Ultrasound-Guided Cortisone and Hyaluronic Acid Injections for Patellofemoral Joint (PFJ) Pain Relief

 

Introduction

Patellofemoral Joint (PFJ) pain is a common cause of anterior knee pain that affects individuals of all ages, particularly those who engage in repetitive knee movements such as running, squatting, and stair climbing. The condition arises due to irritation or degeneration of the structures within the PFJ, leading to discomfort and reduced function.

Managing PFJ pain often involves a combination of physiotherapy, activity modification, and, in some cases, injectable treatments. Ultrasound-guided cortisone and hyaluronic acid injections may be considered in cases where conservative measures have not provided sufficient relief. These injections target inflammation and joint lubrication, potentially reducing pain and improving knee function.

This blog explores PFJ pain in detail, covering its anatomy, pathology, symptoms, diagnosis, and treatment options. It also explains how cortisone and hyaluronic acid injections work and their mechanism of action, tailored specifically to the expertise of Alton Pain Clinic.

Anatomy of the Patellofemoral Joint

The patellofemoral joint (PFJ) is the articulation between the patella (kneecap) and the trochlear groove of the femur. It plays a key role in knee stability and function, allowing smooth movement during flexion and extension.

Key Structures of the PFJ

  • Patella (Kneecap): A sesamoid bone embedded within the quadriceps tendon, which provides mechanical leverage during knee movement.
  • Trochlear Groove: A depression in the femur where the patella glides during movement.
  • Patellar Cartilage: A thick layer of cartilage covering the underside of the patella, reducing friction during movement.
  • Synovial Fluid: Lubricates the joint to facilitate smooth motion.
  • Retinacula and Ligaments: These structures help stabilise the patella within the trochlear groove.

Function of the PFJ

  • Load Distribution: Distributes forces across the knee during movement.
  • Shock Absorption: Helps absorb impact during activities like walking, running, and jumping.
  • Knee Stability: Works in coordination with surrounding muscles and ligaments to stabilise the knee joint.

Pathology of Patellofemoral Joint Pain

PFJ pain may develop due to a combination of structural abnormalities, overuse, or biomechanical issues that alter the normal movement of the patella.

Common Pathological Changes

  1. Chondromalacia Patellae: Softening or degeneration of the cartilage under the patella, leading to pain and swelling.
  2. Patellar Maltracking: Misalignment of the patella within the trochlear groove, often due to muscle imbalances or anatomical variations.
  3. Synovial Inflammation: Inflammation of the joint lining, leading to pain and stiffness.
  4. Osteoarthritis of the PFJ: Degeneration of cartilage over time, resulting in joint space narrowing and pain.

Causes and Risk Factors

Overuse and Repetitive Strain

  • Running, Cycling, and Squatting: Repeated knee flexion can overload the PFJ.
  • Excessive Stair Climbing: Increases stress on the patella.

Biomechanical Issues

  • Muscle Imbalances: Weak quadriceps or tight hamstrings can alter patellar tracking.
  • Flat Feet or High Arches: Poor foot biomechanics can affect knee alignment.

Age-Related Degeneration

  • Cartilage Wear and Tear: Gradual degeneration over time.

Injury or Trauma

  • Direct Impact: A fall or blow to the knee can lead to patellar damage.
  • Previous Knee Surgery: May alter joint mechanics and increase the risk of PFJ pain.

Symptoms of PFJ Pain

  • Pain at the Front of the Knee: Worsened by prolonged sitting, squatting, or stair climbing.
  • Grinding or Clicking Sensation: Often felt during knee movement.
  • Swelling and Stiffness: Particularly after activity.
  • Weakness or Instability: The knee may feel as if it is “giving way.”

Diagnosis of Patellofemoral Joint Pain

Clinical Assessment

A clinician at Alton Pain Clinic will assess:

  • Pain location and severity.
  • Knee alignment and patellar tracking.
  • Muscle strength and flexibility.

Imaging Studies

  • Ultrasound: Detects inflammation and soft tissue abnormalities.

Management of PFJ Pain

Conservative Treatment

  • Activity Modification: Avoiding aggravating activities such as deep squats.
  • Pain Medication: NSAIDs may be used to reduce inflammation.
  • Bracing or Taping: Helps support the patella and improve alignment.

Ultrasound-Guided Cortisone and Hyaluronic Acid Injections for PFJ Pain

Cortisone Injections for PFJ Pain

Cortisone injections may be considered when inflammation contributes to PFJ pain. These injections target inflammation within the joint, potentially providing relief.

Mechanism of Action

  • Reduces Inflammation: Inhibits the release of inflammatory mediators.
  • Modulates Immune Response: Suppresses excessive immune cell activity.
  • Alters Pain Perception: Reduces nerve sensitivity in the joint.

Hyaluronic Acid Injections for PFJ Pain

Hyaluronic acid injections are used to improve lubrication and reduce joint friction, particularly in cases of cartilage wear or early osteoarthritis.

Mechanism of Action

  • Lubricates the Joint: Enhances the function of synovial fluid.
  • Reduces Friction: Provides a cushioning effect to protect cartilage.
  • Potential Anti-Inflammatory Effect: May reduce inflammatory markers in the joint.

Procedure for Ultrasound-Guided Injections

  1. Patient Positioning: The patient is positioned to allow clear access to the PFJ.
  2. Ultrasound Imaging: The clinician visualises the joint space and guides needle placement.
  3. Skin Preparation: The area is sterilised to prevent infection.
  4. Local Anaesthetic: Applied to reduce discomfort during the procedure.
  5. Injection Administration: The medication is delivered precisely into the PFJ.
  6. Post-Injection Care: The patient is monitored for a short period before discharge.

Rehabilitation and Recovery

Post-Injection Care

  • Avoid Excessive Knee Strain: Limit weight-bearing activities for 24–48 hours.
  • Gradual Return to Activity: Physiotherapy may help optimise movement patterns.
  • Monitor Pain Levels: Keep track of symptom improvement over the following weeks.

Expected Duration of Relief

  • Cortisone Injection: Relief may last several weeks to months.
  • Hyaluronic Acid Injection: Effects may last longer, with gradual improvement over time.

Why Choose Alton Pain Clinic for PFJ Pain Treatment?

At Alton Pain Clinic, our clinicians provide ultrasound-guided cortisone and hyaluronic acid injections, ensuring precise and targeted delivery of treatment. Our patient-centred approach focuses on tailored pain management strategies designed to enhance mobility and quality of life.

Conclusion

Patellofemoral Joint (PFJ) pain can significantly impact daily activities and physical performance. Ultrasound-guided cortisone and hyaluronic acid injections may be considered as part of a management approach for individuals with persistent symptoms. Alton Pain Clinic offers advanced imaging techniques and clinician-led care to support patients in managing their knee pain effectively.

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