Kneecap Tracking
Normal Anatomy
Patella slides smoothly in the center of the trochlear groove
Pathological / Affected Anatomy
Patella tracks laterally (off-center) causing increased pressure
Conditions
Patellofemoral Pain
Patellofemoral pain is a common clinical cause of anterior knee pain. This page covers contributing factors, symptoms, and non-surgical load management strategies.
On this page
What is Patellofemoral Pain?
Patellofemoral Pain Syndrome (PFPS) describes pain arising from the articulation between the kneecap (patella) and the groove on the thigh bone (femur). Wording is cautious: it is a complex, multi-factorial biomechanical issue, and oversimplified statements about alignment are avoided. Contributing factors include muscle weakness, training overload, and biomechanics. Suitable load management is the cornerstone of treatment.
This information is for general patient education and does not replace an individual clinical assessment.
Anatomical Overview
Anatomy Comparison
Healthy vs Affected Joint Comparison
Understanding structural differences caused by patellofemoral pain.
Comparison DiagramClinical ReferenceCartilage Loading
Normal Anatomy
Even pressure distribution under the patellar facets
Pathological / Affected Anatomy
Localized overloading and irritation of subpatellar cartilage
| Anatomical Feature | Normal Anatomy | Pathological / Affected Anatomy |
|---|---|---|
| Kneecap Tracking | Patella slides smoothly in the center of the trochlear groove | Patella tracks laterally (off-center) causing increased pressure |
| Cartilage Loading | Even pressure distribution under the patellar facets | Localized overloading and irritation of subpatellar cartilage |
Common symptoms
Symptoms vary, and similar symptoms can occur with other knee conditions. Commonly reported signs include:
Dull, aching pain behind or around the kneecap
Pain aggravated by activities that load the joint (climbing stairs, squatting, kneeling)
Discomfort after sitting with knees bent for long periods ('moviegoer's sign')
Creaking, clicking, or grinding sensations (crepitus) under the kneecap
Causes and associated factors
The development or onset of this condition can be associated with several mechanical, biological, and lifestyle factors, including:
- Repetitive overloading of the patellofemoral joint (running, jumping)
- Muscle imbalances, particularly quadriceps or hip stabilizer weakness
- Abnormal kneecap tracking or altered lower limb biomechanics (e.g., foot overpronation)
- Sudden increases in training volume or intensity
Urgent symptoms? Read urgent advice.Lincolnshire Knee Clinic does not provide emergency medical care. For life-threatening symptoms call 999. For urgent non-life-threatening advice use NHS 111.
Lincolnshire Knee Clinic does not provide emergency medical care. For life-threatening symptoms call 999. For urgent non-life-threatening advice use NHS 111.
Clinical assessment and diagnosis
A comprehensive clinical assessment is performed to understand the root cause of your symptoms and outline appropriate management options.
- Discussion of symptoms, training history, and exacerbating activities
- Physical examination checking patellar tracking, glide, and tenderness
- Assessment of hip abductor, quadriceps, and core muscle strength
- Evaluation of foot biomechanics and leg alignment
A diagnosis should not be made from website information alone.
Investigations
Imaging and other investigations may be recommended depending on clinical presentation. Common assessments include:
Standard X-rays
including skyline views) to check patellar tracking and alignmen
MRI scan to assess the articular cartilage lining the back of the kneecap in select cases
Indicated where clinically appropriate following assessment.
LKC Imaging Console v1.0
Status: clinically approved
Patella (Kneecap)
The kneecap protects the front of the joint and slides within the femoral groove.
Subpatellar Cartilage
Articular cartilage lining the back of the kneecap, which can experience increased stress or wear.
Trochlear Groove
The groove on the thigh bone (femur) that guides the kneecap during bending.
Patella (Kneecap)
The kneecap protects the front of the joint and slides within the femoral groove.
Subpatellar CartilagePathology
Articular cartilage lining the back of the kneecap, which can experience increased stress or wear.
Trochlear Groove
The groove on the thigh bone (femur) that guides the kneecap during bending.
Treatment options
We offer structured, staged treatment pathways, focusing on conservative and non-surgical approaches. Suitability depends on individual assessment.
A
Targeted physical therapy focusing on quadriceps and hip strength
Indicated where clinically appropriate.
Explore Treatment >B
Activity modification and structured load management
Indicated where clinically appropriate.
Explore Treatment >C
Patellar taping or bracing to support kneecap tracking
Indicated where clinically appropriate.
Explore Treatment >D
Orthotics to address foot biomechanics where appropriate
Indicated where clinically appropriate.
Explore Treatment >E
Simple anti-inflammatory pain relief in acute phases
Indicated where clinically appropriate.
Explore Treatment >Staged Clinical Pathway
Clinical Treatment Staged Pathway
Patient Education Pathway: This pathway diagram is for patient educational purposes only. It is not a diagnostic, triage, or clinical decision-making tool. Individual care options are determined dynamically following consultation.
When might surgery be considered?
Surgical intervention may be discussed when non-operative treatments do not provide sufficient relief, symptoms significantly restrict daily function or quality of life, and clinical and imaging findings correlate.
Lateral Release or alignment procedures in rare, selected cases failing rehab
Consultant orthopaedic procedure.
Choosing the right treatment
Decisions depend on a detailed diagnosis, symptom severity, patient goals, activity expectations, and general health history. We support shared decision-making, ensuring you fully understand the expected benefits, risks, and alternatives of each pathway.
Frequently Asked Questions
Only if overloaded. Appropriate, pain-free strengthening of the hips, glutes, and quadriceps is the primary cure and helps reduce joint stress.
No. It is primarily a clinical diagnosis, though an MRI can rule out cartilage defects if symptoms persist despite high-quality rehabilitation.
Aching or pain behind the kneecap after sitting for prolonged periods with bent knees, typical of patellofemoral pain.
It often requires structured biomechanical rehab to correct imbalances, modify training loads, and manage joint loading.
Yes, taping or bracing can temporarily support patellar tracking and reduce pain during exercises, facilitating rehab.
Usually only required for private insurance authorization; self-paying patients can book directly.
Clinically Reviewed
Mr Ricardo J Pacheco (GMC 4145976)Consultant Trauma & Orthopaedic Surgeon
Last reviewed: 29 July 2026
- Sussex Community NHS Foundation Trust — Patellofemoral Pain Syndrome
- Whittington Health NHS Trust — Patellofemoral Pain Syndrome (PFPS)
- Best practice guide for patellofemoral pain based on synthesis of a ... (bjsm.bmj.com)
- Patellofemoral Pain (ifspt.org)
- Patellofemoral pain: an update on diagnostic and treatment options (pmc.ncbi.nlm.nih.gov)
- Patellofemoral pain syndrome (sfh-tr.nhs.uk)
- Knee Pain due to Patellofemoral Disorders & Treatments (hss.edu)
- Patellofemoral Pain Syndrome (MSK Patient Portal) (nhsaaa.net)
Would you like an individual knee assessment?
A consultation can help clarify the cause of your symptoms and discuss appropriate treatment options.
Face-to-face appointments are arranged through the reception team at the chosen clinic. Video consultations use Google Calendar where available.
Continue Your Knee Journey
Explore Treatments→Next Step: Explore Treatment Options
Treatment pathways range from physiotherapy and bracing to injections or surgical procedures, tailored to your symptoms, diagnosis, and physical goals.
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Medical Disclaimer
This website provides educational and general information about knee symptoms, conditions, and treatments. The content is for informational purposes only and does not constitute medical advice, diagnosis, or a treatment plan. It should not be used as a substitute for a professional consultation, examination, or clinical decision-making by a qualified orthopaedic specialist.
If you are experiencing symptoms or are concerned about a knee problem, please arrange a clinical consultation. If you have urgent symptoms, severe pain, or are unable to put weight on your leg, please read our urgent advice guidance or contact emergency services immediately (dial 999 or NHS 111).