Adolescent anterior knee pain

A teenager aged 13-17, or young adult around 24, who is physically active and participates in sports may sometimes experience pain in the front and center of the knee, usually underneath the kneecap (patella). The pain is bilateral, but sometimes more severe in one knee than the other. There is no history of trauma. The pain often prevents regular exercise. They are relieved by painkillers. There is no joint effusion. Blockages are rare. The teenager and her parents are distressed.

Clinical examination reveals a muscle imbalance

Clinical examination will not reveal signs of patellar instability, but may reveal a muscular imbalance. Some muscles are too weak, often the gluteus medius. Others are too stiff, often the quadriceps or hamstrings. Palpation of the medial side of the kneecap often causes pain. Nothing really significant. X-rays are normal. Sometimes additional tests such as CT, NMR, scintigraphy are ordered to rule out projected pain, a problem in the spine or hip, or local pathology in the knee.

An arthroscopy, which is not necessary, would show a mostly regular cartilage surface with sometimes a sensation of soft, watery cartilage on palpation. Cartilage flaps are rare.

These pains are very annoying and sometimes unpleasant for this young teenager who is impatient to get back to normal life.