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Anterior knee pain

Anterior knee pain (AKP) is not a specific disease, but refers simply to pain experienced around the front part of the knee, and which may arise from any of several conditions, some of which may not even involve the knee itself.

Anterior knee pain is one of the most common of knee complaints, and probably the one where clinicians most frequently fail to understand or fully assess the problem prior to undertaking surgery. It is important that the clinician (usually the physiotherapist in the first instance) understands the various separate problems that can cause pain in the front of the knee, so that the right questions are asked and the rights tests done to determine the exact cause of this particular patient’s pain.

Anterior knee pain syndrome may be caused by one or a number of:

• patellar alignment problems - maltracking or tilt of the patellar, rotational deformity of the long bones, increased Q angle, flat feet
• mechanical obstructions - medial or suprapatellar plica
• bony abnormalities - patellar or trochlear dysplasia, patella alta, patella baja, Osgood Schlatter’s disease
• functional imbalance - quadriceps muscle weakness
• local inflamed structures around the knee - tendinitis, bursitis
• distant (referred) - eg from a hip problem

Assessment should include a full functional assessment of the whole lower limb from foot to lower spine. Clinical examination should exclude plica and rotational deformity of the long bones. Radiological examination should include special views to fully assess the patella and its underlying groove (trochlea) in the femur (thighbone).