Anterior Knee Pain

Background

Anterior knee pain is most commonly a combination of two conditions Patellar Tendonitis and Chondromalacia Patella.

Patellar Tendonitis

The most common tendinitis about the knee is irritation of the patellar tendon. Commonly called “jumper’s knee”, patellar tendinitis is inflammation of the tendon that attaches the patella (kneecap) to the tibia (shin bone). This condition is commonly seen in people who play basketball, volleyball, distance running, mountain climbing, figure skating, tennis or high impact aerobics.

In many cases, you will notice a sudden onset of aching and pain in the area just below the kneecap after sports or recreational activities. You may notice pain when landing from a jump or when going up and down stairs. There is sometimes pain after sitting with the knees bent for a period of time. Swelling in the area just below the kneecap is common, as well as a feeling of weakness.

Patellar Chondromalacia (Patellofemoral Pain Syndrome)

Chondromalacia of the patella is a form of “early arthritis.” When the knee moves, the kneecap (patella) slides to remain in contact with the lower end of the thigh bone (trochlear groove of the femur). Normally, this motion has almost no friction. If the patella and/or femur joint surface (articular cartilage) becomes softened or irregular, the friction increases and grinding (crepitus) can be heard or felt with knee motion.

The pressure on the patella is 1.8 times your body weight with each step when walking on a level surface. When climbing up stairs, the force is 3.5 times body weight and when going down stairs it is 5 times body weight. When running or landing from a jump the patellofemoral force can exceed 10 or 12 times body weight.

The symptoms of patellar chondromalacia are usually pain in the front of the knee that is aggravated by going up and down stairs, sitting for long periods of time with the knees bent (such as in a movie) and when doing deep knee bends. Exercises and activities that require deep knee bending, jumping and landing, pushing or pulling heavy loads and stopping and starting will place very high stresses on the front of the knee.

Symptoms / Diagnosis

  • Pain (typically in the front of the knee)
  • Swelling
  • Pain when squatting or twisting
  • Popping and clicking

Although the diagnosis is made based on physical exam, x-rays can help to confirm the diagnosis.

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Treatment Options

Treatment has two objectives: to reduce the inflammation and to allow the tendon to heal. When the knee is painful and swollen, you must rest it. This means avoiding going up and down stairs and hills, deep knee bends, kneeling, step-aerobics and high impact aerobics. Avoid stair climbing and jumping sports. Keep your knee straight while sitting, and avoid squatting. Do not wear high heeled shoes. Do not do exercises sitting on the edge of a table lifting leg weights (knee extension).

Let pain be your guide. You are aggravating the condition if you continue activities while experiencing pain. Mild discomfort or ache is not a problem but definite pain is a reason to decrease your activity.

Ice your knee for 20 minutes, two or three times a day and after any sporting activities apply a bag of crushed ice or frozen peas over a towel. This reduces swelling, inflammation and pain. Aleve (Naproxen / Naprosyn) or Advil (Ibuprofen) sometimes helps to relieve pain and reduce inflammation. An elastic knee support that has a central opening cut out for the kneecap sometimes helps.A physical therapist or the doctor can recommend exercises to strengthen the muscles. Exercises can also be used to stretch and balance the thigh muscles. In some cases surgery may be indicated.

Sports

Use your judgement. When your knees hurt, avoid sports that may aggravate your knee problems. Total rest may be required. When your knee is better after treatment, you should be able to enjoy many sports.

Sports that aggravate patellar tendinitis and chondromalacia patella: volleyball, basketball, soccer, distance running, racquetball, squash, football, weightlifting (squats).

Sports that may or may not cause symptoms: cycling (it is best to keep the seat high and avoid hills), baseball, hockey, skiing and tennis.
Sports that are easiest on the knees: Swimming (especially with a flutter kick), walking (avoid up and down hills), elliptical machine, Exercise bike (make sure seat is high).

Do not do the following exercises:

  • lunges
  • squats
  • stair-stepper machines
  • leg extension machine

The following exercises are OK to do if they cause no pain, grinding or swelling:

  • straight-leg lifting exercises
  • stationary cycle (seat high, resistance low)
  • leg press ( do not let the knees bend past 90 degrees)
  • hamstring curl machine

An exercise program should be followed as instructed by the doctor or physical therapist.

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Further Reading

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