Front (anterior) knee pain

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due March 2022

Pain at the front (anterior) of the knee may also be called anterior knee pain (AKP). Anterior simply means ‘front’.

You may have pain below your kneecap (patella); around your kneecap, on either side of it; or behind your kneecap.

Pain at the front of the knee may come from the kneecap itself or from the tendons that attach the muscles to the bones of the knee.

A diagram by Bupa of where front knee pain is located

Causes of pain at the front of the knee

There is no single cause, but there are several reasons why pain at the front of the knee may develop. It is more common in:

  • people who have had a dislocation, fracture, or other injury to the kneecap
  • people who exercise often, including runners and joggers, cyclists, skiers, football players and other athletes
  • people who are overweight
  • teenagers and healthy young adults, more often girls
  • people with flat feet
  • people with overly flexible joints (sometimes called being double-jointed)

Conditions associated with pain at the front of the knee

There are several medical conditions linked to pain at the front of the knee. Generally, they are caused by:

  • damage from a fall or a sports injury
  • overusing the knee during exercise
  • getting older

Patellofemoral pain syndrome (PFPS) is one of the most common knee conditions related to sporting injuries. It means pain related to the kneecap (the patella) and the thigh bone (the femur). Doctors sometimes call this ‘patella maltracking’ or ‘runner’s knee’.

When you bend and straighten your leg, your kneecap slides up and down a groove at the end of your thigh bone. Damage or swelling where the kneecap and thigh bone meet stops the kneecap from sliding smoothly and causes pain. The knee may feel as if it will give way.

Patella tendinopathy means wearing of the tendons around the kneecap, which can be due to overuse and stress over time. Small tears in the tendon can cause inflammation (tendonitis). These tears are usually due to sudden injury. These conditions are sometimes called ‘jumper’s knee’ and are most common in athletes. Quadriceps tendonitis is a similar condition, but less common. It causes pain and tenderness where the tendon from the thigh muscle attaches to the kneecap.

Infrapatellar fat pad syndrome is a condition where the fat pad below the kneecap gets pinched between the kneecap and the thigh bone. It’s most often caused by over-straightening the leg repeatedly or standing for long periods. It is sometimes called Hoffa’s syndrome.

Anterior cruciate ligament injury is an overstretching or tearing of this ligament, which runs across the knee from the thigh to the shin bone. A tear may be either complete or partial. This is a sudden injury, usually caused by a twisting of the 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. The smooth, shiny cartilage that lines the knee joint becomes worn and rough. This causes pain and increasing damage to the knee over time. It mostly affects people over 50. 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 the kneecap. It can be caused by kneeling a lot and is sometimes called housemaid’s knee or clergyman’s knee. More commonly these days, it’s caused by overuse, a sudden increase in sports training, by being overweight, or by other conditions such as rheumatoid arthritis or gout.

Chondromalacia of the patella is a condition where the smooth tissue under the kneecap (the cartilage) can soften and break down. It’s most often seen in teenage girls.

Recurrent partial dislocation (subluxation) of the patella is an uncommon condition that can run in families. There is sudden pain in the knee, as it gives way. It can be seen in girls with ‘knock-knees’ – ie, when the knees are together, and the ankles are apart. This affects the tracking of the kneecap (the movement of the knee cap as it glides across the thigh bone).

Osgood–Schlatter disease and Sinding-Larsen–Johansson disease are conditions seen mostly in teenagers who take part in a lot of sports. They both cause pain and tenderness just below the kneecap, at the top of the shin bone (the tibia).

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Symptoms associated with pain at the front of the knee

Pain at the front of the knee may be dull and aching, or sharp or shooting.

If your knee pain is caused by wear and tear, it often affects both knees at the same time. But if you’ve sustained a particular sports injury then it will only affect one knee. Pain at the front of the knee is usually made worse by standing up after sitting for a long time, squatting or kneeling, using stairs or running downhill. ‘Jumper’s knee’ may cause pain when you’re active, or may be a continuous dull ache.

Pain from an anterior cruciate ligament injury is usually sudden during sporting activity. You may hear a ‘pop’ as the knee twists and the ligament breaks. The knee is likely to swell from internal bleeding and may feel as if it is going to give way.

Stiffness and loss of movement, first thing in the morning or after sitting for a while, is most common with osteoarthritis. It usually causes pain when weight bearing, which is relieved by rest.

Osgood–Schlatter disease and Sinding-Larsen–Johansson disease cause pain, tenderness and swelling just below the kneecap, at the top of the shin bone (the tibia).

Diagnosis of pain at the front of the knee

Your doctor will examine your knee and take a history, asking about:

  • the type of pain you have, when it started and whether it comes and goes
  • how active you are
  • any activity, accident or injury that could have caused it

They may suggest an X-ray or a magnetic resonance imaging (MRI) scan, but this is often not necessary. The examination and your history may be enough to diagnose you.

If you have cartilage or ligament damage, your doctor may suggest a procedure to look inside your knee, called an arthroscopy (often referred to as ‘keyhole surgery’). This involves making a small cut in your knee and inserting a thin tube with a camera on the end. As well as confirming the diagnosis, the procedure can also be used to repair any damaged tissues, reconstruct any ruptured ligaments or remove damaged tissue.

Managing pain at the front of the knee

You can often treat pain at the front of the knee using an ice pack, resting your leg and taking anti-inflammatory painkillers, such as ibuprofen. Exercises to strengthen the muscles around your kneecap can also help. A physiotherapist can tell you which exercises you need to do.

If your injury is mild, you may not need to see a doctor, but you should if:

  • you cannot put weight on the affected leg
  • you have severe pain, even when not bearing weight
  • your knee gives way, clicks, or locks (gets stuck)
  • your knee is deformed or misshapen
  • your knee is hot, red or very swollen or you have a fever
  • you have pain, swelling, numbness, tingling, or a bluish discoloration in your calf
  • you’re still in pain after three days

In the longer term, you can help to stop knee pain recurring by making a few changes to your lifestyle and exercise regime. Try:

  • varying the type of exercise you do or trying a different sport, swimming or cycling for instance
  • warming up and cooling down properly
  • strengthening your core muscles (back and abdominal), hamstrings and thigh muscles
  • losing excess weight
  • using the right sports equipment properly and looking after it, for example, wearing well-fitting sports shoes, having your bike saddle at the correct height, etc
  • gradually increasing exercise, rather than suddenly doing a lot more

While you’re seeing your 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 or aggravate knee pain. It’s usually quite easily corrected with a shoe insert called an orthotic.

Treatment of pain at the front of the knee

The treatment that you have for pain at the front of your knee will depend on what condition is causing the pain.

For information on treatments, please see the relevant knee condition page.

Not quite what you're looking for? Browse all our knee condition pages to find the right treatment advice for your condition.

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  • Reviewed by Alice Windsor, Specialist Health Editor, Bupa UK Health Content Team, March 2019
    Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
    Next review due March 2022