Anterior Knee Pain in Athletes

1
Anterior Knee Pain in Athletes

• Jerome F. Wall, MD, FACS

2
Anterior Knee Pain in Athletes

• Most common
• Most disabling
• Difficult to make accurate diagnosis
• Long differential diagnosis

3
Anterior Knee Pain in Athletes

• Response Related To
• Correct diagnosis
• Appropriate treatment plan
• Appropriate rehabilitation program

4
Clinical History

• Gender
• Females 2X Males

5
Clinical History

• Age Young
• Stresses of growth

6
Clinical History

• AgeMiddle
• Overuse

7
Clinical History

• Age Mature
• Lack of conditioning

8
Onset

• Acute - Traumatic
• Fracture
• Dislocation

9
Onset

• Chronic - Overuse vs Metabolic

10
Nature of Pain

• Sharp
• Synovial or meniscal
• Impingement
• Loose bodies

11
Nature of Pain

• Aching
• Inflammatory

12
Nature of Pain

• After Activity
• Patella
• Plica

13
Site of Pain

• Joint Line
• Femoral Condyle
• Patella

14
Activity Related

• Positional

15
Activity Related

• Stairs

16
Activity Related

• Theatre Sign

17
Anatomy

• Physical Exam
• Methodical
• Precise
• Reproducible

18
Physical Exam

• Comparison
• Measurements
• Bony soft tissue land marks

19
Developmental

• Bipartite patella
• Osgood-Schlatter

20
Cystic Abnormalities

• Meniscal cyst

21
Cystic Abnormalities

• Ganglion cyst
• Synovial osteochondrmatosis

22
Inflammatory Disorders

• Bursitis
• Pre-patellar
• Tendinitis
• Quadriceps
• Patellar
• Fat Pad Syndrome
• Traumatic
• Post surgery

23
Patellar Femoral Incongruencies

• Exam

24
Patellar Femoral Incongruencies

• X-Rays

25
Patellar Femoral Incongruencies

• Cine MRI

26
Patellar Femoral Incongruencies

• Arthroscopy

27
Surgical Procedures

• Lateral Retinacular Release

28
Surgical Procedures

• Proximal Realignment
• VMO Plication

29
Surgical Procedures

• Distal Realignment
• Maquet Procedure
• Fulkerson Osteotomy

30
Surgical Procedures

• Patellectomy

31
Anterior Knee Pain in Athletes

• Jerome F. Wall, MD, FACS