Patellofemoral problems range from anterior (front-of-knee) pain to a kneecap that slips out of place — patellar instability. Many cases improve with physical therapy and bracing; recurrent instability or cartilage damage may call for procedures such as MPFL reconstruction, tibial tubercle osteotomy, or cartilage repair. Dr. Gomoll focuses on correcting the underlying cause to protect the joint long-term.
What is patellofemoral pain?
The patella (kneecap) glides in a groove at the end of the thigh bone as you bend and straighten the knee. Patellofemoral pain is pain around or behind the kneecap, often aggravated by stairs, squatting, kneeling, or prolonged sitting. It can arise from how the kneecap tracks, from wear of the cartilage behind the kneecap, or from muscle imbalance and alignment.
Patellar instability
Patellar instability is when the kneecap slips partially (subluxation) or fully (dislocation) out of its groove. It may follow a traumatic dislocation or occur in patients whose anatomy predisposes the kneecap to track poorly. Recurrent instability can progressively damage the cartilage on the back of the kneecap. Dr. Gomoll discusses when an unstable kneecap needs surgery in his article "Do I need surgery for my unstable patella?"
Common symptoms
- Aching pain at the front of the knee, around or behind the kneecap
- Pain with stairs, squatting, kneeling, or sitting with the knee bent
- A sensation of the kneecap shifting, catching, or giving way
- Episodes of the kneecap partially or fully dislocating
Treatment options
Treatment is matched to the cause and severity:
- Non-surgical care: physical therapy to balance the muscles around the kneecap, bracing, and activity modification — often the first step, especially after a first dislocation
- MPFL reconstruction: rebuilding the medial patellofemoral ligament that acts as the checkrein holding the kneecap in place
- Tibial tubercle osteotomy: realigning the pull of the kneecap when bony alignment contributes to instability or overload
- Cartilage repair: restoring the joint surface behind the kneecap when it has been damaged by instability or wear
The right plan depends on your imaging and exam. Dr. Gomoll's goal is to address the underlying cause — alignment, ligament support, and cartilage — rather than only the symptoms.
Frequently asked questions
What is patellofemoral pain?
Patellofemoral pain is pain at the front of the knee, around or behind the kneecap (patella), where it glides in a groove at the end of the thigh bone. It is often aggravated by stairs, squatting, kneeling, or sitting for long periods, and can stem from how the kneecap tracks, cartilage wear behind the kneecap, muscle imbalance, or alignment.
What is patellar instability?
Patellar instability is when the kneecap slips partially (subluxation) or fully (dislocation) out of its groove. It can follow a traumatic dislocation or occur in patients whose anatomy predisposes the kneecap to track poorly. Recurrent instability can damage the cartilage on the back of the kneecap over time.
Do I need surgery for an unstable kneecap?
Not always. Many patients are managed without surgery using physical therapy, bracing, and activity modification — especially after a first-time dislocation. Surgery is considered for recurrent instability, or when imaging shows anatomic risk factors or cartilage damage. Dr. Gomoll discusses this decision in detail — see his article, "Do I need surgery for my unstable patella?"
What surgical options treat patellar instability?
Depending on the cause, options include MPFL (medial patellofemoral ligament) reconstruction to restore the checkrein that holds the kneecap in place, tibial tubercle osteotomy to realign the pull of the kneecap, and cartilage repair if the joint surface is damaged. The right combination depends on your anatomy and imaging.
Which doctor treats patellofemoral problems in New York?
Dr. Andreas Gomoll evaluates and treats patellofemoral pain and patellar instability at the Hospital for Special Surgery in New York, with a focus on joint preservation — addressing the underlying cause rather than only the symptoms.
Dr. Gomoll evaluates patellofemoral pain and patellar instability at the Hospital for Special Surgery, 523 East 72nd Street on Manhattan's Upper East Side. See our location and directions or request an appointment.
Medical disclaimer
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a board-certified orthopedic surgeon who has reviewed your imaging, history, and physical examination. Individual outcomes vary.