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Introduction

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In 1996, the world 1 ranked player Steffi Graf experienced “inflammation” in her left patellar tendon at Wimbledon and later in the same year she defaulted a semifinal match at Leipzig—the first withdrawal in her career. In February 1997, she defaulted in the Pan Pacific Open due to reaggravating that injury. On 10 June 1997, she underwent left knee surgery. She won only four of her career total 107 titles after that surgery; she retired in August 1999 aged 30.

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Anterior knee pain is the most common presenting symptom in many physiotherapy and sports physician practices.1, 2 It contributes substantially to the 20–40% of family practice consultations that relate to the musculoskeletal system.3 The anatomy of the anterior knee is depicted in Figure 33.1).

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Figure 33.1

Anatomy of the anterior knee

(a) Surface anatomy

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In this chapter, we:

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  • outline the clinical approach to assessing the patient with anterior knee pain, particularly with a view to distinguishing the common conditions—patellofemoral pain and patellar tendinopathy

  • detail contemporary management integrating high-level evidence with the best of clinical experience (see Chapter 3 for levels of evidence)

  • discuss less common causes of anterior knee pain such as fat pad impingement, which may mimic features of both patellofemoral pain and patellar tendinopathy.

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Clinical approach

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Distinguishing between patellofemoral pain and patellar tendinopathy as a cause of anterior knee pain can be difficult. Rarely, both conditions may be present. Causes of anterior knee pain are listed in Table 33.1.

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Table Graphic Jump Location
Table 33.1  

Causes of anterior knee pain

 
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History

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There are a number of important factors to elicit from the history of a sportsperson with the presentation of “anterior knee pain.” These include the specific location of the pain, the nature of aggravating activities, the history of the onset and the behavior of the pain, as well as any associated clicking, “giving way,” or swelling.

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Although it may be difficult for the patient with anterior knee pain to be specific about the location of the pain, this symptom often provides an important clue as to which structure is affected. For example, retropatellar or peripatellar pain ...

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