Patella (kneecap) pain is a common knee disorder at any age. Overuse, a change of activity associated to a muscular weakness or inbalance may cause patella pain. A direct injury to the kneecap can start the processus. Others terms for patella pain are anterior knee pain, runner's knee. Pain around the kneecap can also be referred pain from hip or back.

As the knee bends and straightens, the patella slides within a slot on the femur called the trochlear groove. The bone surfaces are covered with articular cartilage to make joint movement smooth.

Symptoms :

Pain :

• anterior pain; dull, aching pain of the knee, not necessarily in one specific area.
• running, going up or down stairs, kneeling, squatting, or sitting for a long time with knees bent usually increase pain.
• pain while you stand up and walk after prolonged sitting
• pain often associated with crackling noise in the knee
• both knees can be painful
• it may be injury related (anterior impact) or not

Instability with the feeling of the knee giving way.

Physical examination check for patella tenderness and evaluate the muscular strength of the quadriceps (muscle of the thigh) and the tightness of the hamstring tendons. The physician looks for associated problems (meniscus, ligament). Diagnose is made by clinical examination.

MRI ( magnetic resonnance imaging) may be recommended to rule out associated damage to the meniscus. It can also show cartilage softening or deterioration (patella chondromalacia).

Patella pain treatment is conservative. No surgery +++.

The following options are typically used :

• Activity modification : Exercises or activities that cause pain should be avoided +++.
• Icing : apply ice wrapped in a towel for short periods of time
• Anti-inflammatory medication is recommended
• Specific exercises to strengthen the quadriceps and to stretch the hamstrings +++.
• A knee sleeve can help
• Swimming is a very good activity (but no breaststroke!) to build greater strength and flexibility in the muscles around the knee.
• Sport activities should only be resumed very gradually and cautiously +++.

It can take the knee a long time to show improvement once treatment begins. It is a long process. Note that patella pain does not mean that you will damage your knees by continuing to do activities. You will just hurt more.

Docteur Jean Etienne Perraudin, last updated 10 march 2008.