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Anterior knee pain

Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee

 

Anterior knee pain is pain that occurs at the front and center of the knee. It can be caused by many different problems, including:

  • Chondromalacia of the patella -- the softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella)
  • Runner's knee (sometimes called patellar tendinitis)
  • Lateral compression syndrome - the patella tracks more to the outside part of the knee
  • Quadriceps tendinitis - pain and tenderness at the quadriceps tendon attachment to the patella
  • Patella maltracking - instability of the patella on the knee

Causes

 

Your kneecap (patella) sits over the front of your knee joint. As you bend or straighten your knee, the underside of the patella glides over the bones that make up the knee.

Strong tendons help attach the kneecap to the bones and muscles that surround the knee. These tendons are called:

  • The patellar tendon (where the kneecap attaches to the shin bone)
  • The quadriceps tendon (where the thigh muscles attach to the top of the kneecap)

Anterior knee pain begins when the kneecap does not move properly and rubs against the lower part of the thigh bone. This may occur because:

  • The kneecap is in an abnormal position (also called poor alignment of the patellofemoral joint).
  • There is tightness or weakness of the muscles on the front and back of your thigh.
  • You are doing too much activity that places extra stress on the kneecap (such as running, jumping or twisting, skiing, or playing soccer).
  • You have flat feet.

Anterior knee pain is more common in:

  • People who are overweight
  • People who have had a dislocation, fracture, or other injury to the kneecap
  • Runners, jumpers, skiers, bicyclists, and soccer players who exercise often
  • Teenagers and healthy young adults, more often girls

Other possible causes of anterior knee pain include:

  • Arthritis
  • Pinching of the inner lining of the knee during movement (called synovial impingement or plica syndrome)

 

Symptoms

 

Anterior knee pain is a dull, aching pain that is most often felt:

  • Behind the kneecap (patella)
  • Below the kneecap
  • On the sides of the kneecap

One common symptom is a grating or grinding feeling when the knee is flexed (when the ankle is brought closer to the back of the thigh).

Symptoms may be more noticeable with:

  • Deep knee bends
  • Going down stairs
  • Running downhill
  • Standing up after sitting for awhile

 

Exams and Tests

 

The health care provider will perform a physical exam. The knee may be tender and mildly swollen. Also, the kneecap may not be perfectly lined up with the thigh bone (femur).

When you flex your knee, you may feel a grinding feeling below the kneecap. Pressing the kneecap when the knee is straightening out may be painful.

Your provider may want you to do a single leg squat to look at muscle imbalance and your core stability.

X-rays are very often normal. However, a special x-ray view of the kneecap may show signs of arthritis or tilting.

MRI scans are rarely needed.

 

Treatment

 

Resting the knee for a short period of time and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may help relieve pain.

Other things you can do to relieve anterior knee pain include:

  • Change the way you exercise.
  • Learn exercises to both strengthen and stretch the quadriceps and hamstring muscles.
  • Learn exercises to strengthen your core.
  • Lose weight (if you are overweight).
  • Use special shoe inserts and support devices (orthotics) if you have flat feet.
  • Tape your knee to realign the kneecap.
  • Wear the correct running or sports shoes.

Rarely, surgery for pain behind the kneecap is needed. During the surgery:

  • Kneecap cartilage that has been damaged may be removed.
  • Changes may be made to the tendons to help the kneecap move more evenly.

 

Outlook (Prognosis)

 

Anterior knee pain often improves with a change in activity, exercise therapy, and the use of NSAIDs.

 

When to Contact a Medical Professional

 

Call your health care provider if you have symptoms of this disorder.

 

 

References

Collado H, Fredericson M. Patellofemoral pain syndrome. Clin Sports Med. 2010;29:379-98. PMID: 20610028 www.ncbi.nlm.nih.gov/pubmed/20610028

De Carlo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010;29:81-106. PMID: 19945588 www.ncbi.nlm.nih.gov/pubmed/19945588 .

Tan EW, Cosgarea AJ. In: Miller MD, Thompson SR eds. Patellar instability. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 104.

Silverstein JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine . 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 30.

 
  • Chondromalacia of the patella - illustration

    Chondromalacia of the patella is the grating or grinding sensation during extension of the knee. The cause is thought to be related to overuse, trauma and/or abnormal forces on the knee, such as a mildly abnormal alignment of the patella (knee cap) and femur. Symptoms include knee tenderness, pain in the knee after sitting for a prolonged period of time, knee pain that is worse with stairs or getting out of a chair, and a grating sensation in the knee.

    Chondromalacia of the patella

    illustration

  • Runners knee - illustration

    Chrondromalacia causes knee tenderness, knee pain in front of the knee, and a grating sensation in the knee. The knee pain is worst after sitting for a prolonged period of time or when getting out of a chair. The knee cartilage is affected probably from overuse, trauma and/or abnormal forces on the knee, such as a misaligned patella. Chondromalacia is treated with rest or immobilization and nonsteroidal anti-inflammatory drugs for pain. Physical therapy, especially quadriceps strengthening and hamstring stretching may also be helpful. Surgery is beneficial if there is a problem with the alignment of the patella that cannot be corrected with therapy.

    Runners knee

    illustration

    • Chondromalacia of the patella - illustration

      Chondromalacia of the patella is the grating or grinding sensation during extension of the knee. The cause is thought to be related to overuse, trauma and/or abnormal forces on the knee, such as a mildly abnormal alignment of the patella (knee cap) and femur. Symptoms include knee tenderness, pain in the knee after sitting for a prolonged period of time, knee pain that is worse with stairs or getting out of a chair, and a grating sensation in the knee.

      Chondromalacia of the patella

      illustration

    • Runners knee - illustration

      Chrondromalacia causes knee tenderness, knee pain in front of the knee, and a grating sensation in the knee. The knee pain is worst after sitting for a prolonged period of time or when getting out of a chair. The knee cartilage is affected probably from overuse, trauma and/or abnormal forces on the knee, such as a misaligned patella. Chondromalacia is treated with rest or immobilization and nonsteroidal anti-inflammatory drugs for pain. Physical therapy, especially quadriceps strengthening and hamstring stretching may also be helpful. Surgery is beneficial if there is a problem with the alignment of the patella that cannot be corrected with therapy.

      Runners knee

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

        Tests for Anterior knee pain

         

           

          Review Date: 10/24/2014

          Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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