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Anterior Knee Pain
Diagnosis/definition
Knee pain localized to the anterior portion of the knee, either retropatellar or peripatellar. Usually a gradual, non-traumatic onset aggravated with increased activity, running, squatting, stair climbing or prolonged sitting. Symptoms normally decrease with rest.
Initial diagnosis and management
- History and physical examination
- Plain films not required
- NSAIDs
- Avoidance of aggravating activities (profile for active duty soldiers)
- Strengthening exercises for quadriceps, stretching exercises for quads, hamstrings and calf muscle
- Ice after activities
- Compression wrap is contraindicated
- Patient education (refer patient to PT for Retropatellar Pain Syndrome (RPPS) class)
- Please refer to the Clinical standard on knee pain
Ongoing management and objectives
- Resolution or decreasing symptoms in three to four weeks
If no resolution:
- Trial of alternate NSAID
- Trial of neoprene sleeve with patella opening
- Obtain plain films with sunrise views
- Do not order an MRI. Orthopedic clinic will order, or recommend, if patient meets pre-surgery criteria
Indications for referral to Specialty Care
History of joint locking and giving way
Question of underlying instability
Prolonged effusion > 10 to 14 days
R/O fractures, septic joints, rheumatoid arthritis, etc. should be referred to appropriate specialty clinic (Orthopedics or Rheumatology)
Refer to Physical Therapy if none of the above but progression of atrophy or persistent symptoms despite initial management.
Completed full course of rehabilitation and have any of the following concerning symptoms: catching, locking, effusions, instability, warmth or erythema (Orthopedics referral indicated).
Referral criteria for return to primary care
Resolution of symptoms
If persistence of anterior knee pain > 6-12 months, without concerning symptoms as described above, consider permanent profiling with patient specific limitations.
