Knee Pain (Anterior)
Knee pain localized to the anterior portion of the knee, either retropatellar or peripatellar. Usually a gradual, non-traumatic onset aggravated with increased activity, running, squatting, stair climbing or prolonged sitting. Symptoms normally decrease with rest.
Initial Diagnosis and Management
- History and physical examination
- Plain films not required
- Adults - 200 to 400 milligrams (mg) every four to six hours as needed for up to 2 weeks. Example: Ibuprofen
- Take tablet or capsule forms of these medicines with a full glass (8 ounces) of water.
- Do not lie down for about 15 to 30 minutes after taking the medicine. This helps to prevent irritation that may lead to trouble in swallowing.
- To lessen stomach upset, these medicines should be taken with food or an antacid.
- Avoidance of aggravating activities (profile for active duty soldiers)
- Strengthening exercises for quadriceps, stretching exercises for quads, hamstrings and calf muscle
- Ice PRN after activities
- Compression wrap is contraindicated
- Patient Education
- Please refer to the Clinical standard on knee pain.
Ongoing Management and Objectives
- Resolution or decreasing symptoms in three to four weeks
- If no resolution:
- Trial of alternate NSAID
- Trial of neoprene sleeve with patella opening
- Obtain plain films with sunrise views
- Do not order an MRI. Orthopedic clinic will order, or recommend, if patient meets pre-surgery criteria
Indication a profile is needed
- Any limitations that affect strength, range of movement, and efficiency of feet, legs, lower back and pelvic girdle.
- Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent moderate marching, climbing, timed walking, or prolonged effect.
- Defects or impairments that require significant restriction of use.
Specifications for the profile
- Months 1-3
- No running, jumping, marching, squatting.
- Months 4-6
- Gradual transition into own pace and distance
Patient/Soldier Education or Self care Information
- See attached sheet
- Demonstrate deficits that exist
- Describe/show soldier his/her limitations
- Explain injury and treatment methods
- Use diagram attached to describe injury, location and treatment.
- Instruct and demonstrate rehab techniques
- Demonstrate rehab exercises as shown in attached guide
- Warm up before any sports activity
- Participate in a conditioning program to build muscle strength
- Do stretching exercises daily
- Ask the patient to demonstrate newly learned techniques and repeat any other instructions.
- Fine tune patient technique
- Correct any incorrect ROM/stretching demonstrations or instructions by repeating and demonstrating information or exercise correctly.
- Encourage questions
- Ask soldier if he or she has any questions
- Give supplements such as handouts
- Schedule follow up visit with Primary Care
- If pain persists
- The pain does not improve as expected
- Patient is having difficulty after three days of injury
- Increased pain or swelling after the first three days
- Patient has any questions regarding care
Indications for Specialty Care Referral
- History of joint locking and giving way
- Question of underlying instability
- Prolonged effusion > 10 to 14 days
- R/O fractures, septic joints, rheumatoid arthritis, etc. should be referred to appropriate specialty clinic (Orthopedics or Rheumatology)
- Refer to Physical Therapy if none of the above but progression of atrophy or persistent symptoms despite initial management.
- Completed full course of rehabilitation and have any of the following concerning symptoms: catching, locking, effusions, instability, warmth or erythema (Orthopedics referral indicated).
Criteria for Return to Primary Care
- Resolution of symptoms
- If persistence of anterior knee pain > 6-12 months, without concerning symptoms as described above, consider permanent profiling with patient specific limitations.
- If meets criteria for P3 profile, referral to MAMC MEB section for MEB is appropriate. MEB can be initiated by primary care.