Patellar Chondromalacia

Identifying the root cause of anterior knee pain is crucial in determining its potential resolution. For individuals with a relatively moderate issue, like mild chondromalacia or a muscle imbalance, a carefully crafted rehabilitation program can prove highly effective in alleviating anterior knee pain. However, if the source of anterior knee pain stems from advanced arthritis, either in the kneecap joint or throughout the knee, achieving long-term relief may pose a more significant challenge. In such cases, a comprehensive approach may be necessary to manage and address the symptoms associated with advanced arthritis.

It is important to document the cause of the anterior knee pain to help determine if it is treatable and if there is a good chance the symptoms will resolve. If it is due to a muscle imbalance, a proper rehabilitation program will help this significantly. If it is due to advanced arthritis, one can look at nonoperative measures, but the chances of anterior knee pain going away are much less.

The anterior knee is the front part of the knee. Therefore, any cause of pathology that causes pain in the front part of the knee can be referred to as anterior knee pain. This can include multiple pathologies such as muscle imbalance, patellar tendinopathy, medial plica irritation, patellofemoral chondromalacia, general knee swelling, diffuse arthritis in the knee, quadriceps insertional tendinitis, localized areas of arthritis on the kneecap or on the trochlear groove and other causes.Toggle Content

When one is squatting, one is putting extra stress on the cartilage in the kneecap joint. Squatting and lunging can increase the force across the kneecap joint by 7 to 9 times one’s body weight or more. Therefore, if one has a cartilage problem of their kneecap joint on the kneecap or the trochlea or both surfaces, then one could have this area of arthritis be overloaded while squatting or lunging and lead to pain in the front of their knee.

Pain in the front of one’s knee usually indicates that something is going on that should be evaluated further. Therefore, if one does have anterior knee pain, especially anterior knee pain that does not go away well a well-designed rehabilitation program or time of rest, one should have it evaluated to determine if there is a potentially treatable problem. This can include a course of therapy, therapy with injections, or potentially even surgery. If one has a treatable problem that is ignored, over time, the problem could get worse or become more accelerated so checking it out sooner rather than later would be recommended.

The primary focus of all treatments for anterior knee pain is a well-developed rehabilitation program. This usually involves low-impact exercises to build up one’s core strength so that one has better absorption with activities. Thus, low-impact activities like the use of a stationary bike, an elliptical machine, walking, or swimming are the mainstays of a rehabilitation program.

Other specific exercises can be determined by one’s physician and/or physical therapist. If one does have swelling associated with their anterior knee pain or has significant scarring, the use of a corticosteroid injection may be beneficial to cut down  on the symptoms for anterior knee pain.  If the symptoms are resolved with an injection, one needs to work on a rehabilitation program while the symptoms are minimized to build up their baseline strength. This is because most injections last about 6-8 weeks in terms of their efficacy, so working on one’s general strength is important while the steroid injection is kicking in.

Anterior knee pain is one of the most common presenting symptoms of patients presenting to a sports medicine physician’s office.  It is particularly common in adolescent females who are participating in sports. In younger patients, most anterior knee pain responds well to a program of strengthening and possibly injections. In general, unless there is a well-defined surgical problem, surgery is resolved for those cases that just are nonresponsive to nonoperative means.

There could be multiple causes of anterior knee pain with running, including whether one is running on hard surfaces or softer surfaces.  Causes of anterior knee pain with running can include chondromalacia of the kneecap or trochlea, patellar tendinitis (tendinopathy), quadriceps insertion tendinopathy, and knee swelling from other pathology within the knee which can cause anterior fat pat or plical irritation. In addition, previous surgeries which cause scar in the front of the knee could also contribute to anterior knee pain with running.

Anterior knee pain with prolonged sitting is a fairly common problem. This could include patients having difficulty with long car rides, sitting in a classroom for a long period of time, or sitting in a chair and not moving around at work. This is usually because of some underlying kneecap or trochlear chondromalacia, medial plical irritation, or possibly some scar tissue from previous surgery. Patellar tendinitis can also cause anterior knee pain with sitting, but this is usually a less common cause of anterior knee pain with sitting.

Many patients commonly have anterior knee pain after ACL reconstruction surgery, especially for the first 3-4 months after the surgery. This is because the quadriceps muscles are weak and atrophied and this can cause extra stress in the front of the knee leading to plical irritation or irritation of some mild underlying arthritis. In these patients, proceeding with a rehabilitation progress to address the underlying weakness with cause the anterior knee pain to resolve over time. Patients who have anterior knee pain after surgery which does not resolve  can have several different causes. One of these can be some underlying kneecap or trochlear groove arthritis. In addition, patients who may have scar tissue in the anterior compartment of their knee, which most commonly presents as their kneecap getting stuck and not being able to move so well, can also have knee pain in the anterior aspect of the knee after ACL reconstruction surgery.