Patellofemoral Pain

Pain around the front of the knee is often referred to as patellofemoral pain, also known as runner’s knee or jumper’s knee. This pain may be caused by:

• Pain in the soft cartilage under the kneecap (the patella) or soft tissues around the front of the knee
• Referred pain from another area such as the back or hip
• Abnormal alignment of the kneecap

• Athletes whose sports put repeated stress on the knee, for instance through running, jumping, or climbing
• Teenagers during growth spurts
• Manual laborers
• People who are overweight

In athletes, patellofemoral pain may be caused by strain in the tendons, which connect the kneecap to the lower leg bone (patellar tendon), upper leg bone (quadriceps tendon), and the retinaculum (which supports the kneecap on both the left and right sides).

Your child may experience pain when they:

• Sit with bent knees
• Squat
• Jump
• Use stairs

Your child may also experience:

• Knee buckling under their weight
• A catching, popping, or grinding sensation when walking or when the knee is moving

Your doctor will conduct a physical exam of your child and ask about your child's medical history. The doctor may perform further tests, including:

• X-ray: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Magnetic resonance imaging (MRI): a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
   

Your child’s treatment will depend on what’s causing their pain. Their treatment may include some of the following approaches.

Stretching

If the soft tissues (retinaculum, tendon, or muscle) are the source of the pain, stretching, particularly in the prone (face down) position, can be very helpful.

• One simple stretch is to lie prone, grab the ankle of the affected leg with one hand, and gently stretch the front of the knee. It helps to warm up before doing this or any other stretch.

Strengthening and supporting the knee

Other treatments may involve:

• Exercises to build the quadriceps muscle
• Taping the patella
• Using a specially designed brace that provides support specific to the problem

Using ice and non-steroidal anti-inflammatory (NSAID) medications like Advil or Motrin can also be helpful. Your child may need to temporarily modify their physical activities until the pain decreases.

Avoid activities that could make knee pain worse.

• Avoid sitting or kneeling with bent knees for extended periods of time.
• Adjust the seat of your child’s bicycle so that the seat is at an appropriate height, they can spin the pedals without shifting their weight from side to side, and their legs are not fully extended at the lowest part of the pedal cycle.
• Avoid exercises that bend the knee, such as squats.

Surgery

In more extreme situations, your child may need surgery to relieve the pain.

• If the cartilage under the kneecap is fragmented and causing mechanical symptoms and swelling, arthroscopic removal of the fragments may be helpful.
• If the kneecap is badly aligned, a surgical procedure may be needed to place the kneecap back into proper alignment. This will reduce abnormal pressure on the cartilage and supporting structures around the front of the knee.
• In some people, particularly those who have had previous knee surgery, there may be a specific painful area in the soft tissue around the kneecap that may need to be removed.

• Stretching, particularly in the prone position (face down), will keep the supporting structures around the front of the knee flexible and less likely to be irritated with exercise.
• Proper training, without sudden increases of stress to the front of the knee, will help avoid pain.
• Weight reduction and activity modification may be necessary in some people.

The Orthopedic and Sports Medicine Department at Boston Children’s Hospital is made up of experts in child and adolescent growth patterns and treatments that promote optimal recovery from injury. Whenever possible, we take a non-surgical approach to patellofemoral pain. If your child’s injury requires surgery, we will use the least invasive options and practice pain management techniques to promote faster recovery and minimal exposure to anesthesia.