Skip to main content
SpringerLink
Log in

Pathophysiology of Anterior Knee Pain

  • Chapter
  • First Online:
Anterior Knee Pain and Patellar Instability

  • 581 Accesses

Abstract

Anterior knee pain (AKP) is the most common reason for adolescents, adults, and physically active people to consult with an orthopedic surgeon who specializes in the knee. Despite the high incidence and prevalence of AKP and an abundance of clinical and basic science research, the etiology of this condition is not well-known. This chapter synthesizes a review of the literature and our research and clinical experience on pathophysiology of AKP in the young patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Büdinger K. Üeber ablösung von gelenkteilen und verwandte prozesse. Dtsch Z Chir. 1906;84:311–65.

    Article  Google Scholar 

  2. Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436:100–10.

    Article  Google Scholar 

  3. Royle SG, Noble J, Davies DR, et al. The significance of chondromalacic changes on the patella. Arthroscopy. 1991;7:158–60.

    Article  CAS  PubMed  Google Scholar 

  4. Ficat P, Ficat C, Bailleux A. Syndrome d’hyperpression externe de la rotule (S.H.P.E). Rev Chir Orthop. 1975;61:39–59.

    Google Scholar 

  5. Ficat P, Hungerford DS. Disorders of the Patello-Femoral Joint. Baltimore: Williams & Wilkins; 1977.

    Google Scholar 

  6. Hughston JC. Subluxation of the patella. J Bone Joint Surg. 1968;50–A:1003–1026.

    Google Scholar 

  7. Insall J. “Chondromalacia Patellae”: Patellar malalignment syndrome. Orthop Clin North Am. 1979;10:117–27.

    Article  CAS  PubMed  Google Scholar 

  8. Merchant AC, Mercer RL. Lateral release of the patella: a preliminary report. Clin Orthop Relat Res. 1974;103:40.

    Article  Google Scholar 

  9. Staeubli HU, Bosshard C, Porcellini P, et al. Magnetic resonance imaging for articular cartilage: cartilage-bone mismatch. Clin Sports Med. 2002;21:417–33.

    Article  PubMed  Google Scholar 

  10. James SL. Chondromalacia of the Patella in the adolescent. In: Kennedy JC. editor. The injured adolescent knee. Baltimore: The Williams & Wilkins Company, 1979.

    Google Scholar 

  11. Orthopaedic Knowledge Update 3 Home Study Syllabus Published by American Academy of Orthopaedic Surgeons, Park Ridge, Illinois, January 1990, pp 563–567.

    Google Scholar 

  12. Meister K, James SL. Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity. Am J Orthop (Belle Mead NJ). 1995;24:149–55.

    CAS  PubMed  Google Scholar 

  13. Cooke TD, Price N, Fisher B, et al. The inwardly pointing knee. An unrecognized problem of external rotational malalignment. Clin Orthop Relat Res. 1990;56–60.

    Google Scholar 

  14. Dye SF. The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res. 1996;325:10–8.

    Article  Google Scholar 

  15. Dye SF, Staubli HU, Biedert RM, et al. The mosaic of pathophysiology causing patellofemoral pain: therapeutic implications. Oper Techni Sports Med. 1999;7:46–54.

    Article  Google Scholar 

  16. Powers CM, Ward SR, Fredericson M, et al. Patellofemoral kinematics during weightbearing and non-weightbearing knee extension in persons with patellar subluxation: a preliminary study. J Orthop Sports Phys Ther. 2003;33:677–85.

    Article  PubMed  Google Scholar 

  17. Souza RB, Draper CE, Fredericson M, et al. Femur rotation and patellofemoral joint kinematics: a weight-bearing MRI analysis. J Orthop Sports Phys Ther. 2010;40:277–85.

    Article  PubMed  Google Scholar 

  18. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33:686–93.

    Article  PubMed  Google Scholar 

  19. Sanchis-Alfonso V. Anterior Knee Pain and Patellar Instability. London: Springer; 2011.

    Book  Google Scholar 

  20. Sanchis-Alfonso V, Gastaldi-Orquín E, Martinez-SanJuan V. Usefulness of computed tomography in evaluating the patellofemoral joint before and after Insall’s realignment. Correlation with short-term clinical results. Am J Knee Surg. 1994;7:65–72.

    Google Scholar 

  21. Sanchis-Alfonso V, Roselló-Sastre E, Martinez-SanJuan V. Pathogenesis of anterior knee pain syndrome and functional patellofemoral instability in the active young. A review Am J Knee Surg. 1999;12:29–40.

    CAS  PubMed  Google Scholar 

  22. Dye SF. Functional anatomy and biomechanics of the patellofemoral joint. In: Scott WN, editor. The Knee. St. Louis: Mosby; 1994. p. 381–9.

    Google Scholar 

  23. Dye SF. Forward. In Fulkerson JP. Disorders of the Patellofemoral Joint. Ed 4. Philadelphia, Lippincott Williams and Wilkins xi–xii, 2004.

    Google Scholar 

  24. Hungerford DS, Barry M. Biomechanics of the patellofemoral joint. Clin Orthop. 1979;144:9–15.

    Google Scholar 

  25. Reilly DT, Martens M. Experimental analysis of the quadriceps muscle force and patellofemoral joint reaction force for various activities. Acta Orthop Scand. 1972;73:146–137.

    Google Scholar 

  26. Smith AJ. Estimates of muscle and joint force at the knee and ankle during jumping activities. J Hum Movement Stud. 1975;1:78–86.

    Google Scholar 

  27. Steinkamp LA, Dillinghan MF, Markel MD, et al. Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med. 1993;21:438–44.

    Article  CAS  PubMed  Google Scholar 

  28. Van Haver A, De Roo K, De Beule M, et al. The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med. 2015;43(6):1354–61.

    Article  PubMed  Google Scholar 

  29. Powers CM. Patellar kinematics, part II: the influence of the depth of the trochlear groove in subjects with and without patellofemoral pain. Phys Ther. 2000;80(10):965–78.

    Article  CAS  PubMed  Google Scholar 

  30. Ho KY, Hu HH, Colletti PM, et al. Recreational runners with patellofemoral pain exhibit elevated patella water content. Magn Reson Imaging. 2014;32(7):965–8.

    Article  PubMed  Google Scholar 

  31. Sanchis-Alfonso V. Holistic approach to understanding anterior knee pain. Clinical implications. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2275–2285.

    Google Scholar 

  32. Barton RS, Ostrowski ML, Anderson TD, et al. Intraosseous innervation of the human patella: a histologic study. Am J Sports Med. 2007;35:307–11.

    Article  PubMed  Google Scholar 

  33. Teitge RA. Patellofemoral syndrome a paradigm for current surgical strategies. Orthop Clin N Am. 2008;287–311.

    Google Scholar 

  34. Teitge RA. Does lower limb torsion matter? Tech Knee Surg. 2012;11:137–46.

    Article  Google Scholar 

  35. van Kampen A, Huiskes R. The three-dimensional tracking pattern of the human patella. J Orthop Res. 1990;8(3):372–82.

    Article  PubMed  Google Scholar 

  36. Sanchis-Alfonso V, Roselló-Sastre E. Anterior knee pain in the young patient—what causes the pain? “Neural model.” Acta Orthop Scand. 2003;74:697–703.

    Article  PubMed  Google Scholar 

  37. Biedert RM, Sanchis-Alfonso V. Sources of anterior knee pain. Clin Sports Med. 2002;21:335–47.

    Article  PubMed  Google Scholar 

  38. Fulkerson JP. The etiology of patellofemoral pain in young active patients: a prospective study. Clin Orthop Relat Res. 1983;179:129–33.

    Article  Google Scholar 

  39. Kasim N, Fulkerson JP. Resection of clinically localized segments of painful retinaculum in the treatment of selected patients with anterior knee pain. Am J Sports Med. 2000;28:811–4.

    Article  CAS  PubMed  Google Scholar 

  40. Sanchis-Alfonso V, Roselló-Sastre E. Immunohistochemical analysis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A neuroanatomic basis for anterior knee pain in the active young patient. Am J Sports Med. 2000;28:725–731.

    Google Scholar 

  41. Sanchis-Alfonso V, Roselló-Sastre E, Revert F. Neural growth factor expression in the lateral retinaculum in painful patellofemoral malalignment. Acta Orthop Scand. 2001;72:146–9.

    Article  CAS  PubMed  Google Scholar 

  42. Sanchis-Alfonso V, Roselló-Sastre E, Revert F, et al. Histologic retinacular changes associated with ischemia in painful patellofemoral malalignment. Orthopedics. 2005;28:593–9.

    Article  PubMed  Google Scholar 

  43. Sanchis-Alfonso V, Roselló-Sastre E, Monteagudo-Castro C, et al. Quantitative analysis of nerve changes in the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A preliminary study. Am J Sports Med. 1998;26:703–709.

    Google Scholar 

  44. Fulkerson JP, Tennant R, Jaivin JS, et al. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment. Clin Orthopn Relat Res. 1985;197:196–205.

    Google Scholar 

  45. Mori Y, Fujimoto A, Okumo H, et al. Lateral retinaculum release in adolescent patellofemoral disorders: its relationship to peripheral nerve injury in the lateral retinaculum. Bull Hosp Jt Dis Orthop Inst. 1991;51:218–29.

    CAS  PubMed  Google Scholar 

  46. Baker V, Bennell K, Stillman B, et al. Abnormal knee joint position sense in individuals with patellofemoral pain syndrome. J Orthop Res. 2002;20(2):208–14.

    Article  PubMed  Google Scholar 

  47. Jerosch J, Prymka M. Knee joint propioception in patients with posttraumatic recurrent patella dislocation. Knee Surg, Sports Traumatol Arthrosc. 1996;4:14–8.

    Article  CAS  PubMed  Google Scholar 

  48. Wilson AS, Lee HB. Hypothesis relevant to defective position sense in a damaged knee. J Neurol Neurosurg Psychiatry. 1986;49:1462–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Jensen R, Hystad T, Kvale A, et al. Quantitative sensory testing of patients with long lasting patellofemoral pain síndrome. Eur J Pain. 2007;11:665–76.

    Article  PubMed  Google Scholar 

  50. Ahmed M, Bergstrom J, Lundblad H, et al. Sensory nerves in the interface membrane of aseptic loose hip prostheses. J Bone Joint Surg. 1998;80-B:151–155.

    Google Scholar 

  51. Ashton IK, Ashton BA, Gibson SJ, et al. Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res. 1992;10:72–8.

    Article  CAS  PubMed  Google Scholar 

  52. Ashton IK, Roberts S, Jaffray DC. Neuropeptides in the human intervertebral disc. J Orthop Res. 1994;12:186–92.

    Article  CAS  PubMed  Google Scholar 

  53. Ashton IK, Walsh DA, Polak JM, et al. Substance P in intervertebral discs. Binding sites on vascular endothelium of the human annulus fibrosus. Acta Orthop Scand. 1994;65:635–639.

    Google Scholar 

  54. Coppes MH, Marani E, Thomeer RT, et al. Innervation of “painful” lumbar discs. Spine. 1997;22:2342–9.

    Article  CAS  PubMed  Google Scholar 

  55. Freemont AJ, Peacock TE, Goupille P, et al. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet. 1997;350:178–81.

    Article  CAS  PubMed  Google Scholar 

  56. Grönblad M, Korkala O, Konttinen YT, et al. Silver impregnation and immunohistochemical study of nerves in lumbar facet joint plical tissue. Spine. 1991;16:34–8.

    Article  PubMed  Google Scholar 

  57. Kocher MS, Fu FH, Harner ChD. Neuropathophysiology. In: Fu FH, Harner ChD, Vince KG, editors. Knee Surgery. Baltimore: Williams and Wilkins; 1994. p. 231–49.

    Google Scholar 

  58. Konttinen YT, Grönblad M, Antti-Poika I, et al. Neuroimmunohistochemical analysis of peridiscal nociceptive neural elements. Spine. 1990;15:383–6.

    Article  CAS  PubMed  Google Scholar 

  59. Korkala O, Grönblad M, Liesi P, et al. Immunohistochemical demonstration of nociceptors in the ligamentous structures of the lumbar spine. Spine. 1985;10:156–7.

    Article  CAS  PubMed  Google Scholar 

  60. Palmgren T, Grönblad M, Virri J, et al. Immunohistochemical demonstration of sensory and autonomic nerve terminals in herniated lumbar disc tissue. Spine. 1996;21:1301–6.

    Article  CAS  PubMed  Google Scholar 

  61. Witonski D, Wagrowska-Danielewicz M. Distribution of substance-P nerve fibers in the knee joint in patients with anterior knee pain syndrome. Knee Surg Sports Traumatol Arthrosc. 1999;7:177–83.

    Article  CAS  PubMed  Google Scholar 

  62. Wojtys EM, Beaman DN, Glover RA, et al. Innervation of the human knee joint by substance-P fibers. Arthroscopy. 1990;6:254–63.

    Article  CAS  PubMed  Google Scholar 

  63. Byers PD. Solitary benign osteoblastic lesions of bone. Osteoid osteoma and benign osteoblastoma Cancer. 1968;22:43–57.

    CAS  PubMed  Google Scholar 

  64. Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003;11:334–8.

    Article  PubMed  Google Scholar 

  65. Sanchis-Alfonso V, Roselló-Sastre E, Subías-López A. Neuroanatomic basis for pain in patellar tendinosis (“jumper’s knee”): A neuroimmunohistochemical study. Am J Knee Surg. 2001;14:174–7.

    CAS  PubMed  Google Scholar 

  66. Hasegawa T, Hirose T, Sakamoto R, et al. Mechanism of pain in osteoid osteomas: an immunohistochemical study. Histopathology. 1993;22:487–91.

    Article  CAS  PubMed  Google Scholar 

  67. Grönblad M, Weinstein JN, Santavirta S. Immunohistochemical observations on spinal tissue innervation. A review of hipothetical mechanisms of back pain. Acta Orthop Scand. 1991;62:614–622.

    Google Scholar 

  68. Dicou E, Pflug B, Magazin M, et al. Two peptides derived from the nerve growth factor precursor are biologically active. J Cell Biol. 1997;136:389–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Gigante A, Bevilacqua C, Ricevuto A, et al. Biological aspects in patello-femoral malalignment. 11th Congress European Society of Sports Traumatology, Knee Surgery and Arthroscopy. Book of Abstracts. Athens 5–8 May, 2004.

    Google Scholar 

  70. Malcangio M, Garrett NE, Cruwys S, et al. Nerve growth factor- and neurotrophin-3-induced changes in nociceptive threshold and the release of substance P from the rat isolated spinal cord. J Neurosci. 1997;17:8459–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Abe T, Morgan DA, Gutterman DD. Protective role of nerve growth factor against postischemic dysfunction of sympathetic coronary innervation. Circulation. 1997;95:213–20.

    Article  CAS  PubMed  Google Scholar 

  72. Lee TH, Kato H, Kogure K, et al. Temporal profile of nerve growth factor-like immunoreactivity after transient focal cerebral ischemia in rats. Brain Res. 1996;713:199–210.

    Article  CAS  PubMed  Google Scholar 

  73. Isaacson LG, Crutcher KA. The duration of sprouted cerebrovascular axons following intracranial infusion of nerve growth factor. Exp Neurol. 1995;13:174–9.

    Article  Google Scholar 

  74. Kawaja MD. Sympathetic and sensory innervation of the extracerebral vasculature: roles for p75NTR neuronal expression and nerve growth factor. J Neurosci Res. 1998;52:295–306.

    Article  CAS  PubMed  Google Scholar 

  75. Society for Ultrastructural Pathology. Handbook of diagnostic electron microscopy for pathologists-in-training. New York-Tokyo: Igaku-Shoin Medical Publishers Committee; 1995.

    Google Scholar 

  76. Shweiki D, Itin A, Soffer D, et al. Vascular endothelial growth factor induced by hypoxia may mediate hypoxia-initiated angiogenesis. Nature. 1992;359:843–5.

    Article  CAS  PubMed  Google Scholar 

  77. Liu Y, Cox SR, Morita T, et al. Hypoxia regulates vascular endothelial growth factor gene expression in endothelial cells. Identification of a 5’ enhancer. Circ Res. 1995:77:638–643.

    Google Scholar 

  78. Minchenko A, Bauer T, Salceda S, et al. Hypoxic stimulation of vascular endothelial growth factor expression in vitro and in vivo. Lab Invest. 1994;71:374–9.

    CAS  PubMed  Google Scholar 

  79. Nagashima M, Yoshino S, Ishiwata T, et al. Role of vascular endothelial growth factor in angiogenesis of rheumatoid arthritis. J Rheumatol. 1995;22:1624–30.

    CAS  PubMed  Google Scholar 

  80. Yamada T, Sawatsubashi M, Yakushiji H, et al. Localization of vascular endothelial growth factor in synovial membrane mast cells: examination with “multilabelling subtraction immunostaining.” Virchows Arch. 1998;433:567–70.

    Article  CAS  PubMed  Google Scholar 

  81. Pufe T, Petersen W, Tillmann B, et al. The splice variants VEGF121 and VEGF189 of the angiogenic peptide vascular endothelial growth factor are expressed in osteoarthritic cartilage. Arthritis Rheum. 2001;44:1082–8.

    Article  CAS  PubMed  Google Scholar 

  82. Jackson JR, Minton JAL, Ho ML, et al. Expression of vascular endothelial growth factor in synovial fibroblasts is induced by hipoxia and interleukin 1ß. J Rheumatol. 1997;24:1253–9.

    CAS  PubMed  Google Scholar 

  83. Calzà L, Giardino L, Giuliani A, et al. Nerve growth factor control of neuronal expression of angiogenetic and vasoactive factors. Proc Natl Acad Sci USA. 2001;98:4160–5.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Sandow MJ, Goodfellow JW. The natural history of anterior knee pain in adolescents. J Bone Joint Surg. 1985;67-B:36–38.

    Google Scholar 

  85. Selfe J, Karki A, Stevens D. A review of the role of circulatory deficit in the genesis of patellofemoral pain. Phys Therapy Rev. 2002;7:169–72.

    Article  Google Scholar 

  86. Selfe J, Harper L, Pedersen I, et al. Cold legs: a potential indicator of negative outcome in the rehabilitation of patients with patellofemoral pain syndrome. Knee. 2003;10:139–43.

    Article  CAS  PubMed  Google Scholar 

  87. Gelfer Y, Pinkas L, Horne T, et al. Symptomatic transient patellar ischemia following total knee replacement as detected by scintigraphy. A prospective, randomized, double-blind study comparing the mid-vastus to the medial para-patellar approach. Knee. 2003;10:341–345.

    Google Scholar 

  88. Naslund J. Patellofemoral pain syndrome. Clinical and pathophysiological considerations. Thesis. Karolinska Institutet, Stockholm, 2006.

    Google Scholar 

  89. Damasio AR, Grabowky TJ, Bechara A, et al. Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci. 2000;3:1049–56.

    Article  CAS  PubMed  Google Scholar 

  90. Diekfuss JA, Grooms DR, Nissen KS, et al. Does central nervous system dysfunction underlie patellofemoral pain in young females? Examining brain functional connectivity in association with patient-reported outcomes. J Orthop Res. 2022;40(5):1083–96.

    Article  PubMed  Google Scholar 

  91. Foss KDB, Slutsky-Ganesh AB, Diekfuss JA, et al. Brain activity during experimental knee pain and its relationship with kinesiophobia in patients with patellofemoral pain: a preliminary functional magnetic resonance imaging investigation. J Sport Rehabil. 2022;12:1–10. https://doi.org/10.1123/jsr.2021-0236.

    Article  Google Scholar 

  92. Slutsky-Ganesh AB, Diekfuss JA, Grooms DR, et al. A preliminary investigation of the effects of patellar displacement on brain activation and perceived pain in young females with patellofemoral pain. J Sci Med Sport. 2022;31;S1440–2440(22)00030–5. https://doi.org/10.1016/j.jsams.2022.01.006.

  93. Domenech J, Sanchis-Alfonso V, López L, et al. Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1562–8.

    Article  PubMed  Google Scholar 

  94. Doménech J, Sanchis-Alfonso V, Espejo B. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2295–300.

    Article  PubMed  Google Scholar 

  95. Sanchis-Alfonso V, Montesinos-Berry E, Domenech J. Catastrophic thinking is a new puzzle piece in understanding anterior knee pain. Orthopaedics Today Europe Official Newspaper of EFORT. 2014;17(2):44–50.

    Google Scholar 

  96. Gracely RH. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004;127:835–43.

    Article  CAS  PubMed  Google Scholar 

  97. Rathleff MS, Petersen KK, Arendt-Nielsen L, et al. Impaired conditioned pain modulation in young female adults with long-standing patellofemoral pain: a Single Blinded Cross-Sectional Study. Pain Med. 2016;17(5):980–8.

    PubMed  Google Scholar 

  98. IASP terminology. International Association for the Study of Pain Web site. https://www.iasp-pain.org/terminology.

  99. Sigmund KJ, Hoeger Bement MK, Earl-Boehm JE. Exploring the pain in patellofemoral pain: a systematic review and meta-analysis examining signs of central sensitization. J Athl Train. 2021;56(8):887–901.

    Article  PubMed  Google Scholar 

  100. De Oliveira SD, Rathleff MS, Petersen K, et al. Manifestations of pain sensitization across different painful knee disorders: a systematic review including meta-analysis and metaregression. Pain Med. 2019;20(2):335–58.

    Article  Google Scholar 

  101. Rathleff MS, Roos EM, Olesen JL, et al. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013;43(6):414–21.

    Article  PubMed  Google Scholar 

  102. Rathleff MS, Roos EM, Olesen JL, et al. Self-reported recovery is associated with improvement in localized hyperalgesia among adolescent females with patellofemoral pain: results from a cluster randomized trial. Clin J Pain. 2016;32(5):428–34.

    Article  PubMed  Google Scholar 

  103. Lefaucheur JP, Drouot X, Ménard-Lefaucheur I, et al. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology. 2006;67:1568–74.

    Article  CAS  PubMed  Google Scholar 

  104. Young NA, Sharma M, Deogaonkar M. Transcranial magnetic stimulation for chronic pain. Neurosurg Clin N Am. 2014;25(4):819–32.

    Article  PubMed  Google Scholar 

  105. Powers CM, Bolgla LA, Callaghan MJ, et al. Patellofemoral pain: proximal, distal, and local factors, 2nd International Research Retreat. J Orthop Sports Phys Ther. 2012;42:A1-54.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Soifer TB, Levy HJ, Soifer FM, et al. Neurohistology of the subacromial space. Arthroscopy. 1996;12:182–6.

    Article  CAS  PubMed  Google Scholar 

  107. Solomonow M, D’Ambrosia R. Neural reflex arcs and muscle control of knee stability and motion. In: Scott WN, ed. Ligament and extensor mechanism injuries of the knee: Diagnosis and treatment. St. Louis: Mosby-Year Book, 1991; pp 389–400.

    Google Scholar 

  108. Nilsson G, Forsberg-Nilsson K, Xiang Z, et al. Human mast cells express functional TrkA and are a source of nerve growth factor. Eur J Immunol. 1997;27:2295–301.

    Article  CAS  PubMed  Google Scholar 

  109. Sherman BE, Chole RA. A mechanism for sympathectomy-induced bone resorption in the middle ear. Otolaryngol Head Neck Surg. 1995;113:569–81.

    CAS  PubMed  Google Scholar 

  110. Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med. 2004;140:441–51.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

  2. Department of Pathology, Hospital General de Castellón, Castellón, Spain

    Esther Roselló-Sastre

  3. University of California San Francisco, San Francisco, CA, USA

    Scott F. Dye

  4. Wayne State University, Detroit, MI, USA

    Robert A. Teitge

Authors
  1. Vicente Sanchis-Alfonso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esther Roselló-Sastre
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott F. Dye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert A. Teitge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vicente Sanchis-Alfonso .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sanchis-Alfonso, V., Roselló-Sastre, E., Dye, S.F., Teitge, R.A. (2023). Pathophysiology of Anterior Knee Pain. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-09767-6_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation