Anterior knee pain

What is it?

Anterior knee pain refers to a group of conditions that cause discomfort at the front of the knee.  The pain can be as a result of an injury, or have just come on gradually. Anterior knee pain in itself is not a diagnosis, but more a description of symptoms that can have a number of underlying causes.

Why does it occur?

Pain at the front of the knee can originate from many sites. 

  1. Chondromalacia patellae
    Chondromalacia patellae refers to the softening of the articular cartilage on the back of the kneecap. This can lead to excess stress on the underlying bone, and pain secondary to this. Chondromalacia patellae may be as a result of the kneecap being subject to an abnormal distribution of weight, which in turn may be caused by muscle imbalance.  In some circumstances, normally in young females, it can have no obvious cause. 

  2. Patellar tendonitis

    Patellar tendonitis, also known as jumper’s knee, is a condition whereby the tendon running from the kneecap to the shin bone is subject to repeated stress, leading to tiny micro-tears within the tendon. As the body attempts to repair this, the tendon becomes inflamed and weakened, which leads to  discomfort and pain at the front of the knee. This condition is common in overuse injuries, such as runners and jumping athletes, particularly those with muscular imbalances.

  3. Medial plica syndrome
    Medial plica syndrome is a condition of irritation of the tissue that forms the inner lining of the knee joint. Behind the patellar tendon in the knee there is a specialised fat pad which, sometimes if the knee is over-used after a period of inactivity, can become pinched and inflamed.  The chemical and mechanical irritation within the knee, as a resulf of this, can lead to anterior knee pain.

What are the symptoms?

Anterior knee pain normally manifests as a discomfort behind the kneecap, or just above or below the kneecap, predominantly during activities that involve bearing weight on a flexed knee. Activities that can provoke this sort of pain are: sitting with the knees bent for a prolonged period of time; walking up or down slopes or stairs; performing squats and lunges; and sports that involve jumping or landing.

How is it diagnosed?

As anterior knee pain can have a number of causes, a careful clinical examination combined with appropriate diagnostic imaging, such as x-rays, is essential. Your surgeon will review the biomechanics of your lower limbs carefully, and examine your entire knee. Sometimes it is evident from this examination what the most likely cause of the symptoms is. However, it may be necessary to have either x-rays or an MRI scan in order to differentiate between potential conditions.

How is it treated?

How we manage this type of knee pain will depend on what exactly is causing it. Often measure that do not involve surgery, such as physiotherapy, will resolve the symptoms. IN some cases, physiotherapy can be augmented with appropriate injections, to reduce pain and allow you to exercise more effectively. Conditions that do not respond to non-operative measure may require surgery.  s.

Treatment options

Steroid injections

PRP therapy

Hyaluronic acid injections

Knee arthroscopy

Non-surgical treatment

The One Orthopaedics team specialists

Mike Lemon

Consultant Orthopaedic Knee and Hip Specialist (Tr & Orth)

Oliver Templeton-Ward

Consultant Orthopaedic
Knee Specialist FRCS (Orth)

Kerry Acton

Consultant Orthopaedic Hip and Knee Surgeon FRCS (Tr & Orth)