Patello-Femoral Joint Dysfunction (Anterior Knee Pain)
General advice
Common 16-40 years- Often no history of injury
- Often bilateral
- Can be associated with obesity
- Chronic presentation
- Patient otherwise well
- Effusion uncommon
Adolescent knee pain- Onset usually at the beginning of the growth spurt either insidiously, or with overuse
- Often pain eliminates the ability to do physical activity
- May continue throughout adolescence. Pain should settle
Symptoms and signs
- Retro-patellar ache may also lateralize to the joint lines or all over the knee
- Pain with squatting/kneeling, stairs, hills, sitting for long time and start up pain
- Pain also associated with active patients who do jumping activities
- Pseudo-mechanical symptoms (regular but transient)
- Pain on patella compression or Osmond Clark test (apply an inferior glide to the patella while the patient actively contracts quads)
- Weakness on static quads contraction through range
Initial management
- Analgesia, NSAIDS, walking aid.
- Avoid high impact activities
- Physiotherapy (+/-podiatry/ biomechanical assessment - will be referred by MSK Physio if under their care as appropriate)
- Advice on weight loss if appropriate
Primary Care diagnostics
XR. MRI not indicated.
Who to Refer
- Severe patellar mal-tracking. Only those who have exhausted non-operative interventions, been compliant with physiotherapy and are not obese will be seen for surgical consultation. The results of surgery for severe mal-tracking are unpredictable and lack good clinical evidence for their efficacy.
Who not to refer
- Usually Primary Care management only. There is no good evidence that patellar realignment surgery (soft tissue release, tibial tubercle transfer) provides lasting pain relief and those who do gain some benefit, usually only do so for a few years.
- We therefore do not offer patellar realignment surgery for pain alone unless there is severe patellar mal-tracking (which is uncommon).
- Fat pad impingement. See additional information
- Osgood-Schlatter's Disease and Sinding-Larsen-Johannson Syndrome. - Refer MSK physio.
How to Refer
- SCI Gateway/Orthopaedics/Knee
- If the patient is under the care of NHS Physiotherapy, investigations and onward referral to knee service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention.
Information to include when referring:- Duration, any cause of symptoms
- Site/spread and if pain constant or intermittent, and/or walking at night
- Active and passive ROM
- Treatment to date
- XR results
Useful resources