In my experience, supra-patellar reflects the beginning of a pathology in the knee joint especially patellofemoral joint disorders. In the young person, a combination of malalignment of the patella with overuse may cause supra-patellar symptoms. Activity modification with combined PT and taping can help in this cases. In older people, it can be a sign of an onset of patellofemoral OA. My preferred option for treatment of this patients is a single injection of Hyaluronate. In cases with acute pain and effusion, I inject corticosteroid firstly and Hyaluronate one week later. According my experience, Hyaluronate decreases unwanted local effects of the steroids if injected seven to ten days later.

The option of arthroscopy is a poor (terrible) choice for the treatment.

Thank you Lauren for this very good answer. I do agree with most of these relevant points even if I'm now much more aggressive with this recurrent pathology... Some authors confirmed that point and on my own experience results of arthroscopic debridements are really good... Nice day!

One of the pathologies that may cause supra-patellar problems is the so-called Plica syndrome. In 1987 we published a paper on this syndrome (in German). One of the symptomatic plicae can be the Plica supra-patellaris. If conservative treatment does not work, arthroscopy is a reliable option. Please, s. below. There is also an abstract in English on Researchgate. 

Asparuchow, A., M. Gantscheff, Z. Wassilewa, P.Tantschew. Plica Syndrome – Pathomorphologie und Diagnostik. Beitr. Orthop., 34,1987, 9, 481-489

I fully agree with you Prof TANCHEV. That's my usual option for these cases and I finally opted for rather fast arthroscopy for painful place supra-patellaris... Can you send me your publication?

Thank you once more for this very good answer!

Supra-patellar complaints may be caused by different pathological conditions such as  effusion, synovial hypertrophy in the suprapatellar recess, osteoarthritis, partial tears or enthesophytes at the quadriceps tendon's enthesis, Plica syndrome etc. Treatment depends on the underlying pathology - i.a.glucocorticoids in case of inflammation, hyaluronates in osteoarthritis...... The  right diagnose is very important in this instance.  With that end in view I warmly recommend the ultrasound (US) imaging. US ensures  excellent resolution and  possibility for real-time dynamic assessment of the joints and surrounding soft tissues. It  has some advantages over the other imaging techniques- non-invasiveness, lack of radiation, multiplanar imaging capability, inexpensive.  Using US by the investigation of the knee we can detect  the true reason of the complaints and find the right treatment option.

The DD`s are impotant, thanks Mrs. Petranova. What is often not considered, the shortened Muscles and Fascias. That will lead to imbalance an impaired biomechanics, results in overcompression of the patellofem. joint. First line of treatment should be stretching the hamstrings and Quadriceps, followed by single leg strengthening exercises for the foot, leg and gluteals. In my experience, most cases improve by this very simple approach. You could provide  a foot/ gait analysis to recommend insoles in certain cases, which will also change the tibial rotation, thus decrease the patellar decompression. Next step would be either injections/ taping or orthotic banage, acupuncture, or shockwave therapy. E.g. if joint effusion, do an ultrasound to check for synovial hypertrophy, drain the fluid, inject Cortisone and compressive bandage. If the effusion is gone, you could continue with hyaluronic acid, But if synovial hypertrophie is present, that is often a curse. Ther might be RSO the right treatment for decreasing the synovial thickness. But check for underlying pathologies. In my experience, plica syndrom is relatively rare. Arthroscopy is overstressed it seems to me. Careful rehab will improve long lasting results.

nice discussion and excellent input by Panayot Tanchev  appreciated.Yes supra-patellar findings are helpful in  early diagnosis of knee pathology but is also over diagnosed or over treated in some of the countries.

 Dear colleagues! Arthroscopy is easy, but the results of its place supra-patellaris are not so optimistic. Conservative therapy lasts much longer, but in many cases justifies itself. Glucocorticoids, other anti-inflammatory therapy, allows to avoid arthroscopic intervention with all its positive qualities. Of course, in some cases, in the absence of a positive effect of conservative treatment, especially with osteoarthritis, one can also use arthroscopy.