Anterior Knee Pain

Overview:

Anterior knee pain (Patello-femoral pain) refers to pain on the inside and around the knee cap. The condition affects a wide range of age group from young to old. The presenting complaints of patients is a crepitus or grating sensation in the knee with pain and loss of flexibility. The patients of elderly age group usually have an element of degenerative arthritis which is the main cause. The younger population of the other hand usually have patellar mal-tracking which leads to abnormal wearing out.

Pathophysiology:

The alignment disturbance may be because of a soft tissue cause or a bony abnormality. Soft tissue imbalances(between muscle groups) are more common. They are treatable non-surgically in most cases. Bony alignment issues may need a surgical correction and consultation with an orthopaedic should be done on priority. Knee pain in younger age group should not be ignored as with time it may lead to irreversible deterioration of the cartilage structure and result in early arthritis. Anterior knee pain is most commonly caused by an entity known as the patello-femoral pain syndrome(PFPS) and comprises of an array of bio-mechanical disturbances in normal kinematics of the knee joint. An abnormally high and low riding patella can also lead to pain in the knee which is long lasting and non resolving with conservative treatment.

Most common cause of anterior knee pain in young is PFPS

Treatment:

The normal weight bearing axis and direction of muscle pull when disturbed leads to generation of pain. This pain generating factor leads to inhibition of normal muscular activity which leads to muscular atrophy. These symptoms might arise even with prolonged squatting or cross-legged posture and a flat or pronated foot. Lifestyle modifications along with a tailored rehabilitation programme remains must after diagnosing the cause of pathology to prevent recurrence of symptoms.

Small subset of patients however, have to undergo a surgical correction of the alignment for salvaging the joint from further damage. In these cases a thorough work up is essential for deciding the procedure of choice. Radiological investigations are of big help in decision making. Tibial Tuberosity transfer, Patello-femoral ligament reconstruction and soft tissue procedures are important common surgeries.

Other problems causing a anterior knee pain may include jumpers knee, peri-patellar synovitis, bursitis and patellar tendinitis

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