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Ouch! Anterior Knee Pain

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.

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Ouch! Anterior Knee Pain

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  1. Ouch!Anterior Knee Pain Dr Jonathan Mulford Sydney Orthopaedic Specialists Prince of Wales Private

  2. It is Common • 20-40% of all knee problems. • Commonly 2nd and 3rd decade. • 30% 0f teenages. • 40% men and 60% women.

  3. Common but difficult! • Not well understood. • Confusing terminology

  4. Why is it a “PAIN”?

  5. Chondromalacia Patella Lateral patella overload Patellofemoral pain syndrome PatellofemoralArthralgia Confusing Terminology

  6. Cause of Pain due to Multiple Factors

  7. Bone Better Understanding of Anatomy and Biomechanics

  8. Lower limb Bone Alignment and Rotational Profile

  9. Static Soft tissue Restraints

  10. Dynamic Soft Tissue Restraints

  11. Allows to review commonest causes of knee pain Anterior Knee Pain,According to Site.

  12. Hip Spine Referred Anterior Knee Pain

  13. Patella Tendon • Tendinopathy • Osgood Slatter • Sindig-Larsen-Johanssen

  14. Patella Tendinopathy

  15. Osgood-Schlatter

  16. Intra-articular Pathology/ Hoffa’s Fat Pad • Plica Syndromes • Hoffa’s Syndrome • PVNS • Meniscal Cyst/ Tear

  17. Cyst

  18. Medial Plicae

  19. Hoffa

  20. Bursitis • Prepatellar • Pes ancerine

  21. Patella • Instability • Patellofemoral OA • Patello-femoral pain syndrome (PFPS)

  22. Patellofemoral pain syndrome“Chondromalacia”

  23. Physiotherapy – Most improve

  24. - Quadriceps excercise program utilising closed chain excercises - Trial patella taping

  25. Acute Dislocation

  26. Chronic Instability • Requires investigating to determine best treatment.

  27. OA

  28. Diagnosis Not Clear Cut • My Approach

  29. Hx • Age • Occupation • Sport • Change in activity • Trauma • Instability

  30. Examination • Generalised laxity • Lower Limb Alignment • Feature of the patella • Height , • Size , • Mobility, • Tilt . • Q angle • Tracking – J sign

  31. Investigation • XR • CT • MRI

  32. XR • AP – exclude osteochondral pathology • Lateral – patella alta, trochlea dysplasia • Skyline – numerous measurements

  33. CT

  34. MRI

  35. Arthroscopy

  36. Surgical Treatment Options for Chronic Patella Instability

  37. Trochleoplasty

  38. Isolated Patellofemoral OA • Often dysplastic with history instability • Options include • Unloading procedures • Patellofemoral Arthroplasty

  39. Thankyou

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