Adolescent Anterior Knee Pain

A great many physicians believe that anterior knee pain cannot be broken down into its component pathologic processes. This is incorrect. If one knows the sites that are capable of generating pain and knows how to test those sites, localizing the involved sites is not difficult. It is more work to learn which pathologic processes occur in clusters and why each process evolves. Treatment begins to make sense and, perhaps even more important, the failure of certain treatments begins to make sense. A stepwise approach to obtaining the right history followed by an examination that identifies the sites of pain leads to appropriate diagnoses. Usually, adolescent anterior knee pain turns out to be Sinding-Larsen-Johansson, Osgood-Schlatter, patellofemoral, fat pad, or plica syndrome or a combination of these syndromes. Other syndromes are less common. Treatment frequently requires reducing or redistributing patellofemoral joint reactive forces by one or more of several techniques.