Patellofemoral Pain Syndrome (PFPS), also known as Runner’s Knee, is one of the most common causes of knee pain in women.

While often associated with athletes, PFPS affects office workers, gym-goers, and individuals with biomechanical imbalances. In recent years, regenerative medicine, especially Umbilical Cord–Derived Mesenchymal Stem Cells (UC-MSCs), has emerged as a possible adjunct to reduce inflammation, improve tissue healing, and enhance recovery for persistent PFPS cases.

This guide explains why PFPS is more common in women, how the condition develops, traditional treatments, and how MSC therapy may offer biological support for long-term knee health.

Why PFPS Is More Common in Women

PFPS affects women 2–8 times more frequently than men (Boling et al., 2010). The reasons are rooted in biomechanical, hormonal, and structural differences.

Female-Specific Factors Contributing to PFPS

• Wider Q-Angle

Women naturally have a wider pelvis, creating a larger Q-angle—the angle between the hip and knee. This increases lateral pull on the kneecap, causing:

• Maltracking
• Increased patellar stress
• Irritation of the cartilage

• Greater Ligament Laxity

Estrogen influences ligament elasticity. Higher estrogen levels may lead to:

• Increased knee instability
• Hypermobile patella
• Higher joint stress during movement

• Different Landing Mechanics

Women tend to land with:

• Greater knee valgus (knees collapsing inward)
• Lower hip strength
• More quadriceps dominance

These patterns increase patellofemoral load.

• Weaker Hip and Gluteal Muscles

Gluteus medius weakness leads to poor hip stability, resulting in:

• Femoral internal rotation
• Increased patellar pressure
• Pain during running or descending stairs

• Higher Rates of Patellofemoral Dysplasia

Structural variations in kneecap shape are more common in women.

Symptoms of Patellofemoral Pain Syndrome

Common features include:

• Pain behind or around the kneecap
• Worsening pain during stairs, running, or sitting long periods (“theatre sign”)
• Clicking or grinding sensation
• Sensation of the knee “giving way”
• Stiffness after prolonged sitting

Symptoms often fluctuate and worsen with repetitive knee bending.

Causes of PFPS

PFPS is a multifactorial condition involving:

• Overuse

Repetitive bending, running, jumping.

• Malalignment

Patellar tracking issues from hip, foot, or knee mechanics.

• Muscle Imbalances

Weak hips, tight hamstrings, or quadriceps imbalances.

• Cartilage Irritation

Softening of the cartilage under the kneecap (chondromalacia patellae).

• Inflammation

Synovial irritation due to repetitive stress.

Why PFPS Can Become Chronic

Untreated PFPS may lead to:

• Chronic synovial inflammation
• Progressive cartilage wear
• Weakening of the quadriceps
• Early patellofemoral osteoarthritis

Because the patellofemoral joint absorbs 3–6 times body weight during stair descent, even minor biomechanical issues can escalate over time.

Standard Treatment Options

• Physical Therapy

Cornerstone of PFPS treatment.

Focuses on:

• Hip abductor strengthening
• Gluteal activation
• Vastus medialis oblique (VMO) strengthening
• Stretching hamstrings, quads, and IT band
• Patellar mobilization

• Taping and Bracing

Helps temporarily improve patellar alignment.

• Anti-Inflammatory Medication

Short-term symptom relief.

• Orthotics

Supports foot alignment to reduce knee load.

• Activity Modification

Reducing running, deep squats, and lunges during flare-ups.

When Is Surgery Needed?

Surgery is rarely required but may be considered for:

• Severe maltracking
• Patellar instability
• Structural abnormalities
• Failed conservative management

Procedures include lateral release or tibial tubercle realignment.

Where Stem Cell Therapy Fits In

Patellofemoral pain often involves inflammation, soft tissue irritation, and cartilage stress—processes that MSCs biologically target.

Biological Mechanisms of UC-MSCs in PFPS

Anti-Inflammatory Action

MSCs reduce synovial inflammation by modulating cytokines such as:

• IL-1β
• IL-6
• TNF-α

Reducing inflammation helps interrupt the pain cycle.

Enhanced Cartilage Microenvironment

UC-MSCs secrete growth factors (FGF-2, IGF-1, TGF-β) that:

• Support chondrocyte health
• Slow progression of cartilage softening
• Improve lubrication of the joint

Patellar Tendon Support

If the pain originates partly from patellar tendinopathy, MSCs help by:

• Reducing tendon inflammation
• Promoting collagen repair
• Improving tissue elasticity

Neuromuscular Improvement

Reduced inflammation leads to better activation of stabilizer muscles, including the VMO and gluteals.

When MSC Therapy May Be Considered for PFPS

MSC therapy may be an option if you have:

• Chronic PFPS lasting >3–6 months
• Pain that persists despite physical therapy
• Synovial inflammation shown on imaging
• Early cartilage softening (chondromalacia)
• Patellar tendinopathy
• PFPS combined with early kneecap arthritis

In athletic individuals, MSCs may help reduce downtime and support higher joint demands.

MSC therapy is not a replacement for correction of biomechanical deficits; it works best combined with targeted physical therapy.

The Role of UC-MSCs vs PRP for PFPS

PRP may help mild inflammation, but UC-MSCs offer:

• Greater anti-inflammatory effect
• Ability to modulate cartilage biology
• Support for tendon healing
• More potent cytokine balancing
• No need for blood draw
• Higher stem-cell viability

UC-MSCs show advantages in cases involving degeneration, tendon involvement, or chronic inflammation.

Preventing Recurrence of PFPS

Long-term management includes:

• Strengthening hip abductors and external rotators
• Avoiding excessive knee valgus during exercise
• Maintaining ideal body weight
• Using proper running shoes
• Avoiding repetitive deep bending without proper form

If untreated, PFPS can progress to patellofemoral osteoarthritis, especially in women.

Patellofemoral Pain Syndrome is a biomechanically complex condition, especially common in women due to anatomical and hormonal factors. While physical therapy remains the foundation of treatment, stem cell therapy provides a promising biological option for chronic cases involving inflammation, cartilage softening, or tendinopathy.

By combining TISTR-certified UC-MSC therapy, precise diagnostics, and biomechanical correction, EDNA Wellness supports patients seeking a modern, medically responsible approach to persistent anterior knee pain.

About EDNA Wellness

EDNA Wellness is a private clinic specializing in Stem Cell Therapy in Bangkok, Thailand for Neurology & Stroke as well as Bones & Joints. Beyond rehabilitation, we also provide aesthetic and wellness treatments to support your full-body vitality. All delivered with expert care and compassion

For more information or inquiries, contact us via

LINE @ednawellness

WhatsApp +66 (0) 64 505 5599

www.ednawellness.com

References

• Boling, M. C., et al. (2010). Gender differences in PFPS incidence. Clinical Journal of Sport Medicine.
• Lankhorst, N., et al. (2016). Factors contributing to PFPS. British Journal of Sports Medicine.
• Crossley, K., et al. (2014). Patellofemoral pain: Consensus statement. British Journal of Sports Medicine.
• Wang, Y., et al. (2022). MSC anti-inflammatory effects. Stem Cell Research & Therapy.
• Cook, J., & Purdam, C. (2013). Tendinopathy and biomechanics. British Journal of Sports Medicine.