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Anterior Knee Pain

Anterior knee pain is pain that occurs at the front and center of the knee. Your kneecap (patella) sits over the front of your knee joint, and involves the patellar and quadriceps tendons.

Anterior knee pain refers to a number of different conditions. These include runner’s knee (patellar tendinitis) and chondromalacia of the patella. Anterior knee pain is more common in adolescents and healthy young adults, especially girls; people who are overweight; as well as runners, jumpers, skiers, cyclists, and soccer players.

Anterior Knee PainAnterior Knee Pain: Diagnosis/Definition

Knee pain localized to the anterior portion of the knee, either retropatellar or peripatellar. Usually a gradual, non-traumatic onset aggravated with increased activity, running, squatting, stair climbing or prolonged sitting. Symptoms normally decrease with rest.

Anterior Knee Pain Initial Diagnosis and Management

  • History and physical examination
  • Plain films not required
  • NSAIDs
  • Adults – 200 to 400 milligrams (mg) every four to six hours as needed for up to 2 weeks. Example: Ibuprofen
  • Take tablet or capsule forms of these medicines with a full glass (8 ounces) of water.
  • Do not lie down for about 15 to 30 minutes after taking the medicine. This helps to prevent irritation that may lead to trouble in swallowing.
  • To lessen stomach upset, these medicines should be taken with food or an antacid.
  • Avoidance of aggravating activities (profile for active duty soldiers)
  • Strengthening exercises for quadriceps, stretching exercises for quads, hamstrings and calf muscle
  • Ice PRN after activities
  • Compression wrap is contraindicated
  • Patient education (refer patient to PT for Retropatellar pain syndrome (RPPS) class)
  • Please refer to the Clinical standard on knee pain

Anterior Knee Pain: Ongoing Management and Objectives

Resolution or decreasing symptoms in three to four weeks

If no resolution:

  • Trial of alternate NSAID
  • Trial of neoprene sleeve with patella opening
  • Obtain plain films with sunrise views
  • Do not order an MRI. Orthopedic clinic will order if patient meets pre-surgery criteria

Anterior Knee Pain: Indication a Profile is Needed

  1. Any limitations that affect strength, range of movement, and efficiency of feet, legs, lower back and pelvic girdle.
  2. Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent moderate marching, climbing, timed walking, or prolonged effect.
  3. Defects or impairments that require significant restriction of use.

Anterior Knee Pain Specifications for the Profile

Months 1-3

  • No running, jumping, marching, squatting.

Months 4-6

  • Gradual transition into own pace and distance

Anterior Knee Pain: Indications for Referral to Specialty Care

  • No relief with initial management for eight weeks
  • History of joint locking and giving way
  • Question of underlying instability
  • Prolonged effusion > 10 to 14 days
  • R/O fractures, septic joints, rheumatoid arthritis, etc. should be referred to appropriate specialty clinic (Orthopedics or Rheumatology)
  • Refer to Physical Therapy if none of the above but progression of atrophy or persistent symptoms.
  • Completed full course of rehabilitation and have plateau or not improved (Orthopedics referral indicated)