiologies. This site is not intended for people who suffers from rheumatoid arthritis (RA), gout, avascular necrosis (AVN), and cancer within bones, osteoporosis and other inflammatory or autoimmune diseases.

Acknowledgements

To the Mäxi Foundation: 
This website project would not have been possible without the substantial support of the Swiss “Mäxi Foundation”. The ICRS would like to express a deep gratitude for this very generous contribution to the International Cartilage Repair Society and the respective patient community, making it possible to provide updated information about cartilage damage and cartilage repair technologies free of charge to all interested persons.

To the Authors & Contributors:
The following world-renowned experts in cartilage repair & cartilage research have contributed to the extensive content of this website: Stephen Abelow (USA), William Bugbee (USA), Susan Chubinskaya (USA), Brian Cole (USA), Stefano Della Villa (IT), Chris Erggelet (CH), Jack Farr (USA), Ralph Gambardella (USA), Michael Gerhardt (USA), Wayne Gersoff (USA), Alan Getgood (CA), Alberto Gobbi (IT), Laszlo Hangody (HU), Oliver Kessler (CH), Elizaveta Kon (IT), Jos Malda (NL), Bert Mandelbaum (USA), Tom Minas (USA), Kai Mithoefer (USA), Stefan Nehrer (AT), Lars Peterson (SE), Scott Gillogly (USA), Holly Silvers (USA), Jason Theodosakis (USA) and Kenneth Zaslav (USA)

To anyone else who contributed to this important project
ICRS Office Staff, Medical Writers, Committees, Illustrators and Web Developers, etc.

Terms of Use

These terms of use, together with our Privacy Policy collectively, these “Terms of Use”, governs access to and any use of the website cartilage.org and any sub-sites (the “Website“), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree to bound and abide by the Terms of Use on behalf of all users of the respective computer. Visitors who do not agree with these Terms of Use must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page from time to time so that you are aware of any changes, as they are binding on you.

The information on the Website is not intended to treat, diagnose, cure or prevent any cartilage related issues. Always seek the advice of a physician or other qualified health care provider with any questions you have regarding your medical condition.

Privacy Policy

This privacy policy (“Privacy Policy”), together with the Terms of Use for the patient website section, applies to any use of the website cartilage.org and any sub-sites (the “Website”), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree on behalf of all users of the respective computer to be bound and abide by the Terms of Use and this Privacy Policy. Visitors who do not agree with the Terms of Use and this Privacy Policy must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) is committed to protecting your privacy and ensuring that your personal information is protected. This Privacy Policy explains the types of personal information we collect and how we use, disclose and protect that information.

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Patellofemoral Pain

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Patellofemoral Pain

The kneecap (patella) is the flat, oval bone at the front of your knee. It is held in place by a broad tendon and one of the largest muscles in the body, the thigh muscle (quadriceps).

The patella, its tendon and the quadriceps are responsible for the ability to stand, walk, jump and kneel. During these movements, a normal functioning kneecap slides up and down a groove on the end of the femur as the knee bends.

What is Patellofemoral Pain?

Patellofemoral (PF) pain, is pain in, behind or around your kneecap (patella; see Figure 1). You may get pain when the kneecap moves differently from usual. The cartilage covering the bones in the area behind the kneecap – known as the PF compartment – may also be damaged.

PF pain is the most common problem in knees. As many as one-third of all patients who visit an orthopaedic specialist for knee pain will have PF pain.

When a patient with PF pain is asked to point at where it hurts, the patient most often grabs the whole knee and says that the pain is in the front of the knee, somewhere around the kneecap. It is often difficult to localise a more specific point than that.

Most patients with PF pain say that the pain gets worse when going downhill or down the stairs. Some patients also say that pain also increases when going uphill or when sitting with the knee bent for a long time.

What causes patellofemoral pain?

There could be a variety of causes for PF pain. It is therefore necessary to do a detailed search to determine the specific causes of pain. The pain may be caused by too high pressure on local areas of the PF compartment. It is possible to have healthy cartilage in the PF compartment but still have major pain due to high pressure and overloading of structures in the knee.

Common causes of PF compartment pain are:

  • Injury (e.g. dislocation, fracture or tear of a structure)
  • A poorly aligned kneecap (a lateralization of the kneecap) – which means that pressure on the outer side of the kneecap is too high. A kneecap can be poorly aligned due to soft tissue problems (e.g. a lack of muscular strength) or due to anatomical abnormalities (e.g. bones in the leg have an unusual shape or direction)
  • Wrong gait (walking or running in a wrong way – for instance, it is common to put too much weight on your heel)

Excess weight can also cause issues that will lead to PF pain

How is PF pain diagnosed?

Confirming a PF problem is not straightforward. The specialist will first do a thorough clinical examination of yourknee. He or she will push the patella in different directions, put pressure on different parts, lift it up from each side and flex and extend your leg in order to locate the area that cases the pain.

After the clinical examination, the doctor may also use diagnostic imaging tests such as X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) in order to find the underlying reasons for the pain.

Anatomical abnormalities can initially be diagnosed by looking at an X-ray. If abnormalities are found, then the next step is normally to have a CT or MRI scan to diagnose underlying anatomic abnormalities, which may be the cause of the problem.

Conservative treatment

Once the patellofemoral compartment is confirmed as the main source of pain, the goal is to plan a comprehensive treatment programme to minimise the potential of multiple surgeries.

The vast majority of PF pain (over 95% of cases) responds to physical therapy programmes of exercise and stretching. However, the most common reason patients do not respond well to this non-operative treatment is a failure to follow the most current therapy principles especially designed to help PF pain.

When choosing a physical therapist, patients should look for those who use techniques that focus on hip and pelvic muscular strength, rotational control and a technique known as ‘core strengthening’. The therapist should also include more traditional quadriceps (thigh muscle) strengthening.

The goal of the physical therapy is to normalise the anatomical behaviour of the knee joint. Such a programme can take up to nine months, but there should be signs of improvement after about six weeks.

If there is no improvement after six weeks, then the underlying cause might be an anatomical problem that would need to be further examined by the orthopaedic expert. If the rehabilitation of the PF joint does not lead to improved comfort and function, surgical options may be discussed.

Surgical treatment

Surgery should only be considered after failure of a comprehensive rehabilitation programme. The type of surgical treatment depends on the type of disease affecting the patellofemoral joint.

In cases of traumatic injury and cartilage damage to the PF joint, a number of different cartilage repair options and soft-tissue repair methods can be considered. The outcome of cartilage repair on the patella (kneecap) is highly variable. The main reason for this is that the patella has very little blood supply, which results in a lower potential for successful cartilage regeneration compared to other joints.

When anatomical abnormalities that result in instability are believed to be the underlying cause of PF pain, some other types of surgical procedures might be considered. Medial patella-femoral ligament (MPFL) reconstruction is the most common surgical procedure in reducing PF instability caused by anatomical abnormalities.

Other surgical procedures used to correct serious and recurring dislocation of the kneecap (and to reduce pain) include tibia tubercle realignment (also known as a tibia tubercle transfer) and bone reshaping (trochleoplasty).

The patellofemoral joint is very complex and there are several potential causes of pain (see ‘What causes patellofemoral pain?’ above). Major surgery might reduce the pain, but patients should be aware that surgery might also increase the risk of increasing the amount of pain and for developing osteoarthritis in the longer term.

3D Animations | Patella (Knee Cap) Pain - Drilling/Microfracture)

3D Animations | Patella (Knee Cap) Pain - Removal of Damaged Cartilage

Frequently Asked Questions (FAQs)

Which surgery is right for me?

Only you and your surgeon can answer this question.

PF pain is very common but it has several potential causes (see ‘What causes patellofemoral pain?’ above), which must be considered before deciding which surgery is best. Your surgeon will take these factors into consideration and answer any questions you may have.

Keywords

cartilage repair, Knee pain, knee surgery, Patellofemoral compartment

The kneecap (patella) is…
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