Knee cap pain and Hoffa’s Syndrome

There are lots of causes of pain at the front of the knee, and these are different for people of different ages. It is one of the trickier parts of knee surgery to get right and it is a really common area where less specialist surgeons either get things wrong or give up and tell you to live with it, give up the sport or lose weight. This does not need to be the case, and I can nearly always help!

Why do I get pain at the front of my knee?

The shape of some peoples knees can make them more prone to pain around the kneecap. Us doctors like to call this anterior knee pain. Everyone’s knees are different shapes and sizes and some shapes leave you prone to problems. If the kneecap is too high, too low, lies more towards the outside of the knee, or if you have ‘knock knees’ or crooked knees (valgus knees) then kneecap problems are more common.

What does it feel like?

You may have pain around the front of the knee. Going up and down stairs can often be very uncomfortable and difficult. Some people develop funny ways of coping with stairs. Down is often worse than up. Sitting for long periods of time can be painful (the so-called theatre-goers sign). The knee may swell. You may experience clicking and crunching from under the kneecap as you bend your knee. Kneeling can be really painful or impossible, and getting up from the floor can be tricky. When it is really bad people need crutches to walk.

What are the causes?

There are quite a lot of causes, and it is really common that people come to me after having seen loads of other doctors, physios etc. Part of the skill of being a really top knee surgeon is making the right diagnosis. Some of the more common things are:

-Damage to the cartilage on the knee cap or the kneecap groove (we call this chondromalacia patella)

-Kneecap arthritis (patellofemoral arthritis)

-Hoffa’s Syndrome or fatpad impingment

-Runners knee (patellar tendinits)

-Inflamed plica

Some nonsense diagnoses you may be given by doctors and physios who are a bit misguided maybe things like ‘maltracking knees’ ‘squinting knees’ and ‘anterior knee pain’. These things are not actual diagnoses this is just the specialist tell you what you told them! If you are being told this, then find a new specialist!

What can I do to help?

I will listen to you first. Then I’ll do a careful physical examination. We may need a series of x-rays or an MRI scan and this will usually confirm the diagnosis. Sometimes physiotherapy to improve the muscles around the knee, particularly the VMO muscle, can help. Injections into the knee can be useful for some of the possible causes. Keyhole surgery (arthroscopy) can be helpful to tidy up the worn cartilage.

What if it is arthritis?

For severe kneecap arthritis, knee replacement (arthroplasty) may be required. There is a choice between replacing just the kneecap joint, or the whole knee joint. This is a complicated decision, and is best discussed with me. Kneecap joint replacements tend to perform better, but last less time than total knee replacement, so the decision should be weighed up against many factors like your age and what you want to do with the knee.

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Frequently asked questions

Yes! There are a lot of people around who have had old fashioned surgery or bad surgery (especially something called a lateral release) and ended up worse a few years later. It is tough to deal with this and some damage can't be undone, but I can nearly always help somehow.

This is a common story for me and I see people from all over the world in your situation. With careful listening and scientific approach, I can usually get to the bottom of things and I can get you better!

Yes, that is where I do video consultations and can usually get the diagnosis from afar and make some recommendations. This should get you on the mend.