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Patellar Clunk Syndrome – Causes, Symptoms & Treatment

What is Patellar Clunk Syndrome?

Patellar Clunk Syndrome (PCS) is a condition that occurs after total knee replacement (TKR) surgery, where a painful catching or clunking sensation is felt in the knee when bending or straightening the leg. This happens due to the formation of fibrous scar tissue behind the patella, which gets caught in the knee joint, causing discomfort and restricted movement.

While uncommon, this condition can impact mobility and knee function, especially in patients with posterior-stabilized knee implants.

Diagnosis of Patellar Clunk Syndrome

  • Physical Examination
  • X-ray
  • MRI or CT Scan

Treatment Options for Patellar Clunk Syndrome

Conservative (Non-Surgical) Treatments
  • Physical Therapy: Focuses on stretching and strengthening exercises to improve patellar mobility
  • Anti-Inflammatory Medications: NSAIDs (like ibuprofen) help reduce pain and swelling.
  • Corticosteroid Injections: Temporary relief by reducing inflammation around the knee.
Surgical Treatments (For Severe Cases)
  • Arthroscopic Debridement: A minimally invasive procedure to remove excessive scar tissue behind the patella.
  • Open Surgical Excision: In cases with extensive fibrosis, open surgery may be required to remove the impinging tissue.
  • Revision Knee Replacement: If implant design is contributing to the issue, a revision surgery may be necessary
Causes of Patellar Clunk Syndrome
  • Scar Tissue Formation: Excessive soft tissue growth behind the patella can cause mechanical interference.
  • Posterior-Stabilized (PS) Knee Prosthesis: Certain knee replacement designs have a femoral notch that interacts with the patellar component, leading to clunking.
  • Inflammation & Fibrosis: Post-surgical healing can lead to excessive fibrous tissue buildup.
Symptoms of Patellar Clunk Syndrome
  • Painful “Clunk” or “Click” Sensation: Most noticeable when extending the knee from a bent position.
  • Restricted Knee Movement: Difficulty fully straightening the leg due to tissue obstruction.
  • Swelling & Tenderness: Mild to moderate inflammation around the knee.
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