This refers to a number of medical conditions that cause pain around the kneecap, at the front of the knee. These conditions include anterior knee pain syndrome and chondromalacia patella. It usually gets better with simple treatments such as physiotherapy and exercises, although these can take some time before the symptoms start improving.

Causes

When the biomechanics of the patellofemoral joint is altered, extra strain is placed on the kneecap and the surrounding muscles and ligaments. This can result in pain experienced in front of the knee. Although causes of this syndrome are often multifactorial, it generally results from abnormal tracking of the kneecap in the femoral groove.

Some factors that can result in abnormal biomechanics include:

  1. Weak thigh muscles on inner aspect of the knee
  2. Tight tissues on outer aspect of thigh
  3. High small kneecap or a shallow groove
  4. Abnormal thigh rotation
  5. Flat feet

Symptoms

The pain is usually dull and aching in nature. Often, the exact site of pain cannot be pinpointed but can be felt under or around the kneecap.  The pain is typically worse when going up or down stairs and with certain activities such as kneeling, squatting or sitting with a bent knee for a long period of time. There may be a grating feeling or a grinding noise when the knee moves. Sometimes there is fullness or swelling around the knee.

The diagnosis is made from the history and full physical examination. To aid with treatment planning, it may be necessary to obtain plain radiographs and/or MRI scan.

Treatment

This depends upon the particular problem causing the knee pain and the initial treatment is almost always nonsurgical. Ultimately the aim is to treat the underlying cause.

Strenuous use of the knee and activities that cause the pain should be stopped. This probably means stopping any running or jumping. Symptoms usually improve in time if the knee is not over used. Simple painkillers like Paracetamol and anti-inflammatories like Ibuprofen are often helpful in controlling the symptoms.

Physiotherapy is an extremely useful modality of treatment in this condition. It aims to stretch tight ligaments, strengthen thigh muscles, improve core stability and correct muscle imbalances around the knee. Malalignment problems may be addressed with Patella Taping or using a special brace. The physiotherapist can give advice tailored to the individual situation.

The use of suitable footwear and orthotics such as arch supports in those with flat feet can reduce the strain on the kneecap and significantly improve symptoms.

Most people get better with simple non-surgical treatments although it may take as long as 6 months for full recovery. Surgery is rarely indicated in patellofemoral pain syndrome.