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Anatomical Considerations for Knee Cap Pain for Raleigh, Durham, Chapel Hill, Garner and other Triangle Patients

The patella-femoral, or kneecap joint is a specific section of the entire knee joint composed of the patella (kneecap) and the femur (thigh bone).The quadriceps, (thigh muscle) tendon inserts into the patella at the top and the patella tendon runs from the bottom of the patella to the tibia. The kneecap moves in a groove in the femur called the femoral groove. The patella and femoral groove are lined by  articular cartilage, the smooth lining of the surfaces of joints.

Pain emanating from this joint is a very common in all ages. It can occur for no apparent reason or can result from a specific injury such as a direct blow or twisting injury. Pain can be resistant to all forms of treatment and can recur many years following initial onset.

Particular problems located at the patello-femoral joint include:

The patella dislocation (complete slipping out of joint)

The patella subluxation (partial slipping out of joint)

Malalignment tracking syndrome - kneecap does not move in the groove as it mechanically should. This leads to abnormal stresses and results in abnormal wear, pain, and dysfunction in the area.

Fracture (breaking the bone)

Arthritis (abnormal wearing or pitting of the underneath surface of both the kneecap and femoral groove

Patella tendonitis - specific location of inflammation of the tendon just below the patella

Knee Cap Pain Symptoms include:

• Front (Anterior) knee cap pain usually more intense ascending and descending stairs or prolonged periods of sitting, or squatting or kneeling
• Clicking or grinding (crepitus) within the knee
• Locking or the feeling that the knee cannot move
• Giving way
• Swelling

Knee Cap Pain - Malalignment

The kneecap does not always move normally in the groove. Abnormal sliding is known as malalignment and can result in knee cap pain. This can often be the result of a high riding or small patella, abnormal alignment of the leg, tight structures on the outer aspect of the knee or weak structures on the inner aspect. The surrounding muscles are vital to the normal active tracking of the patella and weakness of the quadricep muscles or muscle imbalance in one or lack of flexibility and overtightening of another can lead to abnormal tracking. It is for this reason that physical therapy plays such an important role in the treatment of this disorder.

Diagnosis of Knee Cap Pain

Determining the location and extent of knee cap pain is based on history and examination and assisted by diagnostic investigations.

Examination includes looking at the overall alignment of the limb, assessing tracking and position of the patella, feeling for areas of tenderness around the tendons or articular cartilage, tightness of soft tissue structures and strength/flexibility of surrounding muscles.

Investigations may include X-rays as well as MRI scans .These can help identify any malalignment damage to the joint surfaces.

Knee Cap Pain Treatment

A majority of time treatment of knee cap pain is non operative and is based around re-establishing the normal tracking of the patella within its groove.

Physical therapy plays a key role in this assisting with;

Relief of acute knee cap pain.
Muscle strengthening exercises (especially the quadricep muscles).
Hamstring and Iliotibial band stretching.
Taping or bracing.

As a last option surgery can be helpful if conservative management has failed. It is especially useful if there is mechanical catching or locking within the knee.

Knee Cap Pain -Surgical Intervention

Knee Cap Pain Surgery options are  as follows:
Arthroscopy to debride any cartilage flaps.

Lateral retinacular release which results in the lengthening of tight structures on the lateral aspect of the patella to help with tracking. This is done arthroscopically.

Extensive realignment procedure which involves a larger incision and repositioning muscle and ligaments to improve the tracking of the patella

Patellofemoral replacement.(much less common and performed in the event of a severely arthritic or traumatized kneecap from traumatic injury)

These knee cap pain procedures have a reasonable chance of success in the right surgical candidate but should only be attempted after a prolonged period of conservative treatment has failed.

Results are not as predictable as with other procedures on the knee and surgery may not be successful in some cases for Garner, Wake Forest, Chapel Hill and other Triangle patients.

For more information on how the knee cap pain specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC.