Expected prevalence from the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening

Context: Anterior knee pain is a common disorder in female athletes with an undefined cause. The relative prevalence of specific patellofemoral disorders associated with anterior knee pain in adolescent females remains undetermined. Objective: To determine the prevalence of specific patellofemoral disorders obtained using the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening. Design: Descriptive epidemiology study. Setting: Preparticipation screening evaluations at a county public school district in Kentucky. Patients or Other Participants: A total of 419 unique middle and high school-aged female athletes. Main Outcome Measure(s): Participants were evaluated by physicians for anterior knee pain over 3 consecutive basketball seasons. Given the longitudinal nature of this study, some participants were tested longitudinally over multiple years. Results: Over the course of 3 basketball seasons, 688 patient evaluations were performed. Of these, 183 (26.6%) were positive for anterior knee pain. A statistically significant difference was noted in the prevalence of anterior knee pain by school level, with 34.4% (n = 67) in high school-aged athletes versus 23.5% (n=116) in middle school-aged athletes (P < .05). In the 1376 knees evaluated, patellofemoral dysfunction was the most common diagnosis, with an overall prevalence of 7.3% (n = 100). The only diagnosis shown to be statistically different between age levels was Sinding-Larsen-Johansson disease or patellar tendinopathy, with 38 cases (9.7%) in high school-aged and 31 (3.1%) in middle school-aged athletes (P < .05). Conclusions: Anterior knee pain was present in 26.6% of the adolescent female athletes screened over 3 years. Symptoms of anterior knee pain likely persist after middle school-aged onset and reach peak prevalence during the high school years.