Anterior Knee Pain Syndrome

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Dr Kau Chung Yuan (许医生)


MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)


What is Anterior Knee Pain Syndrome?

Anterior Knee Pain Syndrome, also known as patellofemoral pain syndrome, manifests as a diffuse, aching pain, often exacerbated by knee bending, and affects the front of the knee, around the patella or kneecap.

While it is pervasive among athletes, especially those engaged in sports that put considerable stress on the knees, it can affect individuals of any activity level.

Causes of Anterior Knee Pain Syndrome

  • Malalignment of the Patella
    Improper alignment of the patella within its trochlear groove can lead to increased stress on the knee joint, contributing to pain.
  • Imbalance in Thigh Muscle Strength
    Weakness or imbalance between the quadriceps muscles can affect patellar tracking, causing the patella to move laterally or tilt, which may lead to pain.
  • Overuse or Excessive Training
    Repetitive stress on the knee joint from high-intensity or high-volume training can overwhelm the patellofemoral joint, leading to inflammation and pain.
  • Poor Foot Mechanics
    Abnormal foot biomechanics, such as overpronation, can alter lower limb alignment, impacting knee mechanics and contributing to the development of anterior knee pain.

Symptoms of Anterior Knee Pain Syndrome

Individuals with Anterior Knee Pain Syndrome may experience a range of symptoms, typically centred around discomfort in the front of the knee. Key symptoms include:

Pain in the Front of the Knee

The hallmark symptom is diffuse, aching pain around the patella, especially noticeable during activities that involve knee flexion.

Swelling Around the Patella

Some individuals may notice mild swelling in the knee area, although this is not always present.

Grinding or Clicking Sensations

Movements of the knee may be accompanied by sensations of grinding, clicking, or popping, which can indicate issues with patellar tracking.

Pain After Prolonged Sitting

The condition is sometimes referred to as the “theatre sign” or “movie-goer’s knee” due to discomfort arising after sitting for long durations with the knee bent.

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Diagnosis of Anterior Knee Pain Syndrome

  • Patient History
    A detailed account of the patient’s symptoms, activities, and any prior knee injuries is crucial. Clinicians often inquire about the onset, duration, and nature of the knee pain, as well as any activities or movements that exacerbate or alleviate the symptoms.
  • Physical Examination
    The examination focuses on assessing knee alignment, patellar tracking, and identifying any tenderness around the patella. The clinician may also evaluate the strength and flexibility of the muscles surrounding the knee, particularly the quadriceps and hamstrings.
  • Imaging and Functional Tests
    Imaging studies such as X-rays, MRI, or CT scans can help rule out other conditions, such as fractures, that may mimic the symptoms of Anterior Knee Pain Syndrome. Functional assessments, including squatting or stepping exercises, may be used to provoke symptoms and assess the biomechanics of the knee during movement.

Non-Surgical Treatment Options

  • Physical Therapy
    Physical therapy is a key component of non-surgical treatment, focusing on enhancing knee stability, increasing the flexibility of the muscles around the knee and the lower leg and improving the alignment and movement of the patella.
  • Rest and Activity Modification
    Reducing or modifying activities that exacerbate knee pain is crucial during the initial phase of treatment to allow inflammation to decrease.
  • Orthotic Devices
    Orthotic inserts may be recommended for individuals with foot biomechanics that contribute to their symptoms, aiming to correct foot alignment and reduce stress on the knee.
  • Knee Braces or Taping
    Knee braces or patellar taping can offer additional support, helping to maintain proper patellar alignment and potentially reducing symptoms.

Surgical Treatment Options

Realignment Procedures

Aimed at correcting the alignment of the patella to ensure it tracks correctly within its groove. Some examples are Lateral Release, Tibial Tubercle Transfer and trochleoplasty.


A minimally invasive surgery to address and repair any underlying issues within the knee joint, such as removing damaged tissue.


Dr. Kau Chung Yuan

MBBS (S’pore)

MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)

Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.

He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.

  • Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
  • Master of Medicine (Orthopaedics), Singapore (MMed) 2013
  • Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
  • Bachelor of Medicine and Surgery (MBBS, Singapore) 2004

Preventative Measures

These measures focus on minimizing stress on the knee and improving lower limb mechanics to prevent the onset or exacerbation of symptoms. Key strategies include:

Adequate Warm-up and Cool-down
  • Dynamic Stretching: Prepares the muscles and joints for activity.
  • Cool-down Exercises: Post-exercise stretching to reduce muscle tightness and aid recovery.
Gradual Increase in Training Intensity

Avoid sudden increases in activity levels, which can place excessive stress on the knee. Gradually building up intensity and duration is essential.

Proper Footwear

Shoes that provide adequate support and cushioning can help in maintaining proper foot alignment and reducing impact on the knee.

Posture and Ergonomics

Awareness of knee positioning during daily activities and sports can prevent unnecessary stress on the patellofemoral joint.

Listening to the Body

Recognizing early signs of knee discomfort and adjusting activities accordingly can prevent minor issues from becoming serious.

Patient Feedback

Ethan Chan
Dr. Kau is an exemplary doctor who is experienced in his field and is very patient with his patients. He walked me through the details of my knee condition and addressed all my concerns. Thanks to Dr. Kau, I had a better understanding of my ACL and MCL injury and the various treatment options available. His advice and treatment have been very valuable to me.
Ming Lee Chua
Dr Kau was very careful and explained clearly the surgery procedures. After surgery, the care while I was in hospital was closely monitored and he even came during weekends! The hip so far has recovered and healed. His ‘predictions’ of when what can happen are so accurate. Trust him.
Teo Pek Suan Diana
I had a very successful total hip replacement done by Dr Kau 4 years ago. 4 months after the operation I was back walking, cycling and swimming. The beautiful job gave me much confidence Dr Kau is most professional and has such great doctor patient communication.

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    Frequently Asked Questions (FAQs)

    Can Anterior Knee Pain Syndrome be cured completely?

    While Anterior Knee Pain Syndrome can often be managed effectively with the right treatment and rehabilitation strategies, some individuals may experience recurrent symptoms, especially if underlying biomechanical issues are not fully addressed.

    How long does it take to recover from Anterior Knee Pain Syndrome?

    Recovery time varies depending on the severity of the condition and the individual’s adherence to their treatment plan. Many patients begin to see improvement within a few weeks of starting treatment, but it can take several months for symptoms to resolve fully.

    Can Anterior Knee Pain Syndrome lead to long-term damage if left untreated?

    While Anterior Knee Pain Syndrome itself does not typically lead to long-term joint damage, chronic pain and dysfunction can impact quality of life and physical activity levels. Untreated, it may predispose individuals to other knee problems due to altered gait and compensatory mechanisms.

    Can Anterior Knee Pain Syndrome occur in both knees simultaneously?

    Yes, Anterior Knee Pain Syndrome can affect both knees simultaneously, especially in individuals who engage in activities that place equal stress on both legs, such as running, cycling, or certain types of athletic training. Bilateral symptoms may also indicate underlying biomechanical or alignment issues affecting both lower limbs.