Anterior Knee Pain (Runner’s Knee or Chondromalacia Patellae)

The knee cap or patella sits over the front of the knee joint, and when you bend your knees, the back of the knee cap glides over the cartilage of the thigh bone (femur). Assisting in this movement are tendons and ligaments that attach the knee cap to the shinbone and thigh muscle. When any of these parts are unable to move or function normally, pain can arise.

Anterior knee pain can be caused by:

• Abnormal position of the kneecap, such as being too high in the knee joint
• Arthritis, which refers to inflammation or degeneration of the cartilage of the knee
• Injury or trauma to the knee cap such as a dislocation or fracture
• Overuse, which includes repetitive stress or excessive training from activities such as long-distance running or sports requiring prolonged jumping
• Poor foot support or flat feet
• Tight hamstrings
• Tight Achilles tendons
• Weak muscles in the thigh, hip or knee, which would normally help to maintain correct alignment of the knee cap

Risk factors for developing anterior knee pain or runner’s knee include:

• Being overweight, which places more stress on the knee joint
• Prior injury to the knee cap
• Excessive exercise that involves the knee joint such as playing football, running or cycling

Preventing anterior knee pain or runner’s knee

• Maintaining a healthy body weight
• Warming up and stretching before running
• Wearing appropriate shoes that offer good support
• Practicing good technique while running, by leaning forward with knees bent
• Increasing activity levels gradually

Typical symptoms of anterior knee pain include:

• A dull aching pain in the front of the knee cap
• Pain that comes and goes, and feels worse after long periods of sitting
• One knee often hurts worse than the other
• A grating or grinding sensation or sound when the knee bends and straightens, known as crepitus
• Puffiness or swelling around the knee cap

These symptoms can be aggravated by:

• Kneeling or squatting
• Running
• Sitting with a bent knee for long periods of time
• Walking up or down the stairs

To diagnose anterior knee pain, your doctor will need to perform a physical examination and may recommend one or more of these tests:

• Blood tests

  Some blood tests can help to identify or rule out certain types of arthritis. It may also reveal inflammation which may be causing your knee pain.

• X-ray

  An X-ray provides an image of your knee joint, which may help to rule out other causes of knee pain, such as an injury.

• Magnetic resonance imaging (MRI)

  An MRI offers doctors a more detailed look at the knee joint and surrounding tissues. It is often useful in identifying chondromalacia patellae.

Treatment for anterior knee pain aims to reduce pressure on the knee. This can include:

• Home care

  In some cases, resting at home and icing the joint several times a day is sufficient to allow healing.

• Pain relief

  This may come in the form of topical formulations such as creams or patches, or over-the-counter anti-inflammatory medication such as ibuprofen to reduce inflammation and swelling. If the pain or swelling is severe or persists, stronger medication such as non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed.

• Physiotherapy

  Non-weight-bearing exercises such as swimming or riding a stationary bicycle can help to strengthen your quadriceps, hamstrings, adductor and abductor muscles in the hips and thighs. These muscles help to prevent misalignment of the knee joint.

• Surgery

  A minimally-invasive procedure known as arthroscopy may be performed, to allow the doctor to view the knee joint using a small camera. If necessary, your doctor may recommend one of several procedures. This includes a lateral release, where some ligaments are cut to release tension and make it easier to move, or smoothing the back of the knee cap. Other surgical options include implanting a cartilage graft or relocating the insertion of the thigh muscle.

Find out more about your treatment options for anterior knee pain.

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Anterior knee pain, or any kind of knee pain, should be diagnosed promptly or it can lead to:

• Increasing pain

  If the knee pain is caused by overuse, continued activity without the chance to heal can cause the pain to worsen.

• Joint damage

  When caused by a degenerative condition like arthritis, delayed treatment allows the disease to progress.

• Disability

  Left untreated, your knee function can worsen and make it increasingly difficult to move around.