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Anterior Lateral Knee Pain: All You Need to Know

According to the American Academy of Family Physicians, nearly 25% of Americans experience knee pain with anterior lateral knee pain being the most common presenting complaint (1). The knee is a complex joint and knee pain in the anterior lateral region occurs due to many reasons.

We’ll talk about what causes anterior lateral knee pain, what are the treatment options and when to see your doctor.

What is Anterior Lateral Knee Pain?

The knee joint is one of the most complex joints of the human body. The femur, the tibia, patella, and fibula all contribute to this joint. They are held together by a myriad of strong ligaments that stabilize and support the joint.

Anterior lateral knee pain is pain that occurs in the anterior and the anterior lateral region of the knee joint. A person may experience this pain front and center, in the outer aspect of the knee, or diffusely throughout the joint. The cause of the pain is some pathology in the anterior and lateral aspect of the knee.

Symptoms of Knee Pain In The Anterior Lateral Knee/ Symptoms of Anterior Lateral Knee Pain

Anterior lateral knee pain is a very broad term. Often, individuals may experience various symptoms along with pain in the anterior lateral region of the knee. They may see any of the following symptoms:

Pain And Swelling In The Knee

Anterior lateral knee pain is very characteristic. While the pain may be sharp or dull, it is exacerbated by certain movements of the knee. For example, climbing a flight of stairs, sitting, standing, and kneeling will worsen the pain. Similarly, exercises like squats or lunges will increase knee pain in the anterior lateral region of the joint.

Any movement that prompts flexion of the knee translates to increased load and this produces pain. The pain may be accompanied by swelling. In cases where the injury is sudden and acute, anterior lateral knee pain is accompanied by swelling in the knee joint as well. The knee joint is warm and tender to touch.

Knee Instability

Various injuries and pathologies affecting the anterior lateral knee make the joint unstable. People may experience a popping or cracking before the knee “gives way.” Others experience a grinding sensation within the joint. Some individuals can even pop the knee back into place. All these symptoms indicate an unstable knee joint.

Stiffness And Bruising of The Knee

Anterior lateral knee pain may also be accompanied by joint stiffness. The knee may not bend or flex smoothly. The motion of the knee is limited and can affect the daily activities of a person. This joint stiffness can be persistent. It may also be more pronounced after a period of inactivity. Bruises on the surface of the joint may or may not be present.

Locking Of Knee

The locking of the knee joint is where the knee becomes fixed. In certain conditions like a meniscus tear, the knee joint cannot bend. This is not a truly locked knee where the knee joint is fixed but rather a pseudo locking where anterior lateral knee pain prevents knee flexion.

Common Causes of Pain In The Anterior Lateral Knee

There are many causes of anterior lateral knee pain. These could be due to the pathology of the ligaments, muscles, menisci, and patella in the anterior and lateral aspects of the knee joint.

Lateral Collateral Ligament (LCL) Injury

The lateral collateral ligament or the fibular ligament originates from the outside of the epicondyle of the femur and inserts into the head of the fibula. Its main purpose is to prevent abnormal extension of the knee. It acts as a stabilizer of the knee joint. Any trauma, injury, or sudden blow from the inside of the knee can injure the lateral collateral ligament.

High contact sports like football, tennis, and gymnastics which require high velocity jumping and pivoting can injure the LCL leading to lateral knee pain. 40% of all LCL injuries come from contact sports while the remainder occurs due to trauma, vehicular accidents, and falls (2).

Iliotibial Band Syndrome

Iliotibial Band Syndrome is one of the main causes of lateral knee pain. The iliotibial band (ITB) is the fascial continuation of the gluteal muscles. It functions as a knee flexor and knee extensor based on the degree of flexion. Repetitive friction of the ITB on the lateral epicondyle of the femur can lead to inflammation.

Mountain running, abrupt changes in the intensity of training, and erroneous running techniques can increase the tension of the ITB and lead to lateral knee pain. ITBS is very common among runners and cyclists but is also seen in other repetitive motion athletes like skiing and weightlifters.

Lateral Meniscus Tear

The lateral meniscus is a crescent-shaped fibrocartilaginous structure that lies between the tibia and the femur. It acts as a shock absorber and load transmitter across the knee joint. Tears to the lateral meniscus occur when the knee is forcefully twisted while the foot is still planted on the ground.

Isolated lateral meniscus tears also occur when there is an increased load on the knee while squatting, a sudden change of direction, or movements that require rapid acceleration and deceleration. Lateral meniscal tears cause intense lateral knee pain.

Osteoarthritis

Osteoarthritis also causes anterior lateral knee pain, particularly patellofemoral arthritis. Here the loss of the patellar cartilage due to wear and tear leads to degenerative arthritis.

The lateral patellar facet experiences more wear over the years and any additional load due to obesity, inflammation and even microtrauma can accelerate osteoarthritis leading to lateral knee pain. Often, people with osteoarthritis find that the pain is aggravated by activity and relieved with rest. It is also accompanied by morning stiffness that dissipates with activity over the day.

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain. It is very commonly seen in runners and climbers. While PFPS is understood to be multifactorial, studies have shown that four factors contribute to this condition (3). This includes malalignment of the patella, muscular imbalance, overactivity/overload, and trauma.

The majority of people with this condition tend to be multisport athletes who overuse or overload the patellofemoral joint.

Patellar tendonitis

Jumper’s knee or patellar tendonitis is another cause of anterior knee pain. Repeated stress on the patellar tendons leads to shearing of the tendon fibers or microtears. As the stress accumulates, the tendon experiences inflammation.

This is common among athletes of jumping sports where there is high eccentric loading of the quadriceps muscles. The injury worsens faster if there is insufficient rest between these periods of jumping which prevents the healing of the microtears. Common sports causing this tendonitis include volleyball, basketball, long and high jumping.

Deeper Dive Into The Associated Conditions

Chondromalacia

Chondromalacia is the knee usually causes pain, typically around the kneecap or deep in the kneecap. You can also have some grinding sensations or crepitus which are sounds and noises coming from around the knee with certain motions. Typically, pain and grinding sensations are worse with bending the knee, especially for prolonged periods of time, kneeling on the knee, walking downstairs, or running downhill. Standing after prolonged sitting or an immobility period where the knee is bent can cause some discomfort as well. Some people may experience swelling, others may experience locking or catching in the knee, feeling the knee wants to give out, or a feeling of weakness….

Read More About Chondromalacia

Iliotibial Band Syndrome (ITB)

Also known as “IT Band Syndrome” also known as “ITB Syndrome,” iliotibial band syndrome is a painful medical condition that affects the lateral hip, leg, and knee. It can affect individuals of all ages and most often is caused by repetitive activities like running, cycling, hiking, and walking. Your iliotibial band is a thick band of connective tissue that runs from the outside of your hip down to the outside aspect of your knee. Its principal function is to stabilize the hip and knee. If it becomes tight and dysfunctional, you may experience pain along with this band of tissue due to strain or inflammation. You may also experience pain, limited range of motion in…

Read More About Iliotibial Band Syndrome (ITB)

Knee Arthritis

In the human body, a joint is simply where 2 ends of bone come together. At the ends of these bones, there is a thick substance called “Hyaline Cartilage” that lines the ends. Hyaline cartilage is extremely slippery which allows the two ends of the bone to slide on top of each other. Then there is a capsule that connects the two ends filled with “synovial fluid” that acts as a further lubricant to make it more slippery! Arthritis in the knee is defined by loss of the hyaline cartilage plus other changes that happen to the bone such as additional bone being laid down (bone spurs/osteophytes). The cartilage layer is worn down to the point of exposing the underlying bone they cover…

Read More About Knee Arthritis

LCL Sprain

What is an LCL Sprain? A strain or tear to the lateral collateral ligament (LCL) is known as an LCL injury. The LCL is a band of tissue that runs along the outer side of your knee. It aids in keeping the bones together while you walk, ensuring that your knee joint remains stable. How you feel and what type of treatment you’ll require depends on how severely your LCL has been stretched or torn. If it’s only a minor sprain, self-care at home might help. However, if it’s a significant tear or sprain, you may need physical therapy, an injection-based procedure, or surgery….

Read More About LCL Sprain

LCL Tear

A strain or tear to the lateral collateral ligament (LCL) is known as an LCL injury. The LCL is a band of tissue that runs along the outer side of your knee. It aids in keeping the bones together while you walk, ensuring that your knee joint remains stable. How you feel and what type of treatment you’ll require depends on how severely your LCL has been stretched or torn. If it’s only a minor sprain, self-care at home might help. However, if it’s a significant tear, you may need physical therapy, an injection-based procedure, or surgery. Orthopedists categorize LCL tears into 3 grades…

Read More About LCL Tear

Meniscus Tears

The meniscus is a c-shaped piece of cartilage in the knee that functions as an important shock absorber. It is sandwiched between the thigh and shin bone. There are two menisci per knee. One on the inside portion of the knee (medial) one on the outside aspect (lateral). The knee meniscus is susceptible to injury. The most common injury is a tear in the meniscus. Not all meniscus tears however cause pain. When symptomatic a meniscus tear can cause pain, swelling, and restriction in range of motion. Tears in the knee meniscus can arise from trauma or degeneration. There are many different types of meniscus tears based upon locations….

Read More About Meniscus Tears

Patellar Tendon Tear

The Patellar tendon is the thick connective tissue that starts at the base of the kneecap (Patella) and extends down to the shin.  The is an extension of the Quadriceps tendon (1).  The Quadricep is the large thick muscle that is often referred to as our thigh. The Patellar tendon works together with the Quadriceps muscle to straighten (extend) the knee. It is easy to touch your Patellar tendon as it is immediately below the knee cap. There are many different causes of Patellar tendon tears.  Patellar tendon tears are a common sport injury but can also occur from overuse or a motor vehicle injury…

Read More About Patellar Tendon Tear

Patellar Tendonitis

What is the Patellar Tendon? A tendon is a piece of connective tissue that connects muscle to bone. It serves to move the bone or a given joint. The patellar tendon is a major tendon in the knee. It is located at the bottom of the kneecap (patella) and stretches down to the shin. The patellar tendon enables you to extend your knee, kick, run, and jump. What is Patellar Tendinitis? Patellar tendinitis is an irritation and inflammation of the tendon that connects your kneecap (patella) to your shinbone. Patellar tendinitis, also known as jumper’s knee, can affect anyone. The most common symptom is pain at the shin or lowest part of the kneecap…

Read More About Patellar Tendonitis
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Common Treatments for Anterior Lateral Knee Pain

There are many options to treat knee pain in the anterior lateral aspect of the joint. These include:

  • Natural or Support Self Care therapies
  • Surgery
  • Non-Surgical therapies
  • Regenerative medicine (Regenexx)
  • Alternative therapies

Anti-Inflammatory Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory medications that are used to relieve pain. They reduce the inflammation within the joint and are taken orally. Ibuprofen, naproxen, diclofenac and celecoxib are common examples of NSAIDS. Other anti-inflammatory medications like cortisone are injected and given when the pain and swelling are acute.

Neoprene Knee Sleeves

Neoprene knee sleeves are supportive sleeves for the knees. These anatomically shaped sleeves compress the joint and also retain heat. They reduce swelling and pain thereby facilitating faster recovery from injury. Neoprene knee sleeves are also a good preventive option as they brace the knee during training and prevent future injuries.

Physical Therapy

Physical therapy is a very good long-term treatment option. It can include strengthening exercises that build all the muscles that support the knee joint. Additionally, it can include rehabilitation exercises that stretch and tone the muscles of the lower extremity.

Strengthening Exercises

Strengthening exercises are exercises or moves that build your hamstrings, quadriceps, glutes, and hip muscles. Stronger muscles make the knee joint more stable and prevent further injury to the knee. These exercises include straight leg raises, side leg raises, step-ups, and hamstring curls among many others.

Rehabilitation Program

A rehabilitation program for the knee is essential once you experience anterior lateral knee pain. It serves many purposes. It can increase endurance, develop the muscle stabilizers of the hip, and strengthen the muscles of the knee joint.

This multipronged approach goes a long way in preventing further problems of the knee joint. To increase endurance, cardio-intense activities like swimming and pool workouts are incorporated into the program. Hip stabilizer muscles are strengthened with targeted exercises that work out the hip muscles.

The rehab program is best done with trained professionals to ensure that the form and technique are right. Certified physiotherapists will also know when is the best time to start a rehab program when a person experiences anterior lateral knee pain.

Surgery

There are various surgical options based on what is causing the anterior lateral knee pain. Meniscal tears are repaired via knee arthroscopy. Surgeons use grafts to rebuild damaged LCLs. For those with osteoarthritis, total knee replacement surgery is an option. In people with ITBS, surgeons can surgically release the band by cutting a small portion of the band that causes friction.

However, it is important to keep in mind that even after surgery, physical therapy, medications, and other alternative treatments will be required to build the knee, so it functions optimally. These treatments must be used in conjunction with surgery for a good post-surgical outcome.

Regenexx

Regenexx is a non-surgical treatment option that uses the body’s natural ability to repair and heal damaged bones, muscles, cartilage, tendons, and ligaments. The cells of the body are used in a concentrated form and introduced to the damaged area of the knee. This is a form of regenerative medicine where the healing environment of the knee is improved. This slows down inflammation, reduces pain, and allows the knee to heal from injuries.

Can You Prevent Anterior Lateral Knee Pain?

You can prevent pain in the anterior lateral knee especially if you’re especially at risk or prone to a knee injury. Some of the things you can do are:

  • Strengthen the knee joint through exercises and a rehab program.
  • Lose weight for those who are overweight as this will reduce the load on the knee joint.
  • Do low-impact exercises like swimming for muscle building without straining the knee joint.
  • Wear supportive knee braces and pads to support the knee joint.
  • Avoid abrupt changes to movements while exercising or playing sports.
  • Wearing the right footwear is another way to prevent knee pain. Stilettos can increase the pressure on the knees and overstretch the tendons. Flat shoes without arches can also strain the muscles of the lower extremity.
  • Rest between injuries. If you’ve injured your knee, rest and give it some time to recover.

Who Is at Risk Of This Condition?

Certain people are at greater risk of developing anterior lateral knee pain. This includes high-impact sports athletes like runners, cyclists, track and field athletes, gymnasts, soccer players, tennis players, skiers, and weightlifters. Most of these sports involve repetitive, abrupt, and high-velocity movements of the knee.

Similarly, occupations that strain the knee joint like farming and construction work are also at higher risk of anterior lateral knee pain.

Osteoarthritis is very common in people over 60 years of age due to a longer period of wear on the joint. However, the prevalence of PFPS is found to be about 20% in adolescents although it’s unclear as to why this is so (4).

Obesity and excessive weight can also increase the risk of lateral knee pain. Women are at higher risk for anterior lateral knee pain for many reasons. The foremost among them is anatomy. Anatomically, women have smaller and weaker muscles, their ligaments are limber and more susceptible to injury, and estrogen can also weaken ligaments. Additionally, their wider hips put more stress on the knee.

Examination & Diagnostics

Doctors usually take a very detailed medical history including specific details about the location, timing, and nature of the pain during the initial evaluation of anterior lateral knee pain.

Medical professionals use a very systematic examination of the knee which includes inspection, palpation, several range of motion tests, strength evaluation tests, neurovascular assessment, and provocative tests.

The provocative tests are special tests that are specific for certain injuries like the McMurray test which is specific for a meniscal tear.

To confirm the pathology causing knee pain in the anterior lateral aspect of the knee imaging is necessary. For all acute injuries, radiographic imaging with an anteroposterior view, lateral view, and Merchant’s view (for the patellofemoral joint) is recommended.

Injuries to the tendons, ligaments, and even complaints of popping and locking are evaluated with an ultrasound.

While an MRI is rare for anterior lateral knee pain, it is reserved for those with vertical meniscal tears, recurrent swelling of the knee joint, or persistent pain even after a trial of conservative treatment.

Complications If Left Untreated

The problem with anterior lateral knee pain is that it can snowball over time if left untreated. Studies have shown that previous knee pain and a history of knee injury are associated with a higher risk of new injuries (5).

For example, an LCL tear will not affect or destabilize the knee but runs a higher risk of a repeat injury. These injuries can accumulate over time which will affect the stability of the knee causing it to give out or get locked. The repeated inflammation can also advance osteoarthritis.

When To See Your Doctor

If you’re experiencing knee pain, the first step is to RICE. Rest, ice, compress and elevate the knee. However, here are some red flags that should prompt you to see your doctor immediately:

  • Visible deformity of the knee.
  • Swelling, redness, and bruising.
  • Inability to bear weight.
  • Unstable knee or a feeling that the knee is about to give out.
  • Popping, locking, snapping sounds within the knee joint.
  • Difficulty walking or reduced range of motion.
  • Severe pain that affects sleep.
  • Loss of sensation in the knee joint area.

If you’re experiencing fever, persistent discomfort, or pain in the knee joint, then seek medical assistance immediately.

  • Start with conservative treatment.
  • Surgery is not a first-line treatment. It is often the last resort. 20 % of patients still experience knee pain after total knee arthroplasty surgery (6). There are other risks as well which include loosening of the prosthesis, deep vein thrombosis, and a higher incidence of heart attacks.
  • For those looking for long-term treatment options, consider regenerative medicine like Regenexx. With Regenexx, the doctor will inject special adult stem cells into the damaged area based on what it needs to heal. This could be platelet-rich plasma, platelet lysate rich in growth factors, or whatever nutrients your knee needs to heal. The treatment is very specific and customized for each person.

Doctors That Treat Knee Pain

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

Read more

Knee Pain Is Not Something to Ignore

Knee pain is a sign that something is wrong with the knee joint. At The Centeno-Schultz Clinic, we want to help patients avoid unnecessary surgeries and procedures. Our team of experts has been using image-guided bone marrow concentrate injections for 15 years. We want our patients to address and treat knee pain right at its inception so the knee has room to heal, and we can avoid knee replacement surgery.

If you’re experiencing knee pain, don’t ignore it. Schedule an in-office evaluation or telemedicine visit with one of our board-certified, fellowship-trained physicians who will review your history and imaging to see if you’re a candidate for Regenexx.

References:

  1. Knee Pain in Adults and Adolescents: The Initial Evaluation, Bunt, C, Am Fam Physician. 2018 Nov 1;98(9):576-585.
  2. Yaras RJ, O’Neill N, Yaish AM. Lateral Collateral Ligament Knee Injuries. [Updated 2022 Jan 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560847/
  3. Bump JM, Lewis L. Patellofemoral Syndrome. [Updated 2022 Feb 18]. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557657/
  4. Tállay A, Kynsburg A, Tóth S, Szendi P, Pavlik A, Balogh E, Halasi T, Berkes I. [Prevalence of patellofemoral pain syndrome. Evaluation of the role of biomechanical malalignments and the role of sport activity]. Orv Hetil. 2004 Oct 10;145(41):2093-101. [PubMed]
  5. McAlindon TE. Knee Pain and a Prior Injury Are Associated with Increased Risk of a New Knee Injury: Data from the Osteoarthritis Initiative. J Rheumatol. 2015;42(8):1463-1469. doi:10.3899/jrheum.150016
  6. Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman-Hill R. Chronic pain after total knee arthroplasty. EFORT Open Rev. 2018;3(8):461-470. Published 2018 Aug 16. doi:10.1302/2058-5241.3.180004

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