Aetiology
- Patellofemoral pain syndrome
- Osgood-Schlatter disease
- Sinding-Larsen-Johansson disease
- Patellar instability and maltracking
- Osteochondritis dissecans
- Symptomatic bipartite patella
- Discoid meniscus
- Synovial plica
- Patellar tendinopathy in older adolescents
Clinical Features
- Activity related pain with stairs, squatting, kneeling or prolonged sitting
- Point tenderness at the tibial tubercle or inferior patellar pole suggests apophysitis
- Apprehension and J sign suggest instability
- Effusion or mechanical symptoms suggest intra articular pathology
- Rotational profile and limb alignment on examination
- Hip examination in every child with knee pain
- Red flags are night pain, rest pain, fever and constitutional symptoms
- Restricted hip rotation suggests hip pathology
- Pain out of proportion with allodynia suggests CRPS
Investigations
- AP, lateral and skyline radiographs
- Hip radiographs if hip examination abnormal or pain referred
- MRI for suspected OCD, meniscal injury or instability
- Bloods if infection, inflammatory arthritis or malignancy suspected
Differential Diagnosis
- Referred hip pain from SCFE or Perthes disease
- Bone tumour, including osteosarcoma of distal femur or proximal tibia
- Osteomyelitis and septic arthritis
- Juvenile idiopathic arthritis
- CRPS
Management
- Treat the specific cause
- Patellofemoral pain, quadriceps and hip strengthening with load management
- Apophysitis, activity modification and stretching, settles with maturity
- Taping or bracing as adjuncts
- Surgery only for structural lesions such as unstable OCD or recurrent instability
- Avoid surgery for nonspecific patellofemoral pain
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.