The Back Pain Doctor
Patellofemoral arthritis is osteoarthritis of the joint between the underside of the kneecap and the groove in the thighbone that it slides in. It causes pain at the front of the knee, most often felt with stairs, squatting, kneeling and rising from a chair, and is frequently accompanied by grating or crackling as the knee moves.
Assessment focuses on confirming the source of pain and how it behaves, checking kneecap tracking and alignment, and distinguishing patellofemoral arthritis from other causes of anterior knee pain. X-rays help confirm that the arthritis is limited to the kneecap compartment. Contributing factors such as prior kneecap injury, alignment, muscle strength, activity load and body weight are also reviewed, because these influence both symptoms and progression.
First-line care is usually non-surgical — education and activity modification to reduce loading of the kneecap, weight management where relevant, simple analgesia or a short course of anti-inflammatory medication where appropriate, and a physiotherapy program targeting quadriceps strength and kneecap tracking. A corticosteroid injection may help a painful flare. Where symptoms progress despite conservative care, referral for an orthopaedic surgical opinion is the appropriate next step.
The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.
This is the starting point for most musculoskeletal conditions.
The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.
Evidence is condition-specific; it is not a universal pain treatment.
Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.
Read moreEvidence varies substantially by condition, tissue and preparation method.
PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.
Read moreBest used for specific inflammatory or irritable pain generators, usually for short-term relief.
An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.
Read moreClinical evidence is still developing and guideline support is limited.
EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.
Read moreEvidence is condition-specific and generally less established than exercise-based care.
Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.
Read moreMost relevant when focal myofascial pain is a clear contributor.
Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.
Read moreRelevant only when the history and examination support nerve irritation or entrapment.
Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.
Read moreThis is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
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Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
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