Knee pain on the front

Anterior knee joint pain is a pain that is mainly (but not always exclusively) concentrated in the anterior part of the knee joint. This includes pain in the area of the anterior thigh and lower leg, the patella, the quadriceps and patellar tendons, and the anterior knee joint space. Anterior knee joint pain can be caused by direct damage to the anatomical structures involved, or it can be a secondary pain that is a result of damage to an anatomically distant location that is not a disease of the knee joint.

The following is an overview of the most common causes of pain in the front of the knee. Diseases of the quadriceps tendon: Causes at the kneecap (=patella): Diseases of the patellar tendon:

Torn tendon (trauma)
Inflammation (transition of the quadriceps tendon to the patella)
Patella luxation
Fracture (trauma)
Degenerative changes
Sinding-Larsen’s disease
Osgood-Schlatter disease
Patellar Tip Syndrome
Torn tendon (trauma)

A patella dislocation can be congenital, habitual (habitual) or rarely traumatic due to twisting. In either case, the patella is not in correct alignment with the rest of the knee.

In most cases it is laterally displaced. Only the traumatic patella dislocation is accompanied by severe pain. The leg is held in a bent position and often a strong joint effusion is formed.

The cause of the dislocation is damage to the inner extensor tendon apparatus of the knee. Sometimes parts of the bone or cartilage may also be injured. In order to detect this, an X-ray and an MRI of the knee joint are made.

In the case of minor injuries, the kneecap can be repositioned by the doctor by hand and then immobilized in extension for a few weeks. For larger injuries, the extensor tendon apparatus must be treated in a small operation (arthroscopy). Sindig-Larsen’s disease (also known as Sindig-Larsen-Johansson’s disease) is a disease of the patella.

Overloading causes an inflammation of the kneecap. This occurs where the patellar tendon attaches to the kneecap. If the overloading continues for a longer period of time, the inflammatory reaction can cause severe damage to the patellar tendon (up to a tear of the tendon) or to the patella.

Small pieces of bone can come loose at the patella, which then die because the blood supply is no longer available. This leads to the so-called necrosis of these bone parts. The symptoms are mainly pain in the anterior knee joint, usually just below the kneecap.

The quadriceps is our large muscle at the front of the thigh. As the name quadri (=four) – ceps (=head) suggests, it is a muscle with four heads, which means it consists of four muscle parts. The quadriceps is the only muscle that causes stretching in the knee joint.

The tendon of the quadriceps pulls on the top of the patella and is usually very thick and strong. Therefore a tear of the quadriceps tendon is very rare. However, such a tear can occur when very high forces are applied (for example, in high-speed accidents).

A weakening of the tendon due to permanent severe overloading or inflammation in the knee joint can also promote a quadriceps tendon tear. The result is pain at the front of the knee joint, usually above the kneecap. Normally, such a torn quadriceps tendon must be treated surgically.

Synonyms: Retropatellar arthrosis, retropatellar arthrosis, arthrosis of the patella
Place of the greatest pain: behind the kneecap
PathologyCause: Cartilage damage
Age: Older (>50 years), in the context of general knee arthrosis; younger, in the context of injuries, congenital cartilage weakness, unfavorable patella run
Gender: Women > Men
Accident: After patella fracture, often after partial or complete dislocation of the patella (patella luxation)
Type of pain: stabbing, bright
Pain development: Usually continuous pain increase over years. Acute after patella dislocation (patella luxation) with cartilage damage
Pain occurrence: Particularly after exertion, especially when going down stairs and climbing stairs; pain when the kneecap shifts.
External aspects: Possibly audible kneecap rubbing; possiblyuneven, too lateral kneecap (patellal lateralization), in older age possibly palpable bone edges.

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Synonyms: jumpers knee, patellar tip syndrome
Place of the greatest pain: Mostly lower patella end (lower patellar pole)
PathologyCause: Inflammation or overuse of the patellar tendon, more rarely inflammation of the quadriceps tendon at the base of the patella.
Age: Any age; often young, active people.
Gender: no gender preference
Accident: No; or repeated micro-injuries to the tendon due to sudden tendon pull during jump loads.
Type of pain: often stabbing
Pain development: mostly creeping
Pain occurrence: Depending on the stage, mostly during or after the sporting activity.
External aspects: Usually none.
Jumper Knee
Synonyms: Enthesopathy Pes anserinus (quotes)
Location of the greatest pain: Below the inner knee joint gap.
Cause of Pathology: Tendon attachment disease of different thigh muscles, which attach as a common tendon plate to the head of the tibia.
Age: Any age. Often with runners (jogging).
Often in older persons after knee prosthesis implantation.
Gender: no gender preference
Accident: No
Type of pain: pulling, stabbing
Origin of pain: dependent on load. Partly morning starting pain.
Pain occurrence: Load-dependent. For runners often after the load and in the morning.
Improvement after warming up.
External aspects: None
Synonyms: Bursitis praepatellaris, Bursitis infrapatellaris
Location of the greatest pain: Directly above the patella (bursitis prepatellaris) or in the course of the patellar tendon = patellar tendon (bursitis infrapatellaris)
PathologyCause: Mostly non-bacterial inflammation (=itis) of the bursa. Most frequently affected are the bursa that lies on the patella (Bursitis prepatellaris), the bursa under the patellar tendon (Bursitis infrapatellaris profunda/superficialis) or the bursa in the area of the Pes anserinus (equivalent to Pes anserinus tendinosis see above).
Age: any age
Gender: no gender preference
Accident: In prepatellar bursitis, often impact trauma to the knee joint or after prolonged kneeling.
Type of pain: stabbing
Pain development: mostly sudden
Pain occurrence: Depending on the load, e.g. when kneeling.
External aspects: Sometimes swelling and overheating above the kneecap. In case of bacterial inflammation severe redness.
Synonyms: Chondropathiae patellae, FPS, CPP
Place of the greatest pain: behind and around the kneecap.
PathologyCause: Pain due to overloading of the patellar cartilage: underdevelopment of the patella and the patellar sliding bearing (patellar dysplasia), too tight patella guidance, knock-knees, wrong running style (see jogging), muscle shortening of the upper and lower leg, muscle imbalances.
Age: Often younger age.
Athletes.
Gender: Women somewhat more often.
Accident: No
Type of pain: Indeterminate
Origin of pain: dependent on load. Pain at rest possible.
Pain occurrence: Running downhill. Sitting for a long time.
External aspects: Possibly small kneecap.
Bow legs.
Synonyms: Hoffitis
Place of the greatest pain: In the course of the patellar tendon (patellar tendon) towards the inside of the knee joint.
PathologyCause: Inflammation or tearing of the knee joint fatty body.
Age: Any age. Increasingly younger people who are active in sports (cross-country skiers).
Gender: No gender preference.
Accident: Possible hyperextension trauma of the knee joint.
Type of pain: Stabbing, bright. Stiffness sensation.
Origin of pain: Slowly increasing.
After trauma also sudden.
Pain occurrence: Especially after standing or squatting for a long time.
External aspects: Joint swelling (joint effusion)
Synonyms: Osteochondrosis deformans juvenilis of the tuberosity tibiae
Location of the greatest pain: At the front of the tibia, insertion of the patellar tendon at the tibia (Tuberositas tibiae)
Cause of Pathology: Relatively frequent necrosis (death) of the tibiaapophysis (child’s bone nucleus).This disease belongs to the group of infantile aseptic necroses, due to a local circulatory disorder.
Age: Mostly occurs between 10-14 years of age in children and adolescents who are active in sports.
Gender: Boys tend to be more frequently affected.
Accident: No
Type of pain: Stabbing, bright.
Origin of pain: Slowly increasing.
Pain occurrence: After or during sporting activity. Especially after jumping sports.
External aspects: Often swelling in the affected area.
Synonym: Patellar tendon rupture
Causes: The patella tendon serves to transmit the force of the quadriceps (front thigh muscle) to the lower leg. Since it is redirected via the patella, it is subject to great forces due to the leverage effect.
During sports exertion, the tendon may therefore tear or crack. Often there has already been an imminent damage to the tendon, for example due to age-related wear and tear, an old knee injury or long-term use of drugs such as cortisone. The most common injury mechanism is a strong tension of the thigh when the knee is bent, for example, during abrupt changes of direction.
Symptoms: Typical symptoms are a sudden pain.
Depending on the extent of the injury, the knee can be stretched only partially or not at all. The transmission of force is considerably reduced and is accompanied by an unsafe stance or gait pattern.
Diagnosis: To diagnose a torn patellar tendon, the kneecap and the tendon are palpated. In doing so, an elevation of the kneecap as well as a continuity interruption of the tendon can be felt.
For a reliable diagnosis, an ultrasound of the tendon is performed and usually an X-ray is taken to show bony injuries or a displacement of the patella. An MRT can also show the injury.
Therapy: The therapy of a complete patellar tendon rupture is inevitably an operation with tendon suture and fixation of the patella with a wire sling to keep it in place. A torn patellar tendon can also be treated conservatively with immobilization and physiotherapy if the extension is slightly restricted.
The prognosis for a torn patellar tendon is good, but a healing process of several weeks must be expected.
Causes: A knee-cap fracture often occurs as a result of direct force being applied to the knee in a fall or traffic accident. Rarely a part of the patella can also break off in the case of patella luxation.
Symptoms and diagnosis: Typically, a joint effusion is also visible and the extension of the knee joint is painfully limited. Obvious injuries to the skin and hematomas can be a first indication of the presence of a kneecap fracture.
Sometimes the fracture fragments can be palpated. However, an X-ray image must be taken for a reliable diagnosis.
Therapy: If the fracture fragments are not displaced to each other, the fracture can be treated without surgery with relief by crutches and immobilization. However, if the debris is displaced, surgical treatment with wires should be performed.
On the whole, the patella fracture heals well, but in the later course a painful restriction of movement or so-called retropatellar arthrosis may develop.

The patellar tendon is located below the patella. Therefore, pain directly below the patella is often due to damage to the patellar tendon. For example, overloading can lead to inflammation of the tendon, which is manifested by anterior knee pain below the patella.

People who work a lot on their knees (e.g. tilers and other craftsmen) are particularly affected. Diseases of the kneecap such as Sindig-Larsen’s disease or the patellar tendon, e.g. Osgood-Schlatter’s disease, can also trigger the symptoms. The quadriceps tendon attaches at the top of the patella, so pain above the patella is often triggered by the tendon or the quadriceps muscle.

Thus, an injury to the muscle, such as a torn muscle fiber or simply aching muscles or tension, can lead to pain above the patella. However, injuries to the tendon, such as a tear of the quadriceps tendon, can also cause pain. Similarly, knee pain above the patella can be triggered by inflammation at the upper edge of the patella.This is often caused by overloading and can even cause bone damage.