Kneecap Problems & Anterior Knee Pain

The kneecap joint, known as the Patello-femoral joint, is made up of the kneecap itself (Patella) and the groove that it runs in (Trochlea). Some of the more common conditions that we treat include instability of this joint (kneecap subluxations and dislocations), pain due to overload and arthritis.

Patella Instability: Patella dislocation can be caused by a traumatic event, particularly during contact or dynamic pivoting sports, or sometimes as a result of only a minor twisting movement in individuals who are more susceptible.

Post-traumatic instability: Traumatic events leading to patella dislocation do occur. After reduction of the patella (which may need to be performed in A & E) an Xray will ensure no other bony injury has occurred. An MRI scan will usually be arranged as an outpatient to check for cartilage damage or an associated ligament injury. After the scan and following a thorough clinical assessment a personalised management plan can be tailored to your personal needs. This may be in the form of physiotherapy, specialised taping and, occasionally, surgery to reconstruct the torn ligament(s). Surgery is usually only performed after a dedicated period of rehabilitation and strengthening.

Non-traumatic instability: Some patients may suffer repetitive patella instability from relatively minor incidents. In this case a thorough assessment may also include a CT scan to assess the bony anatomy of the kneecap joint. In cases that do not respond to physiotherapy and strengthening then a bony realignment procedure, known as an Osteotomy, may be necessary to better control patella glide within it’s trochlea groove.

Patello-Femoral Joint Arthritis: Isolated kneecap arthritis is uncommon but can cause disabling pain at the front of the knee. The main focus of treatment is a maximal conservative approach with surgery only  indicated in severe cases that do not respond to non-operative measures.

Maximal Conservative treatment: Physiotherapy and strengthening. Analgesia as necessary. Weight-reduction programme. Injections of a viscous liquid similar in composition to the normal joint fluid, known as Viscosupplementation, can be helpful in some specific cases.