Treatment of Runner’s Knee

Most cases of patellofemoral pain syndrome or runner’s knee are treated with non-surgical methods.

Surgery is rare and may be recommended if non-surgical treatments have failed and kneecap pain continues to worsen.

Goals of Treatment for Patellofemoral Pain Syndrome

3 primary goals of runner’s knee treatments are¹Bump JM, Lewis L. Patellofemoral Syndrome. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557657/:

• Reduce knee pain
• Improve tracking of the patella (kneecap) in the patellofemoral joint (joint between kneecap and thigh bone)
• Improve knee function and range of motion

Some people may experience recurring pain even with treatment; however, treatments often help significantly reduce the intensity of symptoms and improve daily function.

Non-surgical Treatments for Runner’s Knee

The most common treatments for managing pain from patellofemoral pain syndrome are listed below.

• PRICE – protection, rest, ice, compression, and elevation – reduce the acute symptoms of runner’s knee. This protocol is most effective when used as soon as the symptoms appear.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, reduce inflammation and pain in the knee.
  Some NSAIDs are not suitable for all patients due to significant risks, such as gastrointestinal and cardiac problems.
• Ice therapy reduces patellofemoral pain by calming inflammation inside the kneecap. Applying a cold pack effectively reduces activity-related soreness after participating in exercise, sports, or physical activities. 
  An ice pack should be wrapped inside a towel or t-shirt and applied to the knee for 20 minutes at a time, with a break of at least 2 hours before reapplying the pack.
• Adjusting activities, such as avoiding long periods of sitting and taking the elevator instead of stairs, reduces stress on the knee joint.
• Gradually increasing physical activity by making small increments in the frequency and duration of activities, exercise, or sports prevents excessive loading and stress on the knee joint and patella.
• Physical therapy and exercise strengthen the knee joint and prevent the symptoms of runner’s knee from recurring.
  • The goals of physical therapy for runner’s knee are to improve the balance and tone of the quadriceps and hip flexor muscles in weight-bearing and non-weight-bearing knee positions.
  • A combination of knee and hip exercises is used to increase strength, mobility, and function in the thigh, knee, leg, and foot.

• Knee braces are used to support the knee during movement. These braces reduce activity-related pain flare-ups during daily physical activities, sports, or physical therapy.
• Patellar taping or McConnell taping is similar to knee bracing and involves applying an adhesive sports tape to the knee to support and stabilize the patella or kneecap.
  • Patellar taping helps manage daily pain or pain related to sports or physical therapy.
  • To apply the tape:
    • Sit with the knee straightened out and place a rolled-up towel under the knee to keep it slightly bent and relaxed.
    • Apply the sports tape around the knee in a square-shaped outline.
    • Adjust the tension of the tape to provide the desired level of support while allowing for normal movement. More than one layer of tape can be used for additional support. See Does Kinesiology Tape Really Work?
• Intra-articular injections are an option if patellar pain is not alleviated through the above treatments. Two types of injection treatments considered for runner’s knee include:
  • Corticosteroid injection: These injections are used to reduce inflammation and pain in the knee joint.
  • Platelet-rich plasma (PRP) injection: PRP harnesses the body's healing potential. Platelets are extracted from the patient’s blood, concentrated, and then injected into the hip joint. The goal of this injection is to stimulate tissue healing by reducing inflammation and encouraging the growth of new tissue in the knee joint. See Pros and Cons of Using PRP for Tendon Injuries

For some people, a knee joint injection provides adequate pain relief to enable rehabilitation through physical therapy.

In some cases, changing the type of footwear or using custom-made shoe inserts (foot orthotics) reduces runner’s knee pain by improving foot support and posture while walking or running.

Surgery for Runner’s Knee

Surgical treatment aims to normalize the biomechanics of the knee by correcting anatomical problems in the knee. The surgeries are minimally invasive and performed with instruments inserted through tiny incisions.

Types of surgeries for runner’s knee

Surgeries for patellofemoral pain involve correcting bone and/or soft tissue alignment and include:

• Lateral release or lateral retinacular release: a procedure to release tight ligaments on the outer side of the kneecap, which relieves pressure on the cartilage inside the kneecap and enables the patella to move to its normal position.²Pontoh LA, Dilogo IH, Kholinne E, Fiolin J, Efar TS. The Role of Lateral Retinacular Release in Preventing Patellofemoral Malalignment in Double-Bundle Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. Clin Orthop Surg. 2022;14(3):393-400. doi:10.4055/cios20295
• Tibial tubercle osteotomy: a procedure to unload the patellofemoral joint (joint between the kneecap and thigh bone) by cutting and shifting the tibial tubercle – a bump on the front of the shin bone. The surgery aims to realign the tubercle so that the kneecap (patella) tracks correctly in the center of the trochlea (patellar groove).³Patel RM, Wright-Chisem J, Williams RJ. Anteriorizing Tibial Tubercle Osteotomy for Patellofemoral Cartilage Lesions. Arthrosc Tech. 2021;10(9):e2181-e2187. Published 2021 Aug 28. doi:10.1016/j.eats.2021.05.021
• Medial patellofemoral ligament reconstruction: a procedure to replace a damaged medial patellofemoral ligament with a new ligament to improve knee stability and prevent further damage to the joint. The medial patellofemoral ligament is a tough ligament that connects the kneecap to the thighbone on the side, and the procedure is typically performed when this ligament is torn or stretched due to repeated or severe patellar dislocation.
• Debridement. A procedure to remove damaged articular cartilage from the inner surface of the patella to facilitate smooth joint movements at the patellofemoral joint.

It takes several weeks to months to fully recover from patellofemoral surgery.

Recovery after runner’s knee surgery

The recovery process and surgical success varies for each individual and depends on several factors such as the:

• Type of surgical procedure
• Skill of the surgeon
• Patient’s underlying condition
• Patient’s age and overall health
• Rehabilitation protocol and post-surgical care

As a general rule, weight bearing is limited for 4 to 6 weeks after surgery, and a custom rehabilitation protocol begins soon after the procedure.

Most individuals return to their everyday activities or sports after a course of guided physical rehabilitation.

Runner’s knee surgery is elective, meaning that it is up to the patient to decide if he/she would like to choose surgery as the treatment option. It is essential to discuss the risks, benefits, and surgical alternatives with the surgeon before considering surgery for runner’s knee.

Risks and complications of runner’s knee surgery

As with any surgical procedure, there are potential risks and complications involved with runner’s knee surgery, including hemarthrosis (bleeding inside the knee joint), infection, blood clots, nerve and blood vessel damage, and ligament injuries.