Anterior knee pain is pain people feel at the front and center of the knee. It is a very common complaint caused by a wide range of muscle- or bone-related conditions or injuries.

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Around 1 in 4 adults have knee pain. It is the most frequent reason people consult a doctor for knee conditions.

Injury to any of the various tissues found at the anterior knee may cause pain. However, doctors often refer to anterior knee pain as “patellofemoral pain” since it links to the patellofemoral joint.

This article discusses anterior knee pain, its symptoms, causes, risk factors, and more.

Anterior knee pain refers to the discomfort or pain a person commonly feels behind or around the kneecap, also known as the patella. It comes with a range of symptoms and joint abnormalities in the anterior knee that vary in severity and cause.

Symptoms

People can present with different symptoms of anterior knee pain. However, the main symptom is pain behind or around the kneecap. This can appear or worsen when a person does activities that put a load on the joint, including:

  • going down the stairs
  • wearing high heels
  • sitting for long periods, such as while watching a movie or on a long drive
  • squatting
  • using a car clutch

A person may also report instability of their knees, where the knee gives way or buckles, especially when using stairs or ramps. Crepitus, or a grating feeling or noise when moving the knee, is common.

Pain may occur when there is a change in the intensity of activity, surface, or equipment. A person may also have quadriceps muscle weakness if the pain persists.

Read more about the anatomy of the knee and preventing knee injuries.

The cause of anterior knee pain is unclear and often caused by a complex interplay of functional, mechanical, and structural alterations and imbalances.

Many factors can cause anterior knee pain. Most link to the following:

  • structural or anatomical abnormalities
  • structural damage
  • malalignment or patellar instability
  • muscle weakness, tightness, or imbalances
  • overuse or repetitive use of the knee, for example, in sport
  • patellofemoral instability
  • patellar fracture

Medical conditions

A number of conditions can also cause anterior knee pain, including:

Anterior knee pain is 2.23 times more common in females. It is also more common in teenagers and young adults. Research from 2017 demonstrated anterior knee pain affects 30% of the adolescent population.

People who exercise often and do more physical or repetitive activities are more likely to have anterior knee pain, such as:

  • runners
  • cyclists
  • skiers
  • jumpers
  • athletes

A history of knee injury factors may also predispose a person to have anterior knee pain.

Symptoms of anterior knee pain can be nonspecific, and other similar conditions affecting the knee may cause overlapping symptoms.

A doctor will begin an evaluation by conducting a thorough medical history. They may ask about:

  • previous surgeries
  • activities
  • any other symptoms
  • the characteristics of the pain

They will also do a series of physical examinations to pinpoint the painful area and determine which structure is likely injured. This involves several maneuvers or movements to reproduce the pain or rule out other causes.

They may also ask the person to do a single leg squat or walk around, to assess for core stability, muscle imbalances, and functional limitations caused by the anterior knee pain.

Doctors may request imaging, such as ultrasounds, X-rays, or MRI scans, to rule out other conditions.

There are limited causes that doctors can easily distinguish with exams, history, and imaging. Many doctors may refer people to sports or orthopedic surgeons for joint pain.

The management of anterior knee pain will depend on the underlying cause. Generally, conservative treatment and lifestyle changes are effective. These include:

  • resting the knee for some time
  • taking painkillers, such as nonsteroidal anti-inflammatory drugs, to reduce pain
  • avoiding activities that triggers the pain
  • strengthening and stretching the thigh and buttock muscles
  • maintaining a moderate weight
  • using shoe inserts to correct flat feet
  • using taping to realign the kneecap
  • wearing suitable footwear
  • using heat and ice to control pain
  • limiting prolonged sitting, especially with the knees bent

Healing time also depends on the cause of anterior knee pain. However, symptoms typically settle over a few weeks. Some athletes may not have a complete resolution of symptoms for 2 years in rare cases.

Doctors may refer individuals to physical therapy or rehabilitation. Physical therapists may be able to help:

  • address malalignment
  • correct compensatory movement patterns and other imbalances
  • provide a strengthening program to reduce pain and prevent a recurrence

They will also help increase a person’s flexibility, strength, and endurance.

Find out which knee strengthening exercises to try and avoid.

Fluid removal and steroid injections can also help. Doctors may only consider surgery in persistent cases and when individuals do not respond to conservative measures.

Anterior knee pain causes a person to experience pain behind or surrounding the kneecap. It typically occurs due to structural abnormalities, overuse or activity, muscle imbalances, or conditions affecting the knee.

A comprehensive medical history, physical tests, and imaging can help a doctor pinpoint the cause and prescribe the appropriate management.

Lifestyle changes such as maintaining a moderate weight, choosing well-fitted footwear, and avoiding activities that trigger the pain can all help a person manage anterior knee pain.

Symptoms typically improve within a few weeks. People who experience knee pain for longer than this should consult a doctor for an evaluation and a suitable treatment and rehabilitation plan.