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Patellofemoral Pain Syndrome — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyPatellofemoral Pain SyndromeSCE Rheumatology

A 45-year-old runner reports a gradual onset of anterior knee pain. It is worse during running, when descending stairs and after prolonged sitting with the knee flexed. There was no preceding injury. Examination shows no effusion, instability, joint-line tenderness or focal tenderness of the patellar tendon. Squatting and compression of the patella against the femoral trochlea reproduce the pain. What is the most likely diagnosis?

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Correct answer: D — Patellofemoral pain syndrome

The diagnosis is patellofemoral pain syndrome. The discriminating pattern is gradual anterior or peripatellar pain provoked by activities that load the patellofemoral joint, particularly running, descending stairs, squatting and prolonged sitting with the knee flexed—the cinema sign. Reproduction of the pain with patellofemoral loading supports the diagnosis, although no single examination manoeuvre is diagnostic. A meniscal tear more typically causes joint-line pain, mechanical locking or an effusion. Patellar tendinopathy produces focal tenderness at the inferior patellar pole or along the tendon and pain with tendon loading. An ACL rupture usually follows an acute pivoting injury with rapid swelling and instability. Osteochondritis dissecans is less consistent with this age and typically causes deeper pain, swelling or mechanical symptoms.

Reference: East of England Community Health and Care NHS Trust. Patellofemoral knee pain, 2026. https://www.dynamichealth.nhs.uk/help-and-advice/knee-pain/patellofemoral-knee-pain/