Anterior Knee Pain: Causes, Symptoms, Treatment, Diagnosis

Pain felt in the front and the center of the knee is known as anterior knee pain. It is a common complaint caused by a range of muscle and bone-related conditions. 1 in every 4 adults has knee pain and it is the most frequent reason people consult a doctor.⁽¹⁾ Injury to the tissues may also be a cause of anterior knee pain.

Anterior knee pain is also known as patellofemoral knee pain as it is linked with patellofemoral joint.

What causes anterior knee pain is not clear but its known to be caused due to functional, mechanical, imbalance, and structural alteration. There are many factors that may lead to anterior knee pain. A few of which include:

• Structural damage
• Structural and anatomical abnormalities
• Patellar fracture
• Overuse or repetitive use of the knee
• Patellofemoral instability
• Malalignment or patellar instability

There are many medical conditions that may lead to anterior knee pain, which include:

• Patellar arthritis
• Lateral compression syndrome
• Chondromalacia patella
• Quadriceps tendinitis
• Patellar tendonitis, also known as jumper’s knee
• Plica synovial syndrome. It leads to irritation of the growth plate at the bottom of the knee.
• Sinding-Larsen-Johansson syndrome, which leads to irritation of the growth plate at the bottom of the knee cap
• Bone tumors
• Knee bursitis
• Osgood-Schlatter disease leads to inflammation of the area around the knee

Anterior knee pain is more like to occur in females and more common in teenagers and young adults.⁽³⁾ Research shows anterior knee pain affects more adolescent populations.⁽⁴⁾

Those doing more physical and repetitive exercises are more likely to suffer from anterior knee pain. These activities include:

• Skiers
• Jumpers
• Athletes
• Cyclist
• Runners

A history of knee injury is more likely to cause anterior knee pain in a person.

There are different symptoms presented by different people for anterior knee pain. The main symptom is pain behind or around the knee cap. This can appear or worsen with activities that put load around the knee joint. These activities include:

• Wearing high heels
• Squatting
• Using a car clutch
• Going down the stairs
• Sitting for long periods of time
• Iliotibial band syndrome
• Osteochondritis dissecans

A person may feel knee instability when the knee gives way or buckles, especially while using the stairs or ramps. There is a crepitus or grating feeling, a noise on moving the knee.

There may be pain as the intensity of the activity changes, or there is a change in the surface or equipment. There may also be quadriceps muscle weakness as the pain persists.⁽²⁾

The symptoms of the anterior knee are nonspecific. The symptoms may be overlapping with other symptoms conditions causing knee pain.

Therefore, a thorough medical history is taken, which includes a person’s:

• Medical history
• Activities
• Characteristics of pain
• Other symptoms

A series of physical examinations are done to determine the painful area and to determine what structure is likely injured.

The core stability, muscle imbalance, and functional limitations are assessed by asking the person to do single legs squats and walk around.

Imaging techniques such as ultrasound, X-ray, and MRI scans may be done to rule out other conditions.

The management and treatment of anterior knee pain depend on the underlying cause. Most common are conservative changes and lifestyle changes.

• Wearing suitable footwear
• Maintaining moderate weight
• Resting knee for sometime
• Using ice and heat
• Limiting prolonged sitting
• Using taping to realign knee cap
• Avoiding activities that trigger pain

Healing of the knee depends on the cause of anterior knee pain. The symptoms mostly settle down in a few weeks. In some athletes, the symptoms may completely resolve in 2 years.⁽⁵⁾

A person may be referred for physical therapy and rehabilitation that may help in:

• Addressing malalignment
• Correcting compensatory movement patterns
• Providing strengthening programs to reduce pain and prevent a recurrence

These programs may also increase flexibility, strength, and endurance.

Anterior knee pain experience may vary from person to person. It occurs mostly due to overuse or activity, structural abnormalities, muscle imbalance, or any other condition affecting it. Its symptoms improve within a few weeks and if the symptoms last longer a doctor should be consulted.