Ouch! Anterior Knee Pain
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Ouch! Anterior Knee Pain Dr Jonathan Mulford Sydney Orthopaedic Specialists Prince of Wales Private
description
Ouch! Anterior Knee Pain. Dr Jonathan Mulford Sydney Orthopaedic Specialists Prince of Wales Private. It is Common. 20-40% of all knee problems. Commonly 2 nd and 3 rd decade. 30% 0f teenages . 40% men and 60% women. Common but difficult!. Not well understood. Confusing terminology. - PowerPoint PPT Presentation
Transcript of Ouch! Anterior Knee Pain
Ouch!Anterior Knee Pain
Dr Jonathan MulfordSydney Orthopaedic Specialists
Prince of Wales Private
It is Common• 20-40% of all knee
problems.
• Commonly 2nd and 3rd decade.
• 30% 0f teenages.
• 40% men and 60% women.
Common but difficult!
• Not well understood.
• Confusing terminology
Why is it a “PAIN”?
CONFUSING TERMINOLOGY
Chondromalacia PatellaLateral patella overload Patellofemoral pain syndromePatellofemoral Arthralgia
CAUSE OF PAIN DUE TO MULTIPLE FACTORS
BETTER UNDERSTANDING OF ANATOMY AND BIOMECHANICS
Bone
LOWER LIMB BONE ALIGNMENT AND ROTATIONAL PROFILE
STATIC SOFT TISSUE RESTRAINTS
DYNAMIC SOFT TISSUE RESTRAINTS
ANTERIOR KNEE PAIN,ACCORDING TO SITE.
Allows to review commonest causes of knee pain
REFERRED ANTERIOR KNEE PAIN
HipSpine
Patella Tendon
•Tendinopathy
• Osgood Slatter
•Sindig-Larsen-Johanssen
Patella Tendinopathy
Osgood-Schlatter
Intra-articular Pathology/ Hoffa’s Fat Pad
• Plica Syndromes
• Hoffa’s Syndrome
• PVNS
• Meniscal Cyst/ Tear
Cyst
Medial Plicae
• Hoffa
Bursitis• Prepatellar• Pes ancerine
Patella
• Instability• Patellofemoral OA• Patello-femoral pain syndrome
(PFPS)
Patellofemoral pain syndrome“Chondromalacia”
Physiotherapy – Most improve
- Quadriceps excercise program utilising closed chain excercises
- Trial patella taping
Acute Dislocation
Chronic Instability
• Requires investigating to determine best treatment.
OA
Diagnosis Not Clear Cut
• My Approach
Hx
• Age• Occupation• Sport• Change in activity• Trauma• Instability
Examination• Generalised laxity• Lower Limb Alignment• Feature of the patella– Height ,– Size , –Mobility, – Tilt .
• Q angle• Tracking – J sign
Investigation
• XR • CT• MRI
XR
• AP – exclude osteochondral pathology
• Lateral – patella alta, trochlea dysplasia
• Skyline – numerous measurements
CT
MRI
Arthroscopy
Surgical Treatment Options for Chronic Patella Instability
Trochleoplasty
Isolated Patellofemoral OA• Often dysplastic with history instability
• Options include –Unloading procedures–Patellofemoral Arthroplasty
Thankyou
