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

 

Introduction

The knee is one of the most complex joints in the human body, and the patellofemoral joint (PFJ) plays a crucial role in its smooth function. When this joint becomes painful, it can affect mobility, strength, and the ability to perform everyday activities such as climbing stairs, walking, or squatting. Patellofemoral joint pain is a common clinical presentation that can be seen across a wide age range, from active individuals to older adults.

At Joint Injections, clinicians provide ultrasound-guided injections such as cortisone and hyaluronic acid to target the PFJ with precision. Ultrasound ensures that the injection is placed exactly where intended, helping to address the sources of discomfort and support joint function.

This blog explores the anatomy of the patellofemoral joint, the causes and pathology of PFJ pain, diagnostic considerations, and how ultrasound-guided cortisone and hyaluronic acid injections can be used as part of a management pathway.

Anatomy of the Patellofemoral Joint

The patellofemoral joint is formed by the articulation between the back surface of the patella (kneecap) and the femoral trochlea (a groove at the lower end of the thigh bone).

Key structures of the PFJ include:

  • Patella — The largest sesamoid bone in the body, embedded within the quadriceps tendon.
  • Femoral trochlea — The groove in the femur where the patella glides during knee motion.
  • Cartilage — The posterior surface of the patella and the trochlear groove are lined with articular cartilage, allowing smooth, frictionless motion.
  • Retinaculum and soft tissues — These stabilise the patella laterally and medially.
  • Quadriceps tendon and patellar tendon — Connect the quadriceps muscles to the tibia via the patella, playing a key role in knee extension.

The patellofemoral joint is responsible for transmitting forces during activities such as walking, running, squatting, and climbing stairs. It endures significant load, often several times body weight during high-impact movements.

Pathology of PFJ Pain

Patellofemoral pain can arise from multiple structural and functional issues. Common pathological changes include:

  • Cartilage softening or wear (chondromalacia patellae).
  • Joint space narrowing due to degenerative change.
  • Maltracking of the patella due to muscle imbalance, tight lateral retinaculum, or structural variation.
  • Inflammation of the synovium or surrounding soft tissues.
  • Bone marrow changes beneath cartilage in more advanced stages.

These changes can result in mechanical irritation, overload, and pain during everyday activities.

Causes and Risk Factors

Several factors may contribute to PFJ pain:

  • Overuse from repetitive activities such as running, jumping, or squatting.
  • Muscle imbalance or weakness, particularly of the quadriceps.
  • Anatomical variations such as high-riding patella (patella alta) or shallow trochlear groove.
  • Previous knee injuries or surgery.
  • Degenerative joint changes associated with ageing.
  • Increased body weight placing greater load on the PFJ.

Symptoms of PFJ Pain

Common symptoms include:

  • Pain at the front of the knee, often described as aching or sharp.
  • Pain that worsens with stairs, squatting, or prolonged sitting (“theatre sign”)
  • Grinding, clicking, or popping sensations (crepitus)
  • Stiffness, particularly after rest.
  • Swelling in or around the knee joint in some cases.

Diagnosis

Diagnosis of PFJ pain involves a combination of clinical assessment and imaging.

  • Clinical examination — A clinician may check patellar tracking, tenderness, range of motion, and strength.
  • Ultrasound — Useful for assessing surrounding soft tissues and guiding injections accurately into the PFJ.

Management of PFJ Pain

PFJ pain can be managed through a range of strategies, depending on severity and individual needs. These may include:

  • Exercise therapy — Quadriceps strengthening, hip stabilisation, and stretching.
  • Lifestyle modifications — Reducing high-impact activities and managing weight.
  • Ultrasound-guided injections — Cortisone or hyaluronic acid to address specific joint processes.

Ultrasound-Guided Injections at Joint Injections

Cortisone Injections

Cortisone (corticosteroid) is commonly used for joint conditions involving inflammation.

Mechanism of action:

  • Reduces activity of inflammatory mediators in the joint.
  • Helps calm swelling in the synovium.
  • May reduce irritation of surrounding tissues.
  • Provides an environment where joint motion may feel more comfortable.

Hyaluronic Acid Injections

Hyaluronic acid is a naturally occurring substance in joint fluid, giving it viscosity and elasticity. Levels are often reduced in degenerative joint conditions.

Mechanism of action:

  • Restores lubrication within the PFJ.
  • Provides cushioning between the patella and trochlea.
  • Reduces friction to support smoother joint movement.
  • May improve the quality of the joint environment over time.

Importance of Ultrasound Guidance

At Joint Injections, clinicians use ultrasound to guide injections into the PFJ. This offers several advantages:

  • Real-time visualisation of the needle and joint structures.
  • Accurate delivery of the injection to the PFJ.
  • Avoidance of surrounding structures such as tendons, ligaments, and vessels.
  • Greater precision compared to landmark-guided techniques.

Why Choose Joint Injections

  • Experienced clinicians specialising in musculoskeletal conditions.
  • Use of ultrasound for accurate injection delivery.
  • Tailored treatment approaches based on individual needs.
  • Range of options including cortisone and hyaluronic acid for PFJ pain.

Conclusion

Patellofemoral joint pain is a frequent source of knee discomfort, affecting mobility and quality of life. It may arise from cartilage wear, patellar maltracking, or inflammatory changes. Management often requires a combination of exercise, lifestyle adjustments, and targeted therapies.

At Joint Injections, clinicians provide ultrasound-guided cortisone and hyaluronic acid injections for the PFJ, ensuring precise delivery tailored to each individual. By targeting the joint directly under ultrasound guidance, treatment can support joint function and help individuals continue with their daily activities.

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