Patient Education

About Adolescent Anterior Knee Pain

Adolescent anterior knee pain refers to chronic pain in the front and center of the knee, usually underneath the kneecap (patella). It is a common condition that affects healthy, active young people, especially girls. Here are the key points about adolescent anterior knee pain:

• It is an orthopedic disorder characterized by chronic pain in the front or center of the knee (anterior knee pain).
• It is also known as patellofemoral pain syndrome or chondromalacia patellae.

Common Symptoms

Here are the main symptoms of adolescent anterior knee pain:

• Dull, aching pain around or behind the kneecap (patella)
• Pain that begins gradually and worsens with activity
• Popping, crackling, or grinding sensation when bending the knee (e.g. climbing stairs, squatting)
• Pain at night
• Swelling around the kneecap
• Pain during activities involving repetitive knee bending or weight-bearing

The pain is typically not associated with symptoms like locking, snapping, or giving way of the knee, which could indicate a more serious mechanical problem.

Adolescent anterior knee pain often affects otherwise healthy, active adolescents, especially girls more commonly than boys. The symptoms are usually related to overuse or excessive stress on the knee joint from activities like running, jumping, and rapid changes in direction. It’s important to note that if there is severe pain, swelling, redness, or warmth around the knee, it could indicate a more serious condition and requires prompt medical evaluation.

Cause & Anatomy

Adolescent Anterior Knee Pain is typically not caused by any physical abnormality or defect in the knee. Common contributing factors include:

• Overuse or excessive stress on the knee joint from activities like running, jumping, rapid changes in direction
• Inadequate training routine without proper stretching or strengthening exercises
• Muscle imbalances or weakness (e.g., quadriceps weakness)
• Poor alignment of the legs between the hips and ankles
• Changes in footwear, playing surface, or training intensity

Diagnosis

Patient History and Physical Examination

• The doctor will take a detailed history about the duration, quality, and characteristics of the knee pain, as well as activities that aggravate or alleviate it.
• A thorough physical examination will be performed, including:
• Observing the patient’s gait, leg alignment, and any asymmetries
• Checking for swelling, warmth, redness around the knee
• Assessing range of motion
• Palpating for areas of tenderness
• Evaluating muscle strength, flexibility, and tightness (quadriceps, hamstrings, etc.)
• Performing specific tests like the patellar inhibition or compression test to elicit pain

Ruling Out Other Conditions

• The examination helps rule out other potential knee injuries or problems that could be causing the pain, such as fractures, ligament tears, or mechanical issues.
• Symptoms like locking, snapping, giving way of the knee, or severe swelling and redness suggest a more serious mechanical problem that requires further evaluation.

Imaging Tests

• Plain X-rays may be ordered to rule out conditions like fractures, osteochondritis dissecans, or patellar maltracking, but are not routinely indicated.
• An MRI scan is generally not needed unless there is suspicion of other soft tissue damage or injuries.

The diagnosis is primarily based on the patient’s history, physical examination findings, and ruling out other potential causes. Imaging is used selectively to confirm the diagnosis or exclude other conditions.

Prevention

Here are some key points about preventing adolescent anterior knee pain:

Proper Warm-up and Stretching

• Warm up thoroughly with stretching exercises before physical activity
• Include stretches for the quadriceps, hamstrings, and calf muscles in the warm-up routine
• Stretching after activity is also recommended

Strengthening Exercises

• Perform exercises to improve strength, flexibility, and conditioning of the muscles around the knee, especially the quadriceps and hamstrings
• Maintaining muscle conditioning is crucial to avoid recurrence of knee pain

Footwear and Equipment

• Wear shoes appropriate and designed for the specific sport/activity
• Ensure shoes provide adequate support and cushioning to reduce stress on the knees
• Use proper sports training techniques and equipment

Activity Modification

• Reduce or avoid activities that aggravate knee pain until symptoms resolve
• Limit the duration, intensity, and mileage of high-impact activities like running
• Incorporate low-impact cross-training activities like cycling or swimming
• Avoid prolonged squatting, kneeling, or activities that repeatedly bend the knee

Training Adjustments

• Gradually increase activity levels and training intensity to avoid overuse
• Change training routines to address muscle imbalances or alignment issues
• Vary playing surfaces to reduce repetitive stress on the knees

Treatment

Activity Modification

• Rest from activities that aggravate the knee pain until the pain resolves
• Reduce the duration, intensity, and mileage of high-impact activities like running
• Incorporate low-impact cross-training activities like cycling, swimming, or yoga
• Avoid activities that repeatedly bend the knee like squatting, jumping, or prolonged sitting

Medications

• Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce pain and inflammation

Physical Therapy

• Stretching exercises for the quadriceps, hamstrings, and calf muscles
• Strengthening exercises to improve muscle conditioning, especially the quadriceps and hamstrings
• Exercises to improve flexibility, range of motion, and neuromuscular control

Bracing/Orthotics

• Knee bracing or patellar taping may be recommended in some cases to help track the kneecap
• Orthotic shoe inserts or arch supports to improve lower extremity alignment

Other Measures

• Applying ice packs to the knee to reduce pain and swelling
• Losing weight if overweight to reduce stress on the knee joint
• Correcting training errors like improper techniques or equipment
• Gradually increasing activity levels and intensity to avoid overuse

The key aspects of treatment involve resting from aggravating activities, anti-inflammatory medication, physical therapy for stretching and strengthening, and addressing any biomechanical issues through bracing or orthotics if needed. Most cases of adolescent anterior knee pain can be managed conservatively with these measures. If pain persists despite adequate treatment, further evaluation may be required to rule out other conditions.

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