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Submitted by: Bart - SII

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Therapy for patella femoral syndrome is usually beneficial, if it is treating the underlying cause of your patella femoral pain. Unfortunately, there are usually multiple factors in the manifestation of PFS. In my opinion the most important part of any PFS rehab program is the focus that is paid to strengthening the lateral hip muscles - the abductors and the external rotators. These muscles, not the quadriceps, have the most influence on the position of the patella femoral joint. So, physical therapy that focuses on the hips and core and places less emphasis on the quadriceps has the best chance of being successful. You also need to make sure that any biomechanical issues at the foot and ankle are addressed - over pronation is the most common thing seen with mechanics, and orthotic intervention can be helpful with this as well. I am not a proponent for steroid injections for patella femoral syndrome, as this problem is almost always caused by mechanical irritation and abnormal stresses on the joint rather than chronic inflammation. Steroid injections can also be harmful to articular surfaces and tendon/ligament structures, and I believe should be a last resort. Lateral release procedures can be effective in treating Patella femoral syndrome, and are most beneficial if the problem is due to lateral patellar tilt. However, this procedure is sometimes used as a catch all treatment for PFS that is unresponsive to conservative treatment. If you have lateral patellar tilt diagnosed with an X-ray, and you have gone through a conservative treatment program that addressed all of the areas I talked about above, then lateral release could help. They are probably suggesting bilateral because you have pain in both knees, however, I would recommend one knee at a time, as the recovery can take some time. With conservative treatment as described above, you should start to see results in 3-4 weeks. Most of the patients I have treated successfully for PFS are in treatment for 4-6 weeks and enjoy a full recovery in that time period. Recovery after a lateral release will likely be 3-5 months total, with 6-8 weeks in therapy. This procedure progresses slowly at first, and swelling can be a major factor in the recovery process. Bart

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