Anterior knee pain--a symptom not a diagnosis.

A careful history and physical examination are the cornerstones of consistently successful diagnosis and treatment of anterior knee pain symptoms. Nonoperative treatment must be based on physical examination findings and should include both flexibility and strengthening. If an extended conscientious trial of nonoperative therapy fails to produce improvement, properly selected surgical procedures produce improvement in over 80% of cases. Realignment procedures, including lateral release, should only be proposed when malalignment can be documented. Although anterior knee pain has been called the "low back pain of the knee" by frustrated clinicians, effective treatment is likely when these principles are employed.