The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Retropatellar Pain Syndrome.
These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with Retropatellar Pain Syndrome
The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.
Description / Definition
A retropatellar pain syndrome lasting over three months. Retropatellar pathologies are associated with resultant weakening instability, and pain of the patellofemoral mechanism. Can include malalignment, persistent quadriceps tendinitis, distal patellar tendinitis, patellofemoral arthrosis, and symptomatic plica syndrome.
Mechanism of Injury
May be associated with contusion, repetitive patellar compressive forces, shearing articular injuries associated with subluxation or dislocation of patella, fractures, infection, and connective tissue disease.
Specific Physical Findings
Patient complains of pain, instability and tenderness that interfere with daily living and work functions. Findings on physical exam may include retinacular tenderness, pain with patellar compressive ranging, positive patellar glide test, atrophy of quadriceps muscles, positive patellar apprehensive test. Associated anatomical findings may include increased Q angle; rotational lower extremity joints; ligament laxity, and effusion.
Diagnostic Testing Procedures
RadiographsRecommended – in select patients as clinically indicated. May include tunnel, Merchant, or Laurin views.
CT or Bone Scan
Recommended – in very select patients.
MRI
Not Recommended – as it rarely identifies pathology.
Non-Operative Treatment
Rest/restricted activity, off-loading with crutches or cane, NSAIDs, APAP that may be followed by active and/or passive therapy, functional electrical stimulation of the vastus medialis, bracing, orthotics, therapeutic injections.
Recommended – in select patients as clinically indicated.
Surgical Indications
Patellar tendon disruption, quadriceps tendon rupture/avulsion, fracture, or symptoms not responsive to conservative therapy. There is very limited data on long term outcomes of surgical treatment for anterior knee pain. Surgical intervention should be considered after failure of a comprehensive rehabilitation program that has included quadriceps strengthening.
Operative Treatment
Arthroscopic debridement of articular surface, plica, synovial tissue, loose bodies, arthrotomy, open reduction internal fixation with fracture, patellar button (prosthesis) with grade III-IV osteoarthritis (modified Outerbridge classification) and possible patellectomy.
Recommended – in select patients as clinically indicated.
Indications: Patellar tendon disruption, quadriceps tendon rupture/avulsion, fracture, or symptoms not responsive to conservative therapy. There is very limited data on long term outcomes of surgical treatment for anterior knee pain. Surgical intervention should be considered after failure of a comprehensive rehabilitation program that has included quadriceps strengthening.
Note: Retinacular release, quadriceps reefing, and tibial transfer procedures should only be considered after four to six months of conservative therapy.
Post-Operative Therapy
Therapy; bracing.
Recommended.
