Anterior Knee Pain
Anterior Knee Pain — Causes and Treatments
Pain at the front of the knee is one of the most common reasons patients come to see me. The great majority improve without surgery once the underlying cause is correctly identified and addressed with a structured plan.
Overview
What is anterior knee pain?
Anterior knee pain is an umbrella term for pain felt at the front of the knee, around or behind the kneecap (patella). It is especially common in active people, in adolescents during growth spurts and in those whose kneecap does not track smoothly in its groove on the front of the thigh bone.
It is rarely caused by a single problem. Most often it is a combination of factors — alignment, muscle balance, activity load and sometimes the shape of the joint itself — and the most successful treatment plans address all of the contributing causes together.
Common causes
- Patellofemoral pain syndrome (maltracking of the kneecap)
- Chondromalacia patellae — softening of the cartilage behind the kneecap
- Patellar and quadriceps tendinopathy (jumper's knee)
- Patella alta — a high-riding kneecap that fails to engage the groove
- Muscle imbalance or weakness of the quadriceps and hip stabilisers
- Overuse from running, jumping or repetitive squatting
- Early patellofemoral arthritis
- Fat pad impingement and synovial irritation
Typical symptoms
- Aching pain at the front of the knee, around or behind the kneecap
- Pain worse going up or down stairs and on prolonged sitting
- Grinding, clicking or a feeling of the knee giving way
- Swelling or a sense of pressure after activity
How it is diagnosed
- Detailed history of your activities, symptoms and previous injuries
- Examination of patellar tracking, alignment and muscle strength
- X-rays to assess kneecap position and the patellofemoral joint
- MRI scan where cartilage, tendon or soft-tissue detail is needed
Non-operative treatment plan
The first-line treatment for almost all anterior knee pain is non-surgical. The plan below is followed through in stages, with progress reviewed along the way.
0 – 6 weeks
- Activity modification and load management
- Anti-inflammatory measures and ice as needed
- Start physiotherapy focused on quadriceps and hip control
6 weeks – 3 months
- Progressive strengthening and patellar taping or bracing
- Address foot posture and consider orthotics if needed
- Graded return to running and sport
3 – 6 months
- Review progress and maintain a long-term exercise routine
- Consider injection therapy (PRP) where appropriate
- Investigate further only if symptoms persist
Surgical options when needed
Surgery is only considered when a clear structural cause is found and a thorough non-operative programme has not relieved symptoms. The procedure is tailored to the underlying problem.
Arthroscopy
- Keyhole assessment and treatment of cartilage damage
- Removal of inflamed tissue or fat pad impingement
Realignment surgery
- Tibial tubercle transfer to correct kneecap tracking
- MPFL reconstruction where there is associated instability
- Realignment surgery - DFO
Recovery timings after surgery
0 – 6 weeks
- Crutches and early physiotherapy
- Protect the knee while soft tissues or bone heal
6 weeks – 3 months
- Progressive strengthening and increasing weight bearing
- Repeat X-ray after osteotomy to confirm healing
3 – 6 months
- Return to sport and full activity as strength allows
- Final review to confirm a good, lasting result