title: How to Deal With Anterior Knee Pain in the Active Young Patient.
abstract: BACKGROUND
  Anterior knee pain (AKP) represents the most common reason to consult with a clinician who specializes in the knee. Despite the high incidence of the disorder, however, its etiology is still controversial. Many unnecessary surgeries that may damage the patient are done for this clinical entity.
  
  
  METHODS
  A PubMed search from 1995 through June 2016.
  
  
  METHODS
  Clinical review.
  
  
  METHODS
  Level 4.
  
  
  RESULTS
  The etiology of AKP is multifactorial, and patients with AKP may therefore be divided into several subpopulations. The whole picture must be addressed for each patient to identify all potentially modifiable factors and to achieve better outcomes. Both pelvifemoral dysfunction and psychological factors that may affect the development and symptoms of AKP must be considered to identify therapeutic targets within the context of treatment. Patients presenting with AKP frequently respond well to load restriction that protects their knee and reduces pain during rehabilitation. Surgery should only be considered in very select cases. In a patient who has undergone previous patellar realignment surgery and experienced increased pain, iatrogenic medial patellar instability should be considered.
  
  
  CONCLUSIONS
  The etiology of AKP is multifactorial, and several subpopulations of AKP patients exist and their treatment must be personalized. Normally, the focus is on the knee of a patient with AKP, and only that joint is examined. However, that focus can lead to overlooking other important etiological factors that may be present.
authors.affiliation: Hospital 9 de Octubre and Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Sanchis-Alfonso
authors.affiliation: Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Dye
mesh_terms: D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology*; D010149:Postoperative Pain / Q000503:physiopathology
keywords: anterior knee pain; femoral torsion; homeostasis; patellofemoral pain; psychological factors