Degenerative arthritis occurs when the smooth cartilage between the bones starts to break down and wear away. Our active lifestyles increase the wear and tear on our joints. An estimated 33.6% (12.4 million) adults over the age of 65 will be affected by degenerative arthritis. Isolated kneecap arthritis (patellofemoral arthritis) is the breakdown of cartilage under the kneecap and in the trochlear groove, the groove that our kneecap tracks in. Most patients will report several different symptoms:
- A grinding sensation under the kneecap
- Pain over the front of the knee and occasionally in the back of the knee
- Pain while sitting for extended periods of time (driving, watching television, etc)
- Pain when going up and down stairs
Women are more likely to develop kneecap arthritis than men. There are several reasons for this. Women tend to have narrower femurs, thinner layers of cartilage and biomechanical differences. The way the kneecap tracks in its groove is affected by the angle of the hips in relation to the tibia, known as the “Q-angle.” The “Q-angle” in women is greater than that of men because of a wider pelvis and a knock-knee leg alignment.
Treatment options for kneecap arthritis should always start conservatively. The initial thoughts are to address the most likely causes for developing kneecap arthritis. This could include physical therapy to work on any muscular imbalances, a knee brace that can help center the kneecap within its tracking groove and maybe something as simple as losing a few pounds. When conservative treatments lose effectiveness, that’s when we start to treat symptoms with medications. Oral NSAIDs (Ibuprofen, Naprosyn…) work very well but can have some systemic reactions. Another option is a steroid injection which can help with pain and discomfort for several weeks to several months. We try to only do these injections a maximum of once every 3-4 months. Other injections can include platelet rich plasma (PRP) and viscosupplementation (Synvisc, Supartz, Monovisc…). However, severely arthritic knees do not respond very well to these treatments.
If the conservative treatments aren’t working and the pain is affecting your daily activities, the conversation will turn towards possible surgical options. This can range from a simple scope to smooth roughened cartilage, a “lateral release” to realign the kneecap in its groove and all the way to a partial knee replacement (patellofemoral joint arthroplasty). Before any decisions are made, we would obtain an MRI for further evaluation to check out all parts of the knee to avoid any unnecessary procedure.
Kneecap arthritis is common and can be debilitating if severe enough. There are treatments to help alleviate the symptoms as well as surgeries that can eliminate the arthritis all together. If anterior knee pain is affecting your everyday activities and shortening your playtime in the mountains, kneecap arthritis can very well be the cause.