Anterior knee pain in young athletes By Mark J. Triffon, M.D. In today’s competitive world, an increasing number of young athletes experience knee pain. One type of anterior knee pain – pain in the front of the knee – is almost always due to problems with your child’s “patello-femoral extensor” mechanism. The tendon of the quadriceps muscle envelopes the patella (kneecap) and forms the patellar tendon to insert into the top part of the tibia. Contraction of the quadriceps tendon extends the knee. Here’s a rundown of the three main causes of anterior knee pain in young athletes. I. Patellar Tendonitis Patellar tendonitis or jumper’s knee is characterized by inflammation from overuse or poor technique. Increasing power in the quadriceps in the physically maturing athlete can cause pain where the tendon inserts into the bone. Patients report pain in the front of the knee, usually worse with jumping or squatting. Slight swelling is also a symptom. Athletes who engage in repetitive running and jumping in sports such as basketball and volleyball are more susceptible to this condition. Osgood-Schlatter’s disease is a similar condition common among young athletes in rapid growing years; “disease” being a misnomer for this overuse syndrome. As with jumper’s knee, pain results from repeated stress on the patellar tendon as it grows into the bone. The syndrome occurs more often in boys, but girls develop it at younger ages. Treatment to control the pain and inflammation of these syndromes consists of rest, icing, antiinflammatory medication and, most importantly, physical therapy and rehabilitation. Knee extension exercises should be avoided. II. Patello-femoral instability Patello-femoral instability is caused by excess ligamentous laxity, malalignment or traumatic patellar injuries. The kneecap normally slides down in a groove in the front of the femur as the knee bends. Due to injury and other various factors, the patella may not stay in the groove but move to the side when the knee is bent. If repetitive, this lateral movement causes pain on either side of the kneecap that worsens with activity. X-rays are necessary for evaluation of these conditions. Your physician will assess the bone structure and various angles the patellar mechanism shares with the knee joint. Treatment of patello-femoral instability focuses on aggressive physical therapy to significantly strengthen the quadriceps mechanism. If exercise and other therapies are not successful at returning the patella to a normal path of movement, various surgical realignments may be considered. III. Chondromalacia Chondromalacia patellae or “bad cartilage” refers to injury of the joint cartilage on the underside of the patella. The disorder occurs most often in young adults and may be caused by a direct blow or dislocation that roughens or fragments cartilage. Young athletes complain of dull pain that worsens with stair climbing or prolonged flexing of the knee. The disorder is common in runners and is also seen in skiers, cyclists and soccer players. Treatment consists of low impact exercises to strengthen the quadriceps. Swimming and stationary cycling are acceptable as long as the knee is not bent more than 90 degrees. If necessary, arthroscopic surgery is used to smooth roughened areas and remove loose pieces of cartilage from the knee. Prevention Parents can help their children prevent knee conditions that result from overuse of muscles and tendons by alternating sport activities, rather than playing consecutive seasons of one sport. Encourage your child to maintain maximum flexibility by stretching daily and always warming up before activity. Training tips on proper technique can also lessen the chance of injury. Anterior knee pain has many causes but with thoughtful evaluation and treatment, the problem usually resolves. Rest, ice, bracing, anti-inflammatory medication and aggressive therapy and strengthening are the mainstays of treatment. Surgery is an option for the most difficult cases. Consult your team trainers or orthopedic specialist if you suspect you or your child has a knee condition. Dr. Triffon is an orthopedic sports medicine specialist at the Ohio Orthopedic Center of Excellence in Columbus, Ohio. He specializes in shoulder, elbow, ankle and knee disorders.