Patellar Pain

Patellar pain and patellar arthritisPatellar pain, or kneecap pain, is when you feel discomfort or an ache in the front of your knee around the kneecap. It’s a common issue for people who participate in activities that put stress on the knee joint, such as running, jumping, squatting or lunging..

It can feel unstable and hurt, especially when you are:

  • going down stairs
  • sitting for a long time
  • wearing high heels
  • doing squats or lunges

Often, these conditions have caused you pain for years. And a change in your weight or activity level can make it feel much worse.

Understanding Patellar Pain

Patellar pain can occur in the front of the knee, the kneecap slides up and down in a groove (trochlea) in the thigh bone. In some cases, the kneecap may be malaligned or arthritic, causing pain, swelling, and cartilage injury.

Symptoms of Patellar Pain

  • Pain around or behind the kneecap, especially during activities that involve bending or straightening the knee.
  • Tenderness to the touch in the kneecap area.
  • Swelling or inflammation around the knee.
  • Clicking, grinding, or popping sounds when bending or straightening the knee.
  • Difficulty bending the knee fully.

Causes of Patellar Pain

In some patients, patellar pain or arthritis happens without any trauma and at a young age. In others, it may occur when you were formerly active but got out of shape or when you ramp up activity quickly in an effort to get back in shape.

  • Overuse: Repetitive activities that strain the kneecap, such as running, jumping, or frequent kneeling, may irritate the tissues surrounding the patella, resulting in pain.
  • Injury: A direct blow to the knee or a sudden forceful movement may cause injury to the patellar or trochlear cartilage, resulting in pain.
  • Weak Muscles: If the muscles around your thigh and hip are weak, that can put undue stress on the kneecap and cause pain.
  • Tightness: If the muscles surrounding the kneecap are tight, particularly the quadriceps, it can restrict your movement and cause pain.
  • Arthritis: Osteoarthritis, the wear and tear of joint cartilage, can affect the knee joint and contribute to patellar pain
  • Bursitis: A blow to the knee or excessive kneeling can cause swelling in front of the kneecap which can hurt to touch or kneel..

Recognizing Symptoms

The most prominent symptom is pain around or behind the kneecap. This pain may feel dull and achy or sharp and stabbing, and it may be worsened by activities that involve bending or straightening the knee.

  • Your kneecap and the surrounding area may be tender to the touch.
  • There may be noticeable swelling or inflammation around the knee joint.
  • You may hear clicking, grinding, or popping sounds when bending or straightening your knee, which is called crepitus or crepitation. These sounds could indicate a cartilage flap or defect in some cases.

If the pain appeared suddenly after a specific injury or forceful movement on the knee, seek medical attention to evaluate next steps. If you have severe pain that doesn’t improve with rest or persists for several days, you may want to check in with a doctor. And if you’re feeling instability in the knee joint such as a patellar dislocation, you may need reconstruction of the medial patellofemoral ligament (MPFL). This is another symptom that you should discuss with an orthopedic surgeon.

Diagnosing Patella Pain

Diagnosing patellar pain typically involves a thorough physical examination by a healthcare professional and potentially some imaging tests.

Before Your Appointment

  • Make a note of your symptoms, including the location and severity of pain, when it started, and activities that aggravate or alleviate it.
  • Prepare a list of any medications or supplements you’re currently taking.
  • Be ready to discuss any past knee injuries or surgeries you’ve had.
  • Wear clothing that allows easy access to your knee for examination.

Expect to answer questions about your medical history, including:

  • Whether you have any previous knee injuries or surgeries
  • Where do you feel the pain in your knee? (that is, front, back, side of kneecap)
  • Can you describe the pain? Is it dull, sharp, aching, throbbing?
  • When did the pain start? Did it come on suddenly or gradually?
  • Does the pain occur during any specific activities? 
  • What activities seem to make the pain worse?
  • What helps to relieve the pain?

Physical Examination

Then your doctor will perform a physical examination of your knee, focusing on your:

  • Range of motion: Can you bend and straighten your knee fully?
  • Tenderness: Do you have pain or sensitivity to touch around the kneecap and surrounding tissues?
  • Stability: Do you have any feelings of instability or weakness in the knee joint?
  • Strength: How strong are the muscles around your thigh and hip, and could weakness in these areas be causing the knee pain?

Your doctor might also use the patellar tilt test or the patellar apprehension test to accurately identify the source of the pain.

Imaging Tests

X-rays aren’t always necessary for diagnosing patellar pain, but they can help rule out fractures or other bone abnormalities in the knee joint and identify signs of arthritis or joint alignment issues.

Your doctor may also recommend an MRI scan to get a detailed view of the soft tissues surrounding the kneecap, such as ligaments, tendons, and cartilage, which can reveal tears, inflammation, or other abnormalities. 

What to Ask Your Surgeon

  • Diagnosis: Make sure you understand the diagnosis and the cause of your patellar pain.
  • Treatment Options: Discuss the recommended treatment plan and ask whether there are potential alternatives available.
  • Recovery Time: Ask about the typical recovery timeline and any restrictions you might need to follow and plan for.

Treatment Options

Depending on the cause of your patellar pain, you may have several effective non-surgical treatment options.

Rest and Activity Modification

  • When you first have patellar pain, reduce activities that aggravate the pain to allow inflammation to subside and promote healing.
  • Reintroduce activities gradually as the pain improves but avoid pushing yourself too hard too soon.

Medication and Injections

  • Pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) can help reduce pain and inflammation.
  • Creams or gels containing menthol or lidocaine may also provide localized pain relief.
  • Corticosteroid injections can provide quick pain relief by reducing inflammation, but they are not a long-term solution.
  • Hyaluronic acid injections supplement the natural hyaluronic acid in the knee joint, which acts as a lubricant.

Physical Therapy

If appropriate, a physical therapist can design a program to strengthen the muscles around your knee, particularly the quadriceps and hamstrings to help stabilize the kneecap. Stretching exercises for the quadriceps, hamstrings, and calf muscles can improve flexibility and range of motion in the knee joint; balance exercises can improve proprioception (your body’s awareness of its position in space) and help prevent future injuries.

Additional Therapeutic Measures

  • Apply ice packs to the affected area for 15-20 minutes at a time, several times a day, to reduce pain and inflammation.
  • Wear a patellar support brace for support, stability, and to improve patellar tracking during activities.
  • Kinesio taping techniques may offer support and pain relief, although evidence for its effectiveness is mixed.
  • Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body. Some studies suggest it might offer pain relief for patellar pain.
  • Massage may help relax muscles and improve blood flow, potentially helping you with pain management.

Lifestyle Modifications

  • Achieving a healthy weight can help to reduce stress on the knee joint.
  • Wearing shoes with good arch support and proper cushioning helps to distribute your weight evenly and reduces stress on your kneecap.
  • Warming up before physical activities and doing stretches afterwards can improve your flexibility and reduce the risk of injury.

In some cases, you may require surgery to realign the patella within the groove (tibial tubercle osteotomy) or surgery to replace the cartilage on either the kneecap or the front of the thigh bone (trochlea).

When to Consider Surgery

If you’ve followed a non-surgical treatment plan diligently for an extended period (typically several months) with minimal or no improvement in pain, you may want to consult a surgeon. And if patellar pain significantly impacts your daily activities or your ability to participate in sports or exercise (and non-surgical treatments haven’t helped), surgery may enable you to restore function and improve your quality of life. Sometimes, non-surgical treatments are ineffective because the root cause of the patellar pain hasn’t been accurately identified. This may require further investigation or a surgical exploration to diagnose the underlying issue and determine the most appropriate treatment approach. And if your patellar pain developed suddenly after a specific injury, such as a fall or forceful movement, it could indicate a ligament tear or fracture, requiring surgery for repair.

In some cases, patellar pain is caused by specific conditions that might benefit more from surgery than conservative treatment, such as:

Your doctor will consider several factors when determining if surgery is right for you, such as your age and overall health, the severity of your pain and any functional limitations, your current activity level and expectations, and whether there are significant potential risks and complications of surgery.

Types of Patellar Pain Surgery

The specific surgical approach will depend on the underlying cause of your patellar pain; common procedures include:

  • Arthroscopy: A minimally invasive procedure using a camera and small instruments to diagnose and potentially address issues within the knee joint, such as trimming damaged cartilage or repairing a torn ligament . Arthroscopy also allows your surgeon to trim or repair a torn meniscus.
  • Patellar realignment surgery/Tibial Tubercle Osteotomy: This procedure involves cutting and repositioning the bony attachment point of the patellar tendon (tibial tubercle) to alter the pull on the patella and improve its tracking
  • Ligament repair or reconstruction: In this procedure, torn ligaments that support the kneecap are reconstructed using tendon grafts.

Arthroscopy uses smaller incisions, resulting in less tissue damage, faster recovery times, and potentially less pain than traditional open knee surgery. Following arthroscopic surgery for patellar pain, you’ll likely undergo physical therapy to regain strength, flexibility, and range of motion in your knee joint. Recovery time varies depending on the specific procedure performed.

Recovery and Rehabilitation

Following patellar pain surgery, proper postoperative care is important for a successful recovery and a return to your desired activities. Here’s what you can expect:

Immediately After Surgery:

  • You’ll receive pain medication to manage discomfort.
  • Your vitals and pain levels will be monitored closely in the recovery room.
  • A bandage and possibly a brace will be applied to your knee to provide support and stability.

First Few Days:

  • Rest and Elevation: Prioritize rest and elevate your knee above your heart level to reduce swelling and promote healing.
  • Ice Therapy: Apply ice packs to your knee for 15-20 minutes at a time, several times a day, to help manage pain and inflammation.
  • Pain Medication: Take pain medication as prescribed by your doctor.
  • Supplements: We recommend Calcium (1500mg) and Vitamin D (2000iu) during your recovery. Protein Supplements are also a good idea, such as those available at the recovery shop
  • Physical Therapy: A physical therapist may begin introducing gentle exercises to improve circulation and prevent stiffness.

Weeks 1-4:

  • More physical therapy, including strengthening exercises that target the muscles around the knee joint, particularly the quadriceps and hamstrings, to improve stability and support the patella. You’ll also do stretching exercises to improve range of motion in the knee joint and balance exercises to improve proprioception and prevent future injuries.
  • Your doctor will gradually progress you from using crutches or a walker to putting more weight on your knee (as tolerated).
  • You’ll transition to over-the-counter pain medication as your pain subsides.

After this, you’ll continue physical therapy and gradually resume activities, starting with low-impact exercises and progressing towards your desired activities (when approved by your surgeon). Proper nutrition and adequate sleep are also important for optimal healing.

Some swelling after surgery is normal. Your doctor may advise using compression stockings, a compression knee sleeve, or recommend specific exercises to help manage swelling. Keep your incision clean and dry to help prevent scar tissue formation; your doctor may also recommend scar massage techniques later in the recovery process.

Let your doctor know if you experience any concerning pain or if pain medication isn’t effectively managing your discomfort, and make sure you attend all scheduled follow-up appointments with your doctor to monitor your progress and address any concerns. The recovery timeline following patellar pain surgery varies depending on the specific procedure performed and your individual healing rate. 

Contact me if you want to discuss your patellar pain or get a second opinion.