Anterior knee pain is a generic description for various causes of pain in the patellofemoral joint of the knee. Like the term chondromalacia patella, it is a generic term which does not give any specifics about the anatomic structures which are involved in the joint pathology.

The majority causes of anterior knee pain are due to an imbalance between the quadriceps musculature, which is usually weak, and the hamstring musculature, which is usually caused by tight hamstrings. The resultant increased stress on the anterior knee structures, combined with a less than ideally balanced quadriceps musculature, causes irritation of several anterior knee structures which can cause pain and dysfunction.

The most common cause of pain over the anterior aspect of the knee are suprapatellar plical irritation, bursitis at the hamstring attachment areas (pes anserine bursitis, semimembranosis bursitis, or biceps-femoris bursitis), pain around the patellar tendon mechanism secondary to tight hamstrings (patellar tendonitis, Osgood-Schlatter's irritation, or deep infrapatellar bursitis), scar tissue secondary to injury or previous surgeries (fat pad fibrosis or other scar tissue), and pain and inflammation due to localized or generalized arthritis of the patellofemoral joint.

In addition, lateral patellar subluxation or dislocations due to trauma, malalignment, or muscle imbalance may contribute to irritation of the anterior knee structures. Medial patellar subluxation can also occur, but is usually due to an overzealous lateral release, with a resultant medial patellar subluxation in the initial 0 to 35º arc of the knee.

The ususal treatment for patellofemoral dysfunction problems is a trial of exercise. This usually consists of closed chain quadriceps exercises combined with hamstring stretching and other exercises indicated by what is found in the physical exam. On occasion, a trial of braces or McConnell taping may be indicated to assist with a treatment of this problem. The majority of patients who have pain with the anterior knee structures usually will respond to this type of physical therapy or exercise regiment. In those that don't, a re-evaluation is necessary to determine if a change in therapy or operative methods can alleviate the problem.