Pain in the front of the knee may occur due to bone, muscle, tendon and other soft tissue disorders, especially the kneecap. The pain is sometimes felt steadily under the kneecap . Sometimes knee pain occurs in the cold. It can be exacerbated when sitting up, going up or down stairs. It can occur in the upper part of the knee, above or below the kneecap. Anterior knee pain can be diagnosed according to its location, conditions that cause it to increase or decrease, and examination findings. Except for traumatic events, it would be appropriate to first consult a physical therapy and rehabilitation physician for knee pain . If the true cause of the pain is determined, successful results can be obtained with appropriate treatment.
Who Gets Pain in the Front of the Knee More Often?
Anterior knee pain is more common in overweight people, those who have had a previous kneecap dislocation, fracture or other injury, runners, cyclists, football players, basketball players, youth, and women.
At the front of the knee is the patella bone. While bending and opening the knee, the kneecap makes a sliding motion on the thighbone. Strong tendons hold the kneecap where it should be. The tendon that attaches the kneecap to the quadriceps muscle at the front of the thigh is the quadriceps tendon; The tendon that connects the kneecap to the tibia below is called the patellar tendon.
If the kneecap cannot move freely as it should normally and starts to rub against the lower part of the thigh bone, a complaint of pain occurs in the front of the knee. This problem can develop for several different reasons. Abnormal placement of the kneecap, tightness or weakness of the muscles in the front and back of the thigh, shallow pit in the thigh where the kneecap sits, flat feet, pronation of the foot, excessive stress of the kneecap due to excessive movements such as running and jumping. are the main causes of anterior knee pain. Apart from these, joint inflammation (arthritis) due to rheumatic diseases can also cause pain felt in the anterior part of the knee.
How Is Anterior Knee Pain Diagnosed?
The first step is to question the complaints in detail and physical examination. These are usually sufficient for a preliminary diagnosis. Sometimes X-ray, MRI, or ultrasonographic imaging may be required to rule out other possible problems or confirm the diagnosis.
Runner’s knee is actually a general expression for pain felt in the front of the knee; It is also called patellofemoral pain syndrome. It’s common in runners, but it’s not just a running problem. It does not indicate a specific disorder. Chondromalacia patella, weak or tight thigh muscles, foot problems such as flattening of the sole, misalignment of the bones from the thigh to the ankle, overuse and trauma can lead to a clinical condition described as “runner’s knee” or “patellofemoral pain syndrome”. Pain in the front, sides or back of the kneecap, worsening when sitting up, walking, running, squatting, especially when going down stairs and downhill are typical in runner’s knee.
Chondromalacia patella refers to damage, inflammation, and softening of the cartilage under the kneecap. The cartilage layer provides frictionless movement and has shock-absorbing properties. Therefore, damage to the cartilage layer causes pain, grinding sensation and crunch. During the examination, friction sensation, crackling and pain may occur when sliding the kneecap up-down and right-left.
If there is tenderness and pain at the upper edge of the kneecap, the cause may be quadriceps tendinitis.
Pain and tenderness at the lower edge of the kneecap may be associated with injury to the patellar tendon. This can be painful when the knee is straight, but is usually somewhat relieved when bent 90 degrees. It can occur due to overdoing movements such as running and jumping. It is more common in football and basketball players.
Kneecap Implantation Disorder
Depending on the weakening of the ligaments holding the kneecap, muscle imbalances or structural bone misalignment, the kneecap may come out of its normal groove partially or completely. Partial displacement is called subluxation. While the knee is bent, the kneecap can be pushed to one side, causing tissue damage and pain as a result of friction. If the kneecap is being pushed outward, it is called lateral compression syndrome.
The cause of pain located on the inner or outer edge of the kneecap may be injury or inflammation of the joint membrane called the synovium. This is called plica syndrome.
Inflammation of the Fat Pad Under the Patellar Tendon
In the lower part of the kneecap, deep in the patellar tendon, there is a structure called the retropatellar fat pad. This fat pad can be damaged by trauma, surgery, or thickening of the ligaments that connect the kneecap to the shinbone. The presence of pain in this part on examination leads to the diagnosis.
Treatment of Pain in the Front of the Knee
Treatment may vary depending on the cause of the complaint. In the case of overuse, activity modification is recommended, in which the injurious movements are reduced. It is recommended to lose excess weight. Every 1 kilogram given reduces the load on the knee by 4 kilograms. If there is muscle weakness and stiffness, an appropriate exercise program is performed. Quadriceps strengthening exercises with quadriceps and hamstring stretches are particularly helpful. If there is a knee pad or foot problem, the use of appropriate insoles may be beneficial. Physical therapy methods (hot, cold, electrotherapy, ultrasound, short-wave diathermy, etc.), pain relievers, taping techniques (kinesiotape), injections in or around the knee joint are also applied. Stem cells , PRP and prolotherapyInjections are increasingly preferred in the treatment of many problems that cause anterior knee pain. If all these methods are not sufficient, some surgical treatments may be considered.