Anterior knee pain

In this 'syndrome' the pain in the front of the knee tends to be described with the flat hand because of its poor localisation, rather than pointed at with a finger.

What are the characteristics of anterior knee pain?

The characteristic pain referred to as anterior knee pain tends to be associated with:

• forced activities - squatting, weight bearing activities, running.
• prolonged sitting – producing stiffness, pain, or both, relieved by straightening (extending) the knee.
• pain on getting up from sitting - the pain may be severe, then diminishes and even disappears as the individual keeps walking.
• the “theatre sign” in some - where the individual seeks to sit at the end of any row of chairs, to allow the relief afforded by straightening the knee or even standing up,
• problems with walking - where the person may exhibit weakness, 'giving way' of the knee, and 'catching'.  
• stair climbing producing pain when weight is applied on the leg, when going up or down stairs.
• snapping, popping, or crunching in the knee occurring with activity as simple as walking, that may be accompanied by pain, which may be so severe that the individual feels that the knee locks.

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Investigating anterior knee pain

Diagnosis is primarily one of exclusion, used when the cause of this type of pain has not been properly identified.

In adolescents, where the complaint is seen quite frequently, the surgeon will try to exclude biomechanical causes relating to the patella and its underlying groove, and particularly to irritation of the fat pad.

Routine workup for anterior knee pain may include evaluation of:

• fat pad tenderness
• patellar tilt
• patellar malalignment and maltracking
• rotational deformities of tibia and/or femur
• foot rotation
• symptomatic plica

• Quote from peer-reviewed paper:

  "Although the tendency is to consider AKP as a single entity in clinical practice, it is rather diverse in its etiology [cause]....A holistic approach focused on the patient as a whole, as much as a focus on the joint as the therapeutic target, is....warranted."

  Citation: D'Ambrosi R, Meena A, Raj A, Ursino N, Hewett TE. Anterior Knee Pain: State of the Art. Sports Med Open. 2022 Jul 30;8(1):98. doi: 10.1186/s40798-022-00488-x. PMID: 35907139; PMCID: PMC9339054.

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Forum discussions

• "Success Story - patellofemoral pain syndrome"

  Patience rewarded without surgery.

• "Mpfl reconstruction for chronic pain"

  A patient struggling to locate the cause(s) of chronic patellar pain.

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