Machka 

I've experienced anterior knee pain (front of the knee extending down into the shin area) and I've had patellofemoral syndrome. I've experienced medial knee pain. I've experienced lateral knee pain and still do to some extent because of my iliotibial band.

But this pain is different. It is located just above the knee cap, and runs along the upper edge of the knee cap, the length of the knee cap and about a cm wide. It is quite a sharp pain, is painful to the touch as well as painful while riding, and feels something similar to a bad bruise. Only there is no bruising there.

I developed this pain when riding Frankenbike on a 300K in early April. Frank was built up for me in the 3 days before the 300K and I only had time for a test ride of less than 1 km before the event. The setup wasn't quite right and I was mashing up the hills. Fortunately there weren't many hills. But nevertheless by the end of the ride my knee was in pain ... and the pain hasn't gone away.

I attempted a 400K last weekend but one of the reasons I DNF'd and only did 230 km was because of the knee pain. I was on my new titanium bicycle which is set up very close to what Machak was, but now we're trying to dial in the fit.

My trusty article on knee pain doesn't appear to deal with this particular pain.
https://www.cptips.com/knee.htm


So I wondered ... have any of you had pain directly above your knee cap ... along the upper edge of the knee cap? Did you figure out what caused it?

cooker

Sounds like a tear or inflammation of the quadriceps where it attaches to the patella. I can't give you any medical advice but my amatuerish guess is that it will take weeks or months to fully heal, since tendon and ligaments injuries seem to take a long time. When I got tennis elbow from hoisting tents and sleeping bags into the roof carrier of my van in 2002, it took a year to heal, and when I got a sore knee (a little more to the outside than what you're describing, but also at the top of the patella) from biking in winter boots on a bike with a frozen shifter, it also took months to get better. However, in the second case, I found I could minimize the discomfort (and hopefully avoid aggravating it further) by readjusting seat height to compensate for the chunky soles on the boots, and spinning furiously in lieu of mashing.

RT

It's funny this thread pops up now. After reading innumerable threads on bike fit and adjustment, I tried tinkering with my saddle a tad, lowering the nose by an ever so slight amount. The feeling was immediately felt, ever so slightly, but not uncomfortable - this was a small adjustment. I dialed it back one notch, and it turns out my first adjustment was only two notches, so backing it off was almost back to where it started.

After only two commutes, about 40 miles, my legs were noticeably more tired, and I had pain in the exact area you describe. I know from your experience that you are no stranger to fit, but since Frank was just built up and your body had not yet acclimated to it, maybe a simple saddle adjustment could help?

Saddle adjustment seems like it would be a no-brainer, but I was surprised at how much a little bit did to change my experience.

Machka 

In doing some more research, it appears that it could very well be quadriceps tendinitis.

"Pain from quadriceps tendinitis is felt in the area just above the patella. There may be swelling in and around the quadriceps tendon and it may be sensitive to touch."
https://www.kneepaininfo.com/kneeQuadTendinitis.html

This article attributes it to a bump, which is entirely possible too ... I bang my knees into everything ... but I'm thinking the mashing up hills might have had more to do with it.
https://www.australiancyclist.com.au/...aspx?aeid=2825


I've been micro-adjusting my saddle on the new titanium trying to get it just right ... too high, and I get achilles tendon pain ... too low and I get patello-femoral pain, and the difference between too high and too low seems to be something of a matter of millimetres.

jrobe

I think this is still Chondromalacia Patella. The pain from Patella-Femoral Syndrome or Chondromalacia is often vague and quite variable. Anything around the patella is usually this until proven otherwise.

In many ways, it doesn't really matter what the specific diagnosis is - it is an overuse syndrome. Unfortunately, the primary treatments are going to be rest, anti-inflammatory agents, physical therapy, etc..

If this is limiting your exercise habits, it warrants an Orthopedic evaluation.

bratton

I get the same pain when my seat is too low, or when I have spent a whole day lazily mashing. Usually the pain goes away by the next day for me, though, and as long as I fix my seat and stay conscious not to drop my cadence too low, I'm perfectly fine during and after the ride.