Patellofemoral pain syndrome in the female athlete

Although PFS will continue to be a therapeutic challenge, the prognosis for most female athletes is good, especially if they are motivated and compliant with their treatment program. Particularly in women, care should be taken to avoid placing too much emphasis on biomechanical variants that may not be clinically significant or correctable because such findings can reinforce a feeling that "nothing can be done." In many cases, muscle dysfunction and repetitive loading of the patellofemoral joint rather than fixed biomechanical factors contribute to the development of PFS. Nonetheless, the importance of a detailed biomechanical assessment on physical examination must not be neglected, particularly in athletes who are not improving with conservative treatment and who may become surgical candidates. A practical initial treatment program for most athletes with nontraumatic PFS begins with relative rest, quadriceps strengthening, and stretching of tight myotendinous units. The introduction of NSAIDs, orthoses, taping, knee sleeves, and more specific rehabilitative exercises should be an individualized decision based on physical findings, past treatment results, and athletic expectations. Surgical referral should be considered in cases of PFS or patellar instability refractory to prolonged maximal nonoperative treatment.