Anterior Knee Pain

  • What is anterior knee pain?

    Anterior knee pain is pain at the front and center of the knee. It can refer to many different problems including:

    • Chondromalacia of the patella — softening or breakdown of the tissue (cartilage) under the kneecap (patella) 
    • Inflammation of the patellar tendon, where the kneecap attaches to the shin bone
    • Inflammation of the quadriceps tendon, where the top of the knee cap attaches to the thigh muscles

    Your child's kneecap (patella) is positioned over the front of the knee joint. When your child bends or straightens her knee, the underside of the kneecap glides over the other bones that make up her knee. The patellar tendon and quadriceps tendon help your child's kneecap attach to her shin bone (below the knee) and thigh muscles (above the knee).

    When your child's kneecap doesn't move properly or rubs against the lower part of the thigh bone, it can cause anterior knee pain.

    Anterior knee pain is also referred to as runner's knee, jumper's knee, patellofemoral syndrome, chondromalacia patella and patellar tendonitis.

  • Causes

    Anterior knee pain can be caused by:

    • Abnormal alignment of the lower extremities
    • Abnormal position of the kneecap
    • Muscle tightness or weakness in the front and back of the thigh
    • Overuse of the leg from repetitive impact activity — such as jumping, running, twisting, or participating in competitive sports
    • Contact injuries that may have caused breaks in the bone or cartilage
    • Dislocations or ligament injuries
    • Synovial impingement — pinching of the inner lining of the knee when moving
    • Arthritis (rare in children)
  • Who is affected?

    While anterior knee pain can affect anyone, it is more common in certain types of people including:

    • Active people, particularly those who run, jump, ski or bike regularly
    • Healthy teen girls and young women
    • People who have previously injured their kneecap through dislocation or fracture
    • People who are overweight
  • Signs and symptoms

    Anterior knee pain is often a dull, aching pain that can be felt behind the kneecap, below the kneecap or on the sides of the kneecap.

    A common symptom is a grinding sensation (like bones touching bones) when the knee is contracted or flexed.

    Pain and grinding may become more noticeable when your child runs downhill, goes down stairs, performs deep knee bends or stands for a prolonged time period.

  • Testing and diagnosis

    If your child has anterior knee pain, she should be evaluated by an experienced orthopedic physician.

    At The Children's Hospital of Philadelphia, anterior knee pain is treated by physicians from the Division of Orthopedics and the Sports Medicine and Performance Center who specialize in diagnosing and treating bone and muscle injuries in children, teens and young adults.

    Our expert doctors will examine your child, assess her pain, learn about your child's medical history and perform diagnostic imaging — such as X-rays — to diagnose the problem.

    Then, we will work with you and your child to develop an individualized treatment plan.

  • Treatments

    In most cases, your child's anterior knee pain can be treated with a variety of non-surgical options. In rare cases, surgery may be recommended.

    Non-surgical options

    Non-surgical treatment may include:

    • Resting the knee and taking anti-inflammatory medications such as ibuprofen or aspirin to help relieve pain
    • Modifying your child's activity modification, i.e. changing the way she exercises
    • Learning and performing exercises to strengthen and stretch the quadriceps and hamstring muscles 
    • Using a knee brace or taping your child's knee to ensure proper alignment of the kneecap
    • Wearing appropriate running or sports shoes
    • Using special shoe inserts and support devices (for example, if your child has flat feet, orthotics may help)
    • Losing weight (if appropriate)

    Surgical options

    If your child's anterior knee pain cannot be treated non-surgically, we may recommend surgery to treat the problem.

    During surgery, expert surgeons will remove any kneecap cartilage that has been damaged and adjust your child's tendons to help her kneecap move more smoothly in proper alignment.