Front (anterior) knee pain
Your health expert: Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Content editor review by Pippa Coulter, July 2021
Next review due July 2024
Pain at the front of your knee may also be called anterior knee pain. Anterior means ‘front’. There are lots of things that can cause this type of knee pain. But most of the time, some simple self-care measures should help to get rid of your pain.
Causes of pain at the front of the knee
Pain at the front of your knee may come from your kneecap itself or from the tendons and ligaments in your knee. Tendons connect muscles to bones, and ligaments connect bones together. There are several things that can cause pain at the front of your knee or increase your risk of developing it. These include:
- using your knee a lot – for example, doing lots of exercise or playing sports
- injuring your knee – for example, having a direct blow to your knee
- being overweight – because this puts your knees under more stress
- problems with the alignment of your knees (how your kneecap moves over your thighbone)
- having flat feet
- having overly flexible joints (sometimes called hypermobility)
Conditions associated with pain at the front of the knee
There are several medical conditions linked to pain at the front of the knee. They include the following.
Patellofemoral pain syndrome (PFPS) is one of the most common reasons for pain at the front of the knee. When you bend and straighten your leg, your kneecap slides up and down a groove at the end of your thigh bone (femur). Patellofemoral pain syndrome describes pain related to this joint. It can happen if there’s repeated stress on your knee – for example, from jogging, squatting or jumping. It can also result from problems with the alignment between your kneecap and thigh bone. Doctors sometimes call it runner’s knee. It often happens in people who are very active – particularly teenagers and young adults.
Patella tendinopathy means the patellar tendon in your knee becomes worn down. This tendon attaches your kneecap to your shin bone, and it can become inflamed and tear. This can be due to overuse and stress over time, particularly in sports that involve jumping – like basketball and volleyball. Because of this, it’s often called jumper’s knee. Quadriceps tendonitis is a similar condition but is less common. It causes pain and tenderness where the tendon from your thigh muscle attaches to your kneecap.
Infrapatellar fat pad syndrome is a condition where the fat pad below your kneecap gets pinched between your kneecap and thigh bone. It’s usually due to repeated stress on your knee. It’s sometimes called Hoffa’s syndrome.
Anterior cruciate ligament injury is a tear to one of the ligaments that runs across the inside of your knee, connecting your thigh and shin bones. You might completely or partially tear your anterior cruciate ligament. It’s a sudden injury, usually caused by twisting or overextending your knee. It can happen if you suddenly slow down, stop or change direction and is nearly always associated with sports.
Osteoarthritis of the knee is a common cause of knee pain. In osteoarthritis, there are structural changes to your joints over time. The cartilage which covers the ends of your thigh and shin bones helps them to glide over each other. This cartilage can become damaged and painful. This mostly affects people over 45. The older you are, the more likely you are to get it.
Less common conditions causing pain at the front of the knee
Bursitis is inflammation of the fluid sacs that act as cushions around your kneecap. It can be caused by kneeling a lot and is sometimes called housemaid’s knee or clergyman’s knee. Traditionally, these people spent a lot of time on their knees. More commonly these days, it’s caused by overuse, a fall or injury, or by conditions such as rheumatoid arthritis or gout.
Chondromalacia patellae is a condition where the smooth cartilage underneath your kneecap softens and breaks down. You’re most likely to get symptoms when you put stress on your knees – for instance, going up or down stairs or sitting for a long time.
Recurrent partial dislocation (subluxation) of the patella is where your knee regularly ‘gives way’, because your kneecap moves out of position. It’s more common in girls, especially those with ‘knock-knees’ (where your knees are turned inwards) and can run in families.
Osgood–Schlatter disease and Sinding-Larsen–Johansson disease are common causes of knee pain in children and teenagers who play a lot of sports. They both cause pain and tenderness just below your kneecap, at the top of your shin bone.
There are other conditions that may cause pain at the front of your knee. If your pain doesn’t go away with self-help measures, a doctor or physiotherapist will be able to help find out what’s causing it.
Symptoms of pain at the front of your knee
Pain at the front of your knee can feel different for different people and will depend on what’s causing it. You may have pain below your kneecap, around it, on either side of it or behind it. You may have a dull ache or a sudden, sharp pain.
You’ll often get pain in both knees at the same time, unless it’s due to a particular injury. Pain at the front of your knee is often made worse by:
- standing up after sitting for a long time
- squatting or kneeling
- using stairs
- running downhill
Jumper’s knee may cause pain only when you’re active, but if it gets worse, it may be painful all the time.
Pain from an anterior cruciate ligament injury is usually sudden and you may hear a ‘pop’. Your knee is likely to swell up quite quickly and may feel as if it is going to give way.
Osteoarthritis in your knee usually causes pain when you put weight on the affected leg and gets better when you rest it. You may have stiffness and loss of movement first thing in the morning or after sitting for a while.
Osgood–Schlatter disease and Sinding-Larsen–Johansson disease cause pain, tenderness and swelling just below your kneecap, at the top of your shin bone. Symptoms are usually brought on by running or jumping.
When to seek medical help
If your injury is mild, you may be able to manage your symptoms yourself, without seeking medical advice. But you should see a doctor if:
- you can’t put weight on the affected leg
- you have severe pain, even when you’re not putting weight on it
- your knee gives way, clicks or locks (gets stuck)
- you can’t move your knee
- your knee is hot, red or very swollen or you have a fever
Self-help for pain at the front of your knee
There’s a lot you can do to help yourself if you have knee pain. Avoid doing any activity that triggers your symptoms.
You may be able to relieve your pain by using an ice pack, resting your leg and taking anti-inflammatory painkillers, such as ibuprofen. It might also help to do some exercises to strengthen the muscles around your kneecap. A physiotherapist will be able to advise you on this.
In the longer term, you can help to stop your knee pain coming back by making some changes to your lifestyle and exercise regime. These may include:
- avoiding activities that have previously hurt your knees
- warming up and cooling down properly when you do any activity
- trying to incorporate strengthening your core muscles (back and tummy), hamstrings and thigh muscles into your exercise routine
- losing any excess weight if you need to, to reduce stress on your knees
- wearing the right shoes for your activity
- gradually increasing how much exercise you do, rather than suddenly doing a lot more
If you see a physiotherapist, it’s worth asking them to check whether your feet naturally turn in or out when you walk or run. This is quite common and can cause knee pain or make it worse. It’s usually quite easily corrected with a shoe insert called an orthotic.
Diagnosis of pain at the front of the knee
If you see a doctor because of your knee pain, they’ll examine your knee and ask you some questions. These may include:
- when your pain started and if there’s anything that makes it worse
- whether there’s any activity, accident or injury that could have caused it
- whether you have any other symptoms such as your knee giving way or clicking, or pain in any of your other joints
They may suggest an X-ray or a magnetic resonance imaging (MRI) scan, but this is often not necessary. Your doctor may be able to make a diagnosis based on an examination and your symptoms.
If you have cartilage or ligament damage, your doctor may suggest a procedure to look inside your knee. This is called an arthroscopy (often known as keyhole surgery). It involves making a small cut in your knee and inserting a thin tube and camera. As well as diagnosing the problem, your doctor may sometimes be able to repair or remove any damaged tissues during the procedure.
Treatment of pain at the front of the knee
Whether or not you need further treatment for your knee pain and what treatment you have, will depend on what’s causing the pain. Most conditions causing pain at the front of the knee can be treated with painkillers and physiotherapy. Surgery is usually only needed if other treatments haven’t worked.
For information on treatments, please see the relevant knee condition page.
- Patellofemoral pain syndrome (PFPS)
- Patella tendinopathy
- Infrapatellar fat pad syndrome
- Anterior cruciate ligament injury
- Osteoarthritis of the knee
Not quite sure what you're looking for? Browse all our knee condition pages to find the right treatment advice for your condition.
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The treatment you need for pain at the front of your knee will depend on exactly what’s causing it. There are many things you can do yourself, including resting your knee and applying ice to it. But for some conditions, physiotherapy or surgery may help. For more information, see our sections on self-help and treatment above.
Pain at the front of your knee can be caused by problems with your kneecap or the tendons that hold it in place. Ligament injuries and osteoarthritis can also cause this type of pain. To find out more, see our sections on causes and conditions above.
Your doctor will be able to assess how serious your knee pain is by asking you questions and examining your knee. If necessary, they’ll carry out some scans too. You should see a doctor if your symptoms are severe or don’t start to improve within a few weeks. For more information on this, see our section on symptoms above.
Knee arthroscopy
Knee arthroscopy is a type of keyhole surgery used to diagnose and treat knee pain or other knee problems.
Patellofemoral pain syndrome
Patellofemoral pain syndrome is sometimes called ‘runner’s knee’ because it’s particularly common in people who run or do other sports.
Patellar tendinopathy (jumper's knee)
Patellar tendinopathy is also called ‘jumper’s knee’ because the injury commonly occurs during sports that involve jumping, such as basketball.
Infrapatellar fat pad syndrome
Infrapatellar fat pad syndrome is when your fat pad becomes pinched (impinged) between your kneecap and thigh bone, or your thigh and shin bones.
Anterior cruciate ligament (ACL) injury
An ACL injury can be a partial or a complete tear, an overstretch, or a detachment of the ligament.
Knee osteoarthritis
Osteoarthritis is a disease that causes pain and stiffness in your joints. Your knee is one of the joints that’s most commonly affected.
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