Patellofemoral Syndrome: Covid-19 Edition

Over the past few months, people have been getting creative on how to stay active and healthy during the covid shut down.  For many, running has become an outlet for both mental and physical health.  

Patellofemoral syndrome, commonly referred to as runner’s knee, is an exceeding common condition and we’ve posted about it before.  However, over the past few weeks I’ve noticed a bit of an increase for this condition in our practice.  With gyms closed, it is difficult to stick with a well-rounded routine, balancing both cardio and strengthening.  Without access to gym equipment or a body sculpting class, many are forgoing the strengthening side of the equation altogether, which is contributing to the development of patellofemoral syndrome.  

Whether you are a new runner, or a veteran, it is imperative to supplement running with a strengthening program that focuses on core, gluts, and quads.  Below is a home exercise program we typically recommend to patients.  With the exception of the leg press exercise (which you can skip for now), no equipment is required.  Add bands or light weights as you advance. 

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Managing your ACL injury during COVID-19

Hospitals throughout the country have canceled elective surgery in order to decrease the spread of COVID-19 to patients and healthcare workers and to concentrate their efforts on emergency care. We recognize the impact this has had on our patients. They may have an ACL injury earlier in the year and are hoping to be ready for next season to compete in cutting and pivoting sports or they may rely heavily on a stable knee to perform their jobs. Unfortunately this situation has forced patients to have to wait out their injuries at home until facilities can be reopened to treat their injuries. While things may seem bleak at the moment there are things you can do at home now to help prepare yourself for upcoming ACL surgery. A good at home physical therapy prehabilitation program can help you stay focused and improve your readiness for surgery. Here are some of the basic goals for ACL prehabilitation:

  • Decrease pain   
  • Minimize swelling
  • Maximize knee range of motion(knee bending & straightening)
  • Normalize gait (way we walk)

This Home Exercise Program developed by HSS PT will take you through some exercises that will help you to work toward the above goals with the aim of getting you conditioned for your surgery. If you have been working with a physical therapist already this is a good time to discuss our prehab program with them and stay in touch with them via phone, email or virtual channels as you progress. We recognize that given work and family constraints it may be difficult to find the time but if you can dedicate a few hours per week it can be very beneficial. The current state of our daily lives has been immensely impacted by the crisis but your health and safety is our #1 priority. During these uncertain times what we do know is that healthy habits and movement can have a big impact on your state of mind. Be well and be safe!

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You Don’t Need to Run to Have Runner’s Knee

Beth Shubin Stein, MD, Associate Attending Orthopedic Surgeon

Sabrina Strickland, MD, Associate Attending Orthopedic Surgeon

HSS Patellofemoral Center

Do you feel pain in the front of your knees when going down stairs? Does knee pain interfere with your ability to walk, run, kneel, squat, or stand up comfortably? Has your knee ever “given out” on you? If you answered yes to any of these questions, you may be suffering from patellofemoral knee pain, arthritis, or instability. Anyone can suffer from these conditions, but they are more common in women than men.

Commonly known as “runner’s knee,” patellofemoral (“anterior knee”) pain can affect anyone. It can happen in people with improper alignment, where the kneecap does not slide smoothly in the groove or track of the femur (thighbone). This type of problem may run in families. Or it may result from injury to the knee (usually during adolescence or young adulthood).

Some people feel pain around or under the kneecap. Others feel instability and may experience a kneecap dislocation. Not everyone with patellofemoral problems needs surgery, but in some cases it is warranted to prevent more serious problems down the road. Here’s how to know what may lie ahead for you. (See a doctor to know for sure.)

If You Have Knee Pain

If you have knee pain without dislocation of the kneecap and a short course of modifying your activities does not resolve the discomfort, see a primary care sports medicine doctor or an orthopedic surgeon. You’ll likely have an x-ray of your knee to see how the kneecap is tracking in the groove of the femur. Physical therapy may help to strengthen the muscles around the knee that help keep the kneecap in place. If your pain persists despite physical therapy, you may need an MRI to look for cartilage damage under the kneecap.

If You Have Arthritis

If tests show there is cartilage damage under your kneecap (arthritis), you may continue physical therapy and/or receive injections to reduce inflammation and provide lubrication. Your doctor or physical therapist may advise you to change, reduce, or avoid certain activities that may aggravate your symptoms. Some patients with cartilage damage may have surgery with techniques that allow regrowth of the damaged cartilage or replace damaged bone with donor bone and cartilage. The surgeon may also correct any misalignments to prevent or minimize future cartilage damage. Patellofemoral cartilage surgery is typically reserved for younger patients (under age 35) or for older patients whose pain persists despite nonsurgical treatments. Some older patients may have partial knee replacement to create a new smoothly gliding joint.

If You Have Kneecap Instability

When the kneecap doesn’t track evenly in the groove of the thigh bone, it can slide out to the side (dislocate), causing your leg to give out under you. This instability is most common in adolescents and young adults, and it is also more common in females. But it can happen in anyone at any age with patellofemoral malalignment and trauma.

Doctors used to think that patients who had only one dislocation should always try nonsurgical treatment. However, much has been learned in the last five years indicating which patients with a first-time dislocation have the highest risk of recurrence. As a result, all patients who have a dislocation should see an orthopedic surgeon to determine if they are in that high-risk group and might benefit from early surgery.

If your kneecap dislocates a second time, you will need surgery to reduce the risk of arthritis from continued dislocations. During the procedure, the surgeon may rebuild the medial patellofemoral ligament — a “leash” that holds the kneecap in place, which often tears during dislocation and then heals in a stretched-out position. This can be done using your own or donor hamstring tissue; in some cases, you may require an additional bony surgery to fix problems with poor alignment. We are currently doing research to identify factors that increase the risk of a second dislocation among first-timers and potentially perform surgery earlier in those people to prevent subsequent dislocation.

If your kneecap has dislocated, it’s extremely important to have it checked out. Each time you experience a dislocation, there is likely to be damage to the cartilage that increases your risk of arthritis. See a sports medicine physician or orthopedic surgeon to find out what’s best for you.

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Dr. Shubin Stein featured in NBC Nightly News segment on Knee Replacement

Dr. Shubin Stein is featured in a recent segment on NBC Nightly News entitled “New Study Questions Effectiveness of Knee Replacement Surgery”. In the segment, Dr. Shubin Stein explains types of patients and injuries that would be candidates for knee replacement.

Watch the segment »

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Dr. Shubin Stein featured in Science Today

ScienceTodayScience Daily has recently published an article highlighting a retrospective review of 105 patients who underwent MPFL reconstructions with Beth E. Shubin Stein, MD, with a 10 year follow up.

Dr. Shubin Stein is quoted in the article saying, “With this study, we found that MPFL reconstruction is a safe and effective treatment for patients with patellofemoral instability even if in patients that have trochlear dysplasia.”

Click here to read the article.

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