“Anterior Knee Pain” Exercise booklet for anterior knee pain (PDF 1.7Mb)
Pain around the front of the knee, particularly with bent knee activities and going up and down stairs is very common indeed particularly in teenage athletes. It rarely requires surgery, but very commonly responds to exercises under the supervision of an expert physiotherapist with or without an orthosis (insole) to correct a biomechanical abnormality. There is always a tendency for the knee cap to run over on the outer side of the groove it runs in, in the front of the femur simply because of the angle of the thighs and hips. Since everyone, even men, have wider hips than knees the muscle tend to have a component of their pull, pulling the knee cap toward the outer side. This puts more strain across the outer side of the knee than the inner side and the best way to get on top of this is to build up the small muscle that sits just inside the knee cap in the lower end of the thigh (known as the “VMO” or vastus medialis obliquus). This is not easily done and needs quite a lot of work that can only be done by you the patient. The physiotherapist can help sometimes with some taping and also by instructing you on the appropriate exercises to do, but it really means doing the exercises several times a day for several months to get on top of it. Biomechanical corrections of the feet are popular and do seem to help, but the laboratory evidence is rather thin. See running injuries.
Just occasionally when patients cannot get on top of the muscular imbalance we can help them along with an operation. This is very much a second and third line of attack and to be reserved for when all else fails.
Sometimes the knee cap dislocates completely. This always to the outer side for the reasons mentioned above. Again surgery is sometimes needed for this, but the main stay of management is with building up the muscles around the inner side of the knee to produce a dynamic stability of the knee cap joint.
“Jumper’s Knee” is very common in athletes and usually annoying rather than serious, but if left to become established, it can need surgery and indeed be career-threatening. It always occurs just at the junction of the lower pole of the knee cap, where the tendon attaches to it, and is typically quite sore to touch there with the knee straight and relaxed
Treatments are similar to those described for Achilles tendinopathy. Identifying the cause, whether it is training, technique or equipment. Eccentric strengthening excercise, sometimes with anti inflammatory medication or physiotherapy modalities. If all else fails, surgery.
Extracorporeal shock wave therapy is a very effective and safe new treatment for certain tendonopathies, but requires rather expensive & specialised equipment. We now have access to this routinely and are starting to see the benefits.
Surgery is often now possible through the “keyhole”, but sometimes best supplemented by a radiofrequency coblation probe which can be used during the procedure.