Female runner holding sore knee

What’s the issue with a diagnosis of runner’s knee? Jim Newman explains.

Runner’s knee is a condition lots of people get, and which you see most often in young women. You don’t have to be a runner to get it. In fact, often the activity levels seem to bear little relation to who has the condition. That’s why its correct name of chondromalacia patellae (CMP for short) is a better term.

Even CMP, however, is a frustratingly vague umbrella description. It can cover a range of diagnoses – some of which require surgical intervention but most of which don’t – and it typically describes a softening of the cartilage underneath the patella (kneecap).

An even more accurate description, although still rather vague, is ‘anterior knee pain’. It’s more appropriate because there are lots of potential mechanical problems that can cause pain at the back of the kneecap. One of those is CMP but it’s hardly the only one.

The problem is that when everyone opts for the convenient catch-all diagnosis of CMP or runner’s knee, there’s a danger that you miss what’s really happening. You certainly don’t want someone running on a severe meniscal tear having been told it’s the considerably less troublesome CMP.

Diagnosing anterior knee pain

So having established that anterior knee pain needs its more sinister possibilities excluding before you settle on a diagnosis, what symptoms might indicate CMP?

Well, in addition to pain around or at the back of the patella, you might also spot a patella which tracks unusually. It might tilt to the outside and when you bend your knee it will appear to track almost in a J shape. This is often an alignment and muscle balance problem and whilst it’s very difficult to treat (there’s rarely a quick surgical fix) physio is likely to help.

Shoe inserts could help address flat feet, as could something as simple as properly warming up and down before and after activity. And if you are a runner, it’s worth having your gait analysed to see how your heel lands because if the alignment is poor – if the ankle turns in or out – it will place resultant stress on the knee which can result in anterior knee pain.

As you’ll gather from these various possibilities, pinning down the precise cause of runner’s knee isn’t easy, and a patient’s description of the pain and their everyday activities is likely to be as essential to narrowing down the options as anything else.

What is essential, however, is eliminating far more damaging diagnoses from the equation. If you have persistent undiagnosed knee pain, we’d love to help give it a full and proper diagnosis. To find out more, please get in touch.

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James Newman

James Newman

Consultant Knee Surgeon at the Yorkshire Knee Clinic

“Mr Newman? He’s a genius in my eyes.”

Glen Jackson, YKC patient

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