​Anterior knee pain - It's all about the diagnosis

Dr Michael Burdon talks through the three most common types of anterior knee pain, along with causes, diagnosis and management.

Anterior knee pain refers to pain felt in the front part of the knee and is very common across all ages. There are many causes and diagnoses of anterior knee pain — the three most common are patellofemoral pain, osteoarthritis and patellar tendinopthy.

1. Patellofemoral pain

The patella(knee cap) sits on top of your thigh bone(femur) and forms the patellofemoral part of the knee joint. Pain can result from abnormal positioning or tracking of the patella. This is common when we stress or load the knee joint- such as running, squatting, jumping and hopping. Pain can also be present when sitting for periods of time and straightening the knee out after sitting. Often patients describe creaking or noises from that area of the knee.

In the majority of cases this is due to poor control or tracking of the patella and it does not represent any structural damage to the joint. It is often associated with weak gluteal and core muscles which result in the knee being loaded more than normal. A change in angle of the patella, weakened quadriceps muscles and some foot types may also be seen.

Usually MRI or scan are normal and no needed initially. This can be a tricky problem to treat and therefore a team approach is needed to help. This usually involves physiotherapy and also podiatry to look at the “ biomechanics” if needed. Usually the pain will start to improve after 6 – 8 weeks but is often takes several months to help. MRI scans can be considered if there is no improvement in pain despite rehabilitation.

2. Osteoarthritis

This can affect the knee joint and essentially means some loss of cartilage which can progress to the joint space decreasing and formation of bone spurs. Pain here can be worse with exercise and often is felt later on or into the next day. The pain can be associated with swelling. X‑rays or MRI can be arranged to assess the joint.

In most cases the condition cannot be fixed or cured but can be managed well over time. Options include pain medication, weight loss, physiotherapy, joint injections and surgery in some cases. If overweight then weight loss can often be very successful.

3. Patellar Tendinopathy

The patella tendon is in the front of the knee below the knee cap. Degeneration and some inflammation can lead to tendinitis (better term is tendinopathy). This is usually an over-use condition and seen in runners and military athletes who load their knees a lot.

At Pure we can use diagnostic ultrasound to look at the tendon and assess the condition. Management often included physiotherapy exercises to strengthen the tendon, podiatry and other soft tissue work. There are some further options such as shockwave therapy and dry needling of the tendon. In a few cases that do not respond we can refer you to Professor Alfredson who works with Pure- surgery can help by scraping the tendon.

Please watch the below video to a recent sports medicine conference talk that I gave on Anterior knee pain — this will provide you with much more information if needed.

If you’re interested in being treated by Dr Burdon you can book and appointment in his Chancery Lane clinic .