Often people feel pain on the front side of the knee, mostly when walking up and down stairs. They often go to the doctor for this reason. They are told that it is “osteoarthritis”, “osteophytes of the knee”, “chondromalacia of the patella” and other names. Is this really the case? Actually, it is not. The one thing that the aforementioned names have in common is that they are all bone causes. We know that the bone is persistent, so the pain should be persistent. But the reality is that the pain comes and goes, not persists, indicating that the pain has nothing to do with those names.
To figure out what exactly is causing it, you need to understand the structure of the anterior aspect of the knee and how it changes during movement.
The knee joint is made up of three bones. The femur is at the top, the tibia is at the bottom, and the patella is before the femur. The lower end of the femur is called the femoral condyle and there is a patellar surface depression in front between the two condyles. The patella lies in the depression. All three bones are wrapped together by the joint capsule. The joint capsule thickens on both sides of the patella to form the patellar support ligament. The quadriceps muscle continues downward from the femur into a tendon membrane that wraps around the front and sides of the patella and joins the joint capsule, then converges downward into a thick patellar tendon that attaches to the front of the upper tibia (at the tibial tuberosity). The surface of the patellar tendon is lined by the patellar tendon sheath. The patellar tendon is followed by a fatty bursa. The fascia on the surface of the quadriceps muscle also wraps downward around the knee joint and continues as the calf fascia. Beyond the fascia, the skin is wrapped. In other words, the patella is held in place and pulled by tendons and ligaments from above and below.
During deep knee flexion (deep squat), the quadriceps are elongated and the patella is pressed against the femoral condyles under the pull of the quadriceps, creating a static compression of the femoral condyles. In semi-flexed knee (sitting, semi-squatting), the state of static compression is unchanged. In the upright position, the pressure between the patella and the femur is minimal. During semi-flexed knee exertion (ascent, jumping), the patella forms a sliding compression on the femur due to muscle contraction.
Due to the large number of structures connected to the patella in the front of the knee, causing injury to any structure can result in pain in the front side of the knee.
The patella is the center of the anterior aspect of the knee. Tendons and fascia and patellar ligaments are attached to the patella and are most likely to be injured at the junction of the bone and attached soft tissue. This is the main cause of anterior knee pain.
According to the cause of knee injury, it can be divided into dynamic injury and resting injury.
A power injury is an injury that occurs during activity. Power injuries are seen in movements such as climbing, walking long distances, running and jumping. The patella is repeatedly and abruptly pulled by the quadriceps muscle, resulting in a pulling injury of the quadriceps tendon and patellar tendon at the attachment of the patella and a crushing impact injury of the patella on the femur.
A resting injury is an injury that occurs at rest. Resting injuries are seen in cases such as prolonged sitting on bent knees, prolonged cross-leggedness, and prolonged upright immobility. The patellar surface fascia forms a prolonged strain, as well as the continuous strain of the quadriceps tendon and patellar tendon at the patellar attachment, resulting in a fatiguing injury.
Whether the injury is dynamic or resting, the common feature is the stretching of the patella by the soft tissues. The patella is not stretched at will; the stress is applied at the point where the bone meets the attached soft tissue. The junction is fragile and can be easily injured. Since the patella moves up and down with the flexion and extension of the knee joint, the upper and lower extremities of the patella have the greatest chance of injury.
Small hematomas can develop in the area after the injury. This manifests itself in sensory (clinical) terms as pain. The hematoma resorbs, calcifies, and accumulates in the soft tissue attachments to form a bony scar. In this case, there is no sensory (clinical) pain, but only spike-like bone growths along the soft tissues on the x-ray. Although this spike-like bone growth is not painful, it increases the brittleness of the soft tissue attachment points and makes them more susceptible to injury. As the number of injuries (pain) increases, the redundant bone becomes more numerous and increases in size.
The patella is subjected to a sliding compression of the femur at the same time as the injury is stretched. The prolonged or repeated sliding compression leads to edema of the patellar articular surface and subarticular surface bone, which spreads to the anterior part of the patella, and the edema spreads to the fascia wrapping the patella in front, which manifests clinically as pain (symptomatic phase). The prolonged edema of the patella leads to fragmentation and necrosis of the patellofemoral articular surface. A bone scar is formed and the patella is deformed, at which point there is no sensory (clinical) pain (recovery period). The deformed patella is more prone to injury when stretched.
Now we can know that the pain on the anterior side of the knee is an injury to the soft tissues around the patella, not a cause of bone. The “patellar tenderness”, “osteophytes” and “osteoarthritis” are all scarring after the injury and do not cause pain.
According to the above reasoning, as long as the tissues around the patella are kept loose, the injury to the anterior aspect of the knee can be avoided and no pain in the anterior aspect of the knee will occur. This is the most effective treatment for anterior knee pain.
The treatment is so simple that no medication is needed. During the period of knee pain, simply keeping the knee in a pain-free position and moving as little as possible is the treatment.
This is done by not walking as much as possible (not one step) when there is painful pain in the front of the knee. Do not sit on low supports, such as sofas and small stools, and sit on a high stool. Sitting with the knee semi-extended (not straight). Do not stand for long periods of time and walk long distances. This method does not cost a penny, but it takes time. Usually five to ten days for pain relief. Three to four weeks the pain is completely gone. What if you don’t have time? Sorry – keep on hurting.
So what do I do? You can’t stop the knee from moving, can you?
Actually, there is a “degree” of control. Whether it is a dynamic or resting position, a mild knee pain is the “degree”. The soft tissues (fascia, tendons, ligaments) around the patella can be avoided and there will be no pain on the front side of the knee.
The following: avoid using plasters, massage, bruises, sprays, physiotherapy (heat therapy), closure, cupping, acupuncture, small needles, etc.. It will aggravate the pain and prolong the pain time.
Oral medication for pain relief can be used once before bedtime when pain affects sleep. They cannot be used the rest of the time (they will also prolong the pain).