Anterior Knee Pain in Athletes Jerome F. Wall, MD, FACS

Anterior Knee Pain in Athletes Most commonMost common Most disablingMost disabling Difficult to make accurate diagnosisDifficult to make accurate diagnosis Long differential diagnosisLong differential diagnosis

Anterior Knee Pain in Athletes Response Related To:Response Related To: –Correct diagnosis –Appropriate treatment plan –Appropriate rehabilitation program

Clinical History Gender:Gender: –Females 2X Males

Clinical History Age: YoungAge: Young –Stresses of growth

Clinical History Age:MiddleAge:Middle –Overuse

Clinical History Age: MatureAge: Mature –Lack of conditioning

Onset Acute - TraumaticAcute - Traumatic –Fracture –Dislocation

Onset Chronic - Overuse vs MetabolicChronic - Overuse vs Metabolic

Nature of Pain SharpSharp –Synovial or meniscal ImpingementImpingement –Loose bodies

Nature of Pain AchingAching –Inflammatory

Nature of Pain After ActivityAfter Activity –Patella –Plica

Site of Pain Joint LineJoint Line Femoral CondyleFemoral Condyle PatellaPatella

Activity Related PositionalPositional

Activity Related StairsStairs

Activity Related Theatre SignTheatre Sign

Anatomy Physical ExamPhysical Exam MethodicalMethodical PrecisePrecise ReproducibleReproducible

Physical Exam ComparisonComparison MeasurementsMeasurements Bony & soft tissue land marksBony & soft tissue land marks

Developmental Bipartite patellaBipartite patella Osgood-SchlatterOsgood-Schlatter

Cystic Abnormalities Meniscal cystMeniscal cyst

Cystic Abnormalities Ganglion cystGanglion cyst Synovial osteochondrmatosisSynovial osteochondrmatosis

Inflammatory Disorders BursitisBursitis –Pre-patellar TendinitisTendinitis –Quadriceps –Patellar Fat Pad SyndromeFat Pad Syndrome –Traumatic –Post surgery

Patellar Femoral Incongruencies ExamExam

Patellar Femoral Incongruencies X-RaysX-Rays

Patellar Femoral Incongruencies Cine MRICine MRI

Patellar Femoral Incongruencies ArthroscopyArthroscopy

Surgical Procedures Lateral Retinacular ReleaseLateral Retinacular Release

Surgical Procedures Proximal RealignmentProximal Realignment –VMO Plication

Surgical Procedures Distal RealignmentDistal Realignment –Maquet Procedure –Fulkerson Osteotomy

Surgical Procedures PatellectomyPatellectomy

Anterior Knee Pain in Athletes Jerome F. Wall, MD, FACS