Why Do I Have Pain Under My Knee Cap?Pain under the knee cap, or patellofemoral pain, is a common issue I see. Learn more about this condition, the issues involved, and treatment options in this video. What does it mean if you have pain underneath your kneecap, and what can you do about it? Pain underneath the kneecap, also known as patellofemoral joint pain, is frequently described as pain underneath the kneecap, in front of the knee, around the knee as well. It's typically pain that's worse with prolonged standing, as well as if you're going up and down stairs. The patellofemoral joint is the articulation between the patella, also known as the kneecap, and the femur, the thigh bone. The structures that are involved there include the cartilage in between those two structures. Generally, there's not very much fluid within that knee joint. There's a normal alignment where the kneecap fits in the middle of the femur, along the trochlear groove. There are a number of soft tissue structures that are very key as well, including the ligaments, such as the medial patellofemoral ligament, lateral patellofemoral ligament, as well as the plica, that help to stabilize the lateral, or right and left motion of the kneecap. There's also the quadriceps tendon and the patellar tendon above and below the knee that help to stabilize the kneecap as well. It's also important to remember that the structures above and below the knee make a big difference in terms of what happens in the knee as well. So that would include at the ankle, the hip, and the lower back as well. When there's pathology or dysfunction in the patellofemoral joint, people are frequently complaining of pain in front of the knee, behind the knee, and around the knee. They frequently also describe swelling. Those symptoms, as well as classic examination findings, help to make a diagnosis of patellofemoral pain. Classic examination findings include the patellar compression test, where you compress the patella and have an individual contract their quadricep, and if they have significant pain, that can indicate that they have patellofemoral-related pain. Imaging can make a big difference as well. X-rays can show whether the kneecap is properly aligned within the knee groove. In addition, it can also show if there is significant narrowing within the patellofemoral joint. Diagnostic musculoskeletal ultrasound is also helpful for looking for alignment. It's also very helpful for telling if there's any significant instability within the joint. You can also detect very small amounts of fluid that people may not actually be complaining of. MRIs are generally not to make this diagnosis. However, you can find swelling in the bone, also known as a bone marrow lesion, that can be seen if there's significant stress within the patellofemoral joint. Treatment for patellofemoral-related pain includes a number of different things. First and foremost, weight loss and ideal body weight can make a big difference. As much as possible as you can reduce excess body weight will help to reduce stress on the knee as well. Alignment is a big part of helping with knee pain as well, in particular, patellofemoral pain. Bracing, knee bracing can be helpful in that regard. Also in that regard, instability and alignment can also be improved with physical therapy. Strengthening the appropriate muscles of not only the thigh but also of the hip, can make a big difference as well in terms of patellofemoral-related pain. I frequently recommend over-the-counter supplements such as glucosamine, omega-3, and curcumin for knee related pain in general. That can certainly be helpful in patellofemoral-related pain also. There are a number of different types of injections that can be helpful for patellofemoral-related knee pain. Steroid injections are most commonly given. It can give pain relief. Typically does not give longer term pain relief. It's also not also very helpful and healthy for the joint long-term, so I generally try to get people to avoid that if possible. Hyaluronic acid injections can be useful for pain relief, in particular, if somebody has mild to moderate osteoarthritis. Dextrose prolotherapy is the first-line regenerative medicine treatment that's helpful for mild to moderate patellofemoral osteoarthritis. It can help with not only pain but also instability due to hypermobility and chronic instability in the knee cap and the knee joint. Platelet-rich plasma is also helpful for moderate level osteoarthritis in the knee. Bone marrow derived stem cells are also helpful for more moderate to advanced level knee osteoarthritis and patellofemoral osteoarthritis. And also consider radiofrequency ablation, where you're basically treating the nerves that cause pain around the knee as well. The results to expect from these sorts of injection treatments generally include pain relief and functional improvement and getting back to a high quality of life. It's not necessarily going to significantly improve what your imaging looks like on x-ray, ultrasound, or MRI. But if your goals are to feel better and to live a better lifestyle, then these kind of treatments can certainly make a big difference. Surgery is generally not recommended for patellofemoral knee pain. Certainly arthroscopy does not make sense if you have knee pain from patellofemoral osteoarthritis in large part because there's no evidence that it will actually help in terms of longer lasting pain relief in comparison to just physical therapy. Knee replacement, however, may be needed if you're failing the above treatments that I've already mentioned. I hope that gives some explanation and understanding of what's going on if you have pain underneath the kneecap. 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