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

Why is it a “PAIN”?

CONFUSING TERMINOLOGY Chondromalacia Patella Lateral patella overload Patellofemoral pain syndrome Patellofemoral Arthralgia

CAUSE OF PAIN DUE TO MULTIPLE FACTORS

B ETTER 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 Hip Spine

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