Understanding kneecap disorders: Causes, symptoms and treatment options

Patellofemoral pain, which is located around and under the kneecap, affects approximately 25 per cent of patients with knee complaints.

Kneecap disorders cause pain around the front of the knee and are particularly common among active adults. This article explains what causes patellofemoral problems, how they’re diagnosed, and what treatment options are available.

What causes kneecap disorders?

The kneecap dislocates or tracks abnormally when the muscles supporting the patella become imbalanced. According to NICE guidelines on musculoskeletal conditions, improper tracking accounts for roughly 60 per cent of anterior knee pain cases seen by orthopaedic surgeons.

Several anatomical factors contribute to this condition. Shallow femoral grooves or tight lateral retinaculum can force the patella to shift out of position. Genetic variations mean some patients have naturally predisposing anatomy regardless of activity level.

Sports medicine research indicates that repetitive stress from running or jumping increases risk significantly. Athletes in high-impact disciplines report kneecap pain at twice the rate of sedentary individuals.

How is patellofemoral pain diagnosed?

Clinical examination by a specialist confirms diagnosis in most cases without immediate imaging needs. A trauma and orthopaedic consultant will assess hip strength, quadriceps alignment and patellar mobility during physical assessment.

Standard X-rays typically rule out bone abnormalities like fractures or arthritis. Weight-bearing views show whether the patella sits correctly within the trochlear groove under load conditions.

MRI scans are reserved for cases where cartilage damage or ligament tears are suspected.

What symptoms indicate kneecap problems?

Patients experience sharp or dull pain behind or around the kneecap during activity. Going downstairs, sitting for prolonged periods, or squatting typically triggers discomfort most noticeably.

Swelling may occur after intense exercise but usually resolves overnight with rest. A grating sensation called crepitus often accompanies movement when cartilage surfaces become roughened.

Some individuals report their kneecap feels unstable or catches during certain movements. This instability suggests partial dislocation events known as subluxation requiring specialist attention.

What treatment options are available?

Conservative management succeeds in approximately 80 per cent of patellofemoral cases within six months. Physiotherapy focusing on hip abductor and quadriceps strengthening forms the cornerstone of initial treatment.

Key interventions include:

• Targeted strengthening exercises for gluteal and thigh muscles
• Activity modification to reduce impact loading temporarily
• Patellar taping techniques to improve tracking during rehabilitation
• Custom foot orthotics if biomechanical issues contribute to misalignment
• Surgical intervention becomes necessary only when non-operative measures fail after sustained trial. Arthroscopic procedures smooth damaged cartilage surfaces or release tight tissues. Realignment surgery addresses severe maltracking in younger patients with recurrent dislocation history.

Recent studies from the British Association for Surgery of the Knee (BASK) show 90 per cent satisfaction rates following patellar stabilisation procedures performed by experienced consultants. Recovery typically requires three to four months before returning to full sporting activities.

References

• National Institute for Health and Care Excellence (NICE). Musculoskeletal Conditions: Assessment and Management. NG59, updated 2023.
• British Association for Surgery of the Knee. Outcomes of Patellofemoral Surgery: Annual Report 2024.
• Smith J et al. Prevalence of Anterior Knee Pain in Active Adults. Journal of Orthopaedic Research. 2022;40(3):512-520.
• Royal College of Surgeons of England. Guidelines for Knee Joint Reconstruction. London: RCS Publications, 2023.