Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Anterior Knee Pain

SYMPTOMS

Gradual onset of diffuse or localised exercise-induced pain around the anterior part of the knee. Prolonged sitting or squatting often trigger the symptoms (positive ‘movie sign’ – so named because you are in the same position for a long period when watching a movie at the cinema) as can walking down stairs.

AETIOLOGY

Anterior knee pain is not a diagnosis but a symptom that can be caused by a number of underlying pathologies. The correct diagnosis must be made before treatment can be successful. This condition often occurs as a result of sudden changes in training habits, such as increase in intensity or amount of impact.

CLINICAL FINDINGS

This depends on the underlying diagnosis. If there is effusion, the cause is often intra-articular; if not, it is more likely to be extra-articular. If no structural pathologies can be found the problem can be functional, for example induced by poor core stability, pain referred from the back or poor ankle control. A systematic and thorough approach in the clinical examination is crucial for a successful outcome. Tests of core stability, proprioception, muscle strength and balance and flexibility of the entire kinetic chain must be thoroughly evaluated.

INVESTIGATIONS

X-ray can exclude fractures, OCD, patella abnormalities, other osteochondral injuries and bone tumours. MRI can exclude soft tissue tumours and other localised soft tissue lesions such as the presence of medial plicae. It often under-estimates chondromalacia and other superficial chondral injuries as well as many meniscal tears and medial plica syndrome. CT scans can rule out severe patella mal-tracking. Ultrasound can be useful for evaluating functional tendons and ligament disorders such as jumper’s knee or tendinosis around the knee. Arthroscopy is often an excellent diagnostic tool when clinical findings are vague.

TREATMENT

Depends on the diagnosis.

REFERRALS

These patients are very much helped by being evaluated clinically by their physician, surgeon and physiotherapist in close collaboration.

EXERCISE PRESCRIPTION

Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Meniscus tear, chondral injuries, OCD, medial plica syndrome, chondromalacia patellae, patellar instability or
mal-tracking, quadriceps insufficiency, Sinding-Larsen’s syndrome, synovitis, Pigmented Villonodular Synovitis (PVNS), patellar tendondisorders, referred pain, reactive arthropathies, secondary symptoms from ankle or back insufficiency, core instability and more.

PROGNOSIS

Because many cases never reach an absolute diagnosis and correct treatment, anterior knee pain ends the career of many young athletes.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>