Which factor leads to retropatellar (patellofemoral) pain?

• A. Increased Q angle
• B. Increased quadriceps tone and strength
• C. Osgood-Schlatter Disease
• D. Hamstring stretching

Answer: (A)

An increased Q angle pushes the patella laterally as the quadriceps pull and the patellar tendon align. That lateral vector boosts patellofemoral contact forces, especially when the knee bends, causing irritation of the retropatellar cartilage and surrounding tissues. This pattern of pain is classic in patellofemoral pain syndrome and explains why an wider pelvis, genu valgum, or other factors that raise the Q angle contribute to anterior knee pain behind the patella.

Stronger or tighter quadriceps don’t typically produce this retropatellar pain and may even help stabilize patellar tracking. Osgood-Schlatter disease causes pain at the tibial tubercle rather than behind the patella, and hamstring stretching isn’t a primary cause of retropatellar pain.