Pain in the front of the knee

Pain at the front of the knee due to a patella fracture

Traumatic pain localized to the front of the knee joint is most often the result of acting with high energy after falling over the knee. Pain at the front of the knee is characteristic of, among other things, a fracture of the patella, where there is also damage to structures located at the front of the knee, namely rupture of the ligament of the patella or rupture of the distal attachment of the quadriceps muscle of the thigh.

Symptoms of a fracture of the patella

• pain at the front of the knee
• severe pain and tenderness localized to the patella
• appearance of a hematoma on the front of the knee
• sometimes with a displaced fracture - there is a palpable space between the patella fragments
  inability to straighten the knee due to interruption at some stage of the knee joint upright apparatus
• severe pain when bending the knee due to the displacement of bone fragments from each other

Treatment of patella fracture

Pain in the front of the knee requires appropriate diagnosis by an orthopedic surgeon. The basis is a clinical examination, as well as an imaging study in the form of an X-ray of the entire knee joint. If there is suspicion of other pathology, such as damage to the attachments of the quadriceps tendon of the thigh to the patella or damage to the ligament of the patella, then ultrasound will be the test that will best visualize these soft tissues.

In the case of a fractured patella without displacement of any fragments, one proceeds to non-operative treatment. Bracing of the limb in extension is performed using a plaster shell called a longette, or using an orthosis positioned in extension. The bracing of the limb lasts about six weeks. This period is followed by a period of rehabilitation. A return to full fitness occurs about 3 months after the patella fracture. A return to sports is possible when the patella is fully fused and the rehabilitation period is completed, i.e. full mobility and strength in the limb is restored.

In the case of a fracture of the patella with displacement, when the bony fragments separate, the orthopedic surgeon opts for surgical treatment as soon as possible after the injury occurs. In this case, the limb is also braced in extension to relieve the tension as much as possible.

Pain in the front of the knee due to rupture of the patellar ligament

Pain in the front of the knee caused by trauma can also be related to soft tissue damage. The cause of pain can be a rupture of the ligament of the patella or a rupture of the distal attachment of the quadriceps muscle of the thigh. In these cases, surgical treatment is most often indicated, the purpose of which is to bring the stumps of the ligament or the detached muscle ligament closer to the patella. This is a very important structure that is subjected to great forces, and if at some stage this knee upright apparatus is disrupted, a very large limb function is lost.

Pain in the front of the knee due to bursitis of the patellar bursa

The pain in the front of the knee, as determined by the patient, caused by a sudden impact or as a result of prolonged overloading, can be the result of a hematoma or inflammation of the preacromial bursa. The antebrachial bursa, is a structure located between the skin and the patella. Usually it is a space in which there is no fluid. On the other hand, it can appear with repetitive trauma, such as when the patient works on his knees (laying tiles, working in the garden), or if there has been a blow or even several blows. At this point, the bursa produces fluid, which swells to form a characteristic swelling at the front of the knee. It can also proceed with inflammation, in which case the knee is hotter, fluid is felt at the front of the knee, and sometimes patients develop a subfebrile condition.

Treatment of antebrachial bursitis

After a major injury, an orthopedic surgeon may perform an LP of such a bursa pulling off the hematoma. In cases of overload, when the fluid appears later, for example, after prolonged work on the knees, as a rule, anti-inflammatory treatment is introduced, cooling compresses are applied, and the limb is spared. In occasional cases, the patient may develop bacterial superinfection. If pus develops during the LP, antibiotics are introduced for treatment.

If, despite treatment of the bursa with good results, there is a recurrence and fluid collects again, then at the next fluid extraction, the doctor administers a steroid preparation into the bursa. This is a safe procedure; the injection is intralesional. The steroid has an anti-inflammatory effect giving the condition a chance to be completely cured. If, despite all attempts at treatment, the bursa continues to cause problems, there is an exudative inflammation of the bursa, then eventually the doctor decides to surgically excise the bursa.

Pain in the front of the knee due to meniscus damage

Patients sometimes describe their complaint as pain in the front of the knee, which is actually related to, for example, meniscus damage or osteoarthritis. In Patients over the age of 50, there are visible degenerative changes in the knee joint - the most advanced are in the patellofemoral joint. This is when the articular cartilage, which is already partially damaged, rubs out, which can proceed with pain in the front of the knee. The pain is characterized by the fact that it intensifies when walking up stairs, sitting in a chair, or doing squats. Periodically, there may also be an overhang in the knee, as with other degenerative changes.

Pain in the front of the knee due to knee valgus.

In young people who report pain in the front of the knee, an abnormal path of motion of the patella at the fork of the femur can often be the cause. This can be caused by knee valgus, or with abnormal development of the condyles of the femur, or an anatomical variant, where the patella does not move only up and down, but there is a so-called “sliding” of it between the center and the side. With repetitive movement, this can lead to overload changes. Pain will occur when walking up and down stairs and sitting on a chair, and in people who work out when doing lunges or squats with a load. At the same time, patients often report skipping, rubbing of the kneecap - so-called sound symptoms.

Pain in the front of the knee caused by damage to the meniscus is treated conservatively at the first stage. After a medical diagnosis, the patient reports to a physiotherapist, with whom he will work to correct the muscle imbalance. Rehabilitation usually involves strengthening the medial head of the quadriceps thigh muscle and appropriate exercises to activate the quadriceps thigh and gluteal muscles. This makes it possible to improve the path of the patella.
In patients with patellofemoral joint complaints, in addition to rehabilitation, the orthopedic surgeon also has delivery injections, most commonly hyaluronic acid, to support treatment and speed up the return to normal activity.

Pain in the front of the knee of an overload nature

Pain in the front of the knee can also be of a muscle overload nature or an overload on the ligament of the patella. With repetitive movements, there is a micro-injury on the attachment to the patella, either the quadriceps muscle of the thigh or the ligament of the patella. The patient then has problems getting up from a squat, getting up from sitting, and will also have pain after prolonged cycling. This problem often occurs in athletes training in jumping sports like volleyball players. In this case, x-ray and ultrasound are the primary diagnostics to see these changes. The best solution is rehabilitation and a change of training phase to allow time for recovery. Attention should be paid to stretching and rolling the muscles, not just strengthening them.

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Learn about other possible injuries to the knee joint.

Bibliography:

• Medical News Today - What causes pain in the front of the knee? - Medically reviewed by Angela M. Bell, MD, FACP — By Ismahan Shire on March 17, 2023
• Knee Pain Explained - Front Knee Pain - Written By: Chloe Wilson, BSc(Hons) Physiotherapy, Reviewed by: KPE Medical Review Board - 2021
• Chronic traumatic anterior knee pain - Author links open overlay panelA.J Price, J Jones, R Allum - Injury - Volume 31, Issue 5, 1 June 2000, Pages 373-378