Chapter 36: Anterior knee pain

INTRODUCTION

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 Anterior knee anatomy is shown in Figure 36.1.

In this chapter, we:

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

• detail contemporary management integrating high level evidence (Chapter 2) with the best of clinical experience

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

• highlight new research investigating PFP in adolescents, patellar tendinopathy and patellofemoral osteoarthritis (OA).

CLINICAL APPROACH

Distinguishing between PFP 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 36.1.

History

A number of important factors can be elicited from the history of a athlete presenting with anterior knee pain. These include the specific location of the pain, the nature of aggravating activities, the history of the onset and behaviour of the pain, as well as any associated clicking, giving way or swelling.

Although it may be difficult for the patient with anterior knee pain to be specific about the location of pain, this symptom provides an important clue as to the likely diagnosis. For example, retropatellar or peripatellar pain suggests that the patellofemoral joint (PFJ) is a likely culprit, lateral pain localised to the lateral femoral epicondyle increases the likelihood of iliotibial band syndrome as the diagnosis (Chapter 37). Patellar tendon pain will be localised to the inferior pole of the patella and the patient can point to it with a ...