Anterior knee pain in children and adolescents, often assigned the vague diagnosis of “patellofemoral syndrome,” may have a number of different causes.

Subtle anatomic abnormalities in the alignment of an adolescent’s hips, knees, or legs can contribute to anterior knee pain.  

Miserable malalignment syndrome   (MMS) is a term used to describe a triad of anatomic findings—excessive femoral anteversion (inward rotation of the knee, relative to the hip), increased knee Q angle (alignment that creates an outward pull on the knee

cap by the connecting tendons), and external tibial torsion (outward rotation of the leg)—which are more frequently found in females and are associated with anterior knee pain.