My Research Journey in Patellofemoral Osteoarthritis
Patellofemoral osteoarthritis (PFOA) is both common and under-researched. I dedicated seven years of postgraduate study to this condition, completing a research degree in 2024. That work underpins the insights in this article – what we know, what remains unclear and how this translates into better care for people with PFOA.
What we’ll cover in this blog
- Knee osteoarthritis as context.
- Why patellofemoral osteoarthritis is unique and important.
- Risk factors and causes.
- Management strategies – what we know from knee OA and from limited PFOA research.
- How treatment decisions are influenced—by people with PFOA, clinicians, and systems.
Knee Osteoarthritis – Setting the Scene
Knee osteoarthritis is extremely common. The 2022 Global Burden of Disease study estimated that 3.2 million Australians live with osteoarthritis, with 1.9 million cases affecting the knee.
Risk factors overlap with other chronic diseases – age, obesity, cardiovascular disease, diabetes, and major joint injuries. Since 1990, knee OA has increased by 126%, reflecting both an ageing population and rising obesity rates.
Why Patellofemoral Osteoarthritis Matters
- Most common compartment affected – In people over 50 with symptomatic knee pain, 64% have PFOA, compared with 44% tibiofemoral involvement. Many present with combined disease, but PFOA is a major contributor to symptoms and reduced quality of life.
- Marker of progression – Isolated symptomatic PFOA often precedes tibiofemoral OA.
- Chronicity – There may be a continuum from patellofemoral pain in adolescence to PFOA in middle age, meaning patients could present with a 20-year pain history.
Causes and Risk Factors
Like knee OA generally, PFOA involves modifiable and non-modifiable risk factors:
- Modifiable – Overweight/obesity, occupational loading, major joint injuries (including ACL injury).
- Non-modifiable – Female sex, age, trochlear dysplasia, patella alta.
Interestingly, although logic suggests that patellar instability leads to PFOA, the research hasn’t yet been done to quantify this risk.
Management Approaches
Learning from Knee OA
Evidence-based guidelines for knee OA emphasise:
- First-line – Education, exercise, weight management.
- Second-line – Manual therapies, taping and bracing, medications and injections only when needed.
- Third-line – Surgery for end-stage disease after conservative options are exhausted.
For PFOA, we cautiously extrapolate these principles, but with some caveats.
Physical & Physiotherapy Interventions
- Bracing – Three studies show medium-term improvements in pain and function, but no added benefit from patella realignment straps. Braces can be bulky and difficult for patients to exercise in.
- Taping – Limited, low-quality evidence. Some studies suggest medial glide taping may help pain immediately and may enhance exercise outcomes.
- Foot Orthoses – Evidence is mixed; small studies show conflicting results for prefabricated and customised devices.
- Exercise & Multimodal Physiotherapy – Strongest evidence so far. Programs combining exercise, education, taping and manual therapy show short-term improvements in pain and function, with some medium-term benefit. Long-term results are less clear, often due to poor adherence after studies end.
Medical & Surgical Interventions
- Medications/Injections – Very limited evidence.
- Surgery – Patellofemoral arthroplasty has shown positive short- and medium-term results compared with total knee replacement in isolated patellofemoral cases.. Longer-term outcomes (six years) still suggest benefit, though numbers are small. Good candidates for this surgery are rare.
Influences on Treatment Decisions
My qualitative research found that patient treatment choices were shaped by:
- Intrapersonal factors – Preferences, pain experiences, beliefs.
- Interpersonal factors – How clinicians communicate, the relationships they build with their clients, medical imaging, and the influence of social networks.
- Systemic factors – Access to services, and healthcare pathways.
Crucially, clinicians play a central role: the language we use in explaining things, the way we discuss imaging results, and the recommendations we make can significantly affect confidence and decision-making – for better or worse.
What this means for people with Patellofemoral Osteoarthritis
- PFOA is highly prevalent, often more symptomatic than tibiofemoral OA, and may act as a gateway to more widespread knee disease.
- Evidence for treatment is limited, but exercise and multimodal physiotherapy remain the best supported approach.
- Bracing and taping may have a role, while evidence for foot orthoses, medications, and injections is weak.
- Isolated patellofemoral arthroplasty may help selected people with PFOA, but good candidates are rare.
- Most importantly, how clinicians communicate and guide patients matters just as much as the interventions themselves.
How we help at Complete Physio Richmond
At Complete we work with people every week who are living with patellofemoral osteoarthritis. Our approach combines education, tailored exercise rehab programs and evidence based treatments to reduce pain and improve function.
If you’d like support, you can book an appointment in Richmond with one of our physiotherapists.
This article is adapted from my presentation at the PFJ Masterclass seminar which covered topics across the spectrum of Patellofemoral Joint disorders.
