Front of knee pain is a common complaint in active people. The most common cause is the runner’s knee or patellofemoral pain. However, not all pain in front of the knee is the runner’s knee. The key to ending knee pain is finding the correct cause and treating it. The reason is based on a person’s age, activity level, and the type of sport. So, what are the causes of front of knee pain, and how do we get to the bottom of it?
What are the Critical Structures for Front of Knee Pain?
The knee is a complex structure consisting of three bones: the thigh bone or femur, the leg bone or tibia, and the kneecap. The knee joint comprises three compartments: medial, lateral, and patellofemoral. Tendons and ligaments hold bones together. Other noteworthy structures include the fat pads and bursa.
The kneecap slides on the front of the knee during the knee movement. The kneecap, or patella, provides a vital lever to generate more power at your knee joint.
Common Causes of Front of Knee Pain
Active people develop common injuries at the front of the knee.
Runner’s knee
Runner’s knee, also called patellofemoral pain syndrome or PFJ pain, is common in runners and cyclists. We think people get hurt due to increased pressure between the kneecap and the front of the knee. This increased pressure comes from too much running or cycling combined with muscular imbalances or weakness.
Generally, your doctor has you perform exercises such as squats or lunges to reproduce pain at the front of the knee. Imaging, such as an X-ray or MRI of the knee, is often normal.
Most PFJ pain will settle with a sensible rehab program under the guidance of an experienced physiotherapist. We lead treatment to correct muscle imbalances such as tight hamstrings, weak buttock muscles, and flat feet. Often, hip and knee muscle strengthening exercises are helpful for PFJ pain. Also, taping the kneecap, changing your activity, and acupuncture can help.
Tips for treating PFJ pain
- reduce activity that flares your pain, i.e., running
- Ice the knee regularly to reduce inflammation
- Volarol gel applied to the front of the knee can help. Sometimes anti-inflammatory tablets such as ibuprofen are needed
- A knee brace with a hole in the middle may lower pain during some activities, such as gym or running
- Occasionally, we perform injections to reduce pain, particularly if you have degeneration in the joint
Patellar tendonitis
Patellar tendonitis is also called jumper’s knee. This condition occurs in people who play jumping or change-of-direction sports such as volleyball, football, or netball.
Usually, pain is more focal than the runner’s knee. It is localised to the tendon just below the bottom of the kneecap.
Fat pad impingement
Fat pad impingement is also called fat pad pinching. These fat pads are situated on either side of the patellar tendon. We think that fat pad impingement is also associated with patellofemoral pain.
Generally, pain and tenderness are localised to the fat pads.
Less Common Causes of Front of Knee Pain
Not all causes of anterior knee pain are common. Many reasons occur infrequently, but the treatment differs from that of more common causes.
Prepatellar bursitis
Prepatellar bursitis, also called housemaid’s knee, is a swelling of the prepatellar bursa. This swelling occurs due to irritation of the prepatellar bursa from a single fall or from continuous trauma.
Often, pain occurs when pressure is applied to the bursa, such as when kneeling. Occasionally, the swelling in the bursa can prevent repeated kneeling.
Quadriceps tendonitis
Quadriceps tendonitis is similar to patellar tendonitis. However, it occurs just above the kneecap rather than below the kneecap. This condition is common in jumpers or in sports that involve changes in direction.
Kneecap arthritis
Kneecap or patellofemoral arthritis is common in older patients. They develop wear and tear or degenerative change in the patellofemoral joint. Generally, pain from kneecap arthritis occurs at the front of the knee.
An X-ray or MRI scan often shows degenerative changes in the patellofemoral joint.
Meniscal cyst as a cause of front of knee pain
Meniscal cysts often develop from degenerative meniscal tears. For example, in tears involving the front or anterior horn of the meniscus, cysts can form at the front of the knee and enter the fat pads. Often, imaging such as ultrasound or MRI confirms this diagnosis.
Plica of the knee
Plica is thick synovial tissue in the knee. Sometimes, these plicae can become caught between the kneecap and the knee, causing medial plica syndrome.
Generally, pain from a thickened medial plica presents as pain on the inside of the knee with clicking or catching with knee bending.
Hip arthritis: one to not miss as a cause of front of knee pain
Sometimes, front-of-knee pain does not always come from the knee joint. In these cases, pain may arise above the knee, such as from the hip joint. For example, hip arthritis can cause pain in the knee, not the hip.
Gout in the knee
Gout is an inflammatory arthritis caused by the formation of uric acid crystals in joints and soft tissues.
While the big toe is the most common joint affected, the knee joints are also frequently targeted. Generally, knee gout presents with pain, swelling, and restricted movement.
Rare Causes of Front of Knee Pain
Bone tumours
Growths within the bones around the knee can cause pain. Examples include osteosarcoma or osteochondroma.
Stress fracture of the patella
In very active runners, anterior knee pain can occur due to fatigue or a stress fracture of the patella.
Generally, pain at the kneecap is often mistaken for other causes.
Usually, we use an MRI scan to confirm the diagnosis of a stress fracture.
How Do We Make a Diagnosis of Front of Knee Pain?
See an experienced doctor to diagnose your front of knee pain and offer the correct treatment. Your doctor will take a history and perform a thorough medical examination, including evaluation of all structures in the anterior knee.
X-ray, ultrasound, and MRI imaging often sort out the diagnosis, especially in more complex cases.
Final Word from Sportdoctorlondon about Front of Knee Pain
Anterior knee pain is a common presentation that needs a proper examination to define the cause. Getting the condition better means identifying the cause and directing appropriate treatment.
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