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Anterior knee pain

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  • Anterior knee pain refers to pain that occurs at the front of the knee, around or behind the kneecap (patella). It is a common symptom rather than a specific diagnosis and can result from multiple various conditions affecting the structures at the front of the knee. It is often aggravated by activities such as stairs, squatting, or prolonged sitting.

  • There are many causes of anterior knee pain:

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    • Patellofemoral pain syndrome (PFPS) - Most common cause, often from overuse, muscular imbalance or poor conditioning. Usually no underlying anatomical abnormality.

    • Chondromalacia patella - Softening and early wear of the cartilage on the underside of the patella. May be associated with anatomical abnormalities.

    • Quadriceps tendinopathy - Inflammation or degeneration of the quadriceps tendon that inserts on to the top of the patella.

    • Patella tendinopathy (Jumper’s Knee) - Inflammation of the patella tendon that connects the patella to the tibia (shin bone). Is usually an overuse injury, especially in jumping athletes.

    • Osgood-Sclatter’s Disease - Inflammation where the patella tendon inserts onto the tibia (shin bone). Results in a bump of bone that can be painful. Tends to settle once growing stops, but loose fragments can cause inflammation and pain.

    • Sinding-Larson-Johansson Syndrome - Similar to Osgood Slatter’s disease, except that it affects the inferior pole (bottom part) of the patella.

    • Plica Syndrome - Condition where a fibrous band (usually a developmental remnant) can catch in the front of the knee causing mechanical symptoms.

    • Lateral Patella Tendon Conflict / Fat Pad Impingement Syndrome - Inflammation and pain of the proximal (top) part of the patella tendon and underlying fat pad, caused by impingement on the front of the femur. Usually associated with patella alta (high-riding patella).

    • Patellofemoral arthritis - Loss of the articular (joint) cartilage between the knee cap and the front of the femur.

    • Patella instability - Knee cap instability can be associated with anterior knee pain, but usually only if there is associated patella tendon conflict or cartilage loss (arthritis). 

  • Anterior knee pain is a symptom, not a diagnosis. A careful physical examination is used to assess for any anatomical contributing factors. X-rays and an MRI scan are used to look at the anatomy and quality of the cartilage around the patellofemoral joint.

  • The vast majority of anterior knee pain can be treated with non-surgical options, which are tailored to the individual pathology or cause:

    • Managing body weight - due to the mechanics of the patellofemoral joint, eight-times body weight passes through the kneecap joint when descending stairs. Weight loss therefore often has a large impact on improving anterior knee pain.

    • Activity modification - Reduction of aggravating factors such as stairs, squats or excessively long runs

    • Physiotherapy - This focusses on strengthening and conditioning of core, gluteal (hip and buttock) and quadriceps musculature. 

    • Pain management - Anti inflammatory medications (e.g. ibuprofen), ice, and patella taping can be helpful. Topical anti inflammatory preparations (gels or creams) can be bought over the counter, and may be particularly good for tendinopathies.

  • Surgery is reserved for cases whereby there is un underlying anatomical factor that can be corrected. This is most commonly for patella tendon impingement seen in lateral patella tendon conflict, excision of plica, and sometimes to treat cartilage damage.

  • You should seek assistance if you experience persistent knee pain, swelling, or if your symptoms interfere with daily life. 

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