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Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning the patellofemoral joint (PFJ):

  • Have a basic knowledge and understanding of the anatomy

  • Understand normal arthrokinematics and osteokinematics

  • Understand normal biomechanics of the PFJ

  • Recognize pathomechanics and its relation to dysfunction at the PFJ

  • Have a general understanding of common PFJ disorders

  • Have a common understanding of surgical procedures used to address PFJ disorders

  • Design a rehabilitation plan with the understanding of surgical precautions

  • Implement a rehabilitation plan including proper stretching, strengthening, proprioception, and exercise technique in accordance with principles of basic exercise

  • Perform manual treatment techniques including basic stretching, joint mobilization, and soft tissue mobilization

  • Demonstrate and educate the patient on a comprehensive home exercise program

  • Utilize adjunct treatment interventions such as pain control modalities, bracing, taping, neuromuscular electrical stimulation, and orthotic prescription


Patellofemoral pain is one of the most commonly observed and treated conditions among the athletic population.1 The patellofemoral joint (PFJ) is a complex joint whose stability depends on both dynamic and static structures. Understanding basic anatomy, being aware of any underlying dysfunctions, and obtaining a thorough history and physical evaluation of the patient are pivotal in being able to adequately address patellofemoral pain.1

Clinical Pearl 16-1

The challenge in treating patellofemoral pain is that it encompasses numerous underlying dysfunctions and cannot be treated by a single treatment protocol.


The bony anatomy of the PFJ is comprised of the patella (the largest sesmoid bone in the body) and its interaction with the femoral condyles in the intercondylar (trochlear) groove. The patella, a triangularly shaped bone (apex of the patella is inferior) embedded within the quadriceps tendon, plays an important role in proper knee function (Fig. 16-1). Its primary role is to reduce friction between the quadriceps tendon and the femoral condyles by acting as an anatomic pulley to increase the mechanical advantage of the quadriceps.2 Other roles include increasing the leverage (torque) of the quadriceps by increasing the distance from the axis of motion, providing bony protection to the distal surface of the femoral condyles when the knee is in a flexed position, and preventing damaging compressive forces on the quadriceps tendon with resisted knee flexion.1,3

Figure 16-1.

Anatomy of the patellofemoral joint.

Clinical Pearl 16-2

The patella reduces friction between the quadriceps tendon and the femoral condyles by acting as an anatomic pulley to increase the mechanical advantage of the quadriceps.

Articular cartilage covers and protects both the surface of the femoral intercondylar groove and the posterior surface of the patella.3 In fact, the thickest articular cartilage in the body is located on the posterior surface of ...

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