Patellofemoral Pain in Female Athletes

Patellofemoral pain syndrome (PFPS) is the most common complaint in female athletes. There are clear structural, biomechanical, sociological, and hormonal differences between women and men that contribute to an increased incidence of PFPS in women. Unfortunately, the etiology of PFPS is still not well understood. It may represent the end result of multiple intrinsic and extrinsic factors. Three major factors can be attributed to its etiology: quadriceps muscle imbalance and/or weakness, lower extremity and patellofemoral malalignment, and physical overload of patellofemoral joint. Exclusion of intraarticular pathology is essential to diagnose PFPS. Imaging can be helpful to diagnose any associated patellar instability. Conservative management, a mainstay in management, includes rehabilitation focusing on proprioception, strength, flexibility, endurance, and a gradual progression of the musculoskeletal load. Various training programs are in use, including isometric open kinetic chain exercises and eccentric closed kinetic chain exercises. Surgery may be required if conservative measures fail. Various procedures have been described, including lateral retinaculum release and proximal and distal realignment procedures.