anterior knee pain in athletes jerome f. wall, md, facs
TRANSCRIPT
Anterior Knee Pain in Anterior Knee Pain in AthletesAthletes
Jerome F. Wall, MD, FACSJerome F. Wall, MD, FACS
Anterior Knee Pain in AthletesAnterior Knee Pain in Athletes
• Most commonMost common
• Most disablingMost disabling
• Difficult to make Difficult to make accurate accurate diagnosisdiagnosis
• Long differential Long differential diagnosisdiagnosis
Anterior Knee Pain in AthletesAnterior Knee Pain in Athletes
• Response Related To:Response Related To:– Correct diagnosisCorrect diagnosis– Appropriate treatment Appropriate treatment
planplan– Appropriate Appropriate
rehabilitation programrehabilitation program
Clinical HistoryClinical History
• Gender:Gender:– Females 2X MalesFemales 2X Males
Clinical HistoryClinical History
• Age: YoungAge: Young– Stresses of growthStresses of growth
Clinical HistoryClinical History• Age:MiddleAge:Middle
– OveruseOveruse
Clinical HistoryClinical History
• Age: Mature Age: Mature – Lack of conditioningLack of conditioning
OnsetOnset
• Acute - TraumaticAcute - Traumatic– FractureFracture– DislocationDislocation
OnsetOnset
• Chronic - Overuse vs Chronic - Overuse vs MetabolicMetabolic
Nature of PainNature of Pain
• SharpSharp– Synovial or meniscalSynovial or meniscal
• ImpingementImpingement
– Loose bodiesLoose bodies
Nature of PainNature of Pain
• AchingAching– InflammatoryInflammatory
Nature of PainNature of Pain
• After ActivityAfter Activity– PatellaPatella– PlicaPlica
Site of PainSite of Pain
• Joint LineJoint Line
• Femoral CondyleFemoral Condyle
• PatellaPatella
Activity Activity RelatedRelated
• PositionalPositional
Activity RelatedActivity Related
• StairsStairs
Activity RelatedActivity Related
• Theatre SignTheatre Sign
AnatomyAnatomy
• Physical ExamPhysical Exam
• MethodicalMethodical
• PrecisePrecise
• ReproducibleReproducible
Physical ExamPhysical Exam
• ComparisonComparison
• MeasurementsMeasurements
• Bony & soft tissue Bony & soft tissue land marksland marks
DevelopmentalDevelopmental
• Bipartite patellaBipartite patella
• Osgood-SchlatterOsgood-Schlatter
Cystic AbnormalitiesCystic Abnormalities
• Meniscal cystMeniscal cyst
Cystic AbnormalitiesCystic Abnormalities
• Ganglion cystGanglion cyst
• Synovial osteochondrmatosisSynovial osteochondrmatosis
Inflammatory DisordersInflammatory Disorders
• BursitisBursitis– Pre-patellarPre-patellar
• TendinitisTendinitis– QuadricepsQuadriceps– PatellarPatellar
• Fat Pad SyndromeFat Pad Syndrome– TraumaticTraumatic– Post surgeryPost surgery
Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• ExamExam
Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• X-RaysX-Rays
Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• Cine MRICine MRI
Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• ArthroscopyArthroscopy
Surgical ProceduresSurgical Procedures
• Lateral Retinacular ReleaseLateral Retinacular Release
Surgical ProceduresSurgical Procedures
• Proximal RealignmentProximal Realignment– VMO PlicationVMO Plication
Surgical ProceduresSurgical Procedures
• Distal RealignmentDistal Realignment– Maquet ProcedureMaquet Procedure– Fulkerson OsteotomyFulkerson Osteotomy
Surgical Surgical ProceduresProcedures• PatellectomyPatellectomy
Anterior Knee Pain in Anterior Knee Pain in AthletesAthletes
Jerome F. Wall, MD, FACSJerome F. Wall, MD, FACS