1. Knee pain n Dr Shrenik Shah n Shrey hospital n www.shockwavetherapyindia.com www.shockwavetherapyindia.com n www.eswtindia.com

2. etiology n Intraarticular- Acute/ overuse n extraarticular- u bursa u musculo -tendinous u ligaments n bony n referred - hip/spine n Paediatric- u Os Good Schlater’s disease u physeal injuries

3. Osteo arthritis n Age > 50 years n Clinical n x ray evidence n MRI

4. Extraarticular n PATB Syn-Pes Anserinus tendino bursitis syndrome n ITBS- iliotibial band syndrome n Jumper’s knee n Hoffa’s fat pad syndrome n Morant Baker’s cyst

5. PATB Syn n Semimembranosus n semitendinosus n sartorius

6. PATB CLINICAL

7. PATB

8. ITBS- ILIO TIBIAL BAND SYNDROME

10. Jumper’s knee

11. OA KNEE

13. OA KNEE MRI

14. OA KNEE USG

15. MORANT BAKER’S CYST

16. management n RSWT n DIACERIN- alpha interleukin 1 blocker- disease modifying drug for OA n Continue light exercises n Cycling as aerobics n Back to jogging

17. Osteonecrosis(ON) of the knee n SPONK- Spontaneous ON of the knee n Secondary ON of the knee n Postarthrosopic ON of the knee

18. SECONDARY ON OF KNEE CASE 1 n Young surgeon complained of pain in knee with some episodic effusion with occ feeling of giving way n No history of trauma, alcohol or medical problem n Xrays normal from time to time n Not relieved of symptoms with routine Rx n MRI detected bilateral ON of knee n Ficat and Arlet grade I

19. Knee pain in young patient with normal X rays

20. MRI before ESWT LYSHOLM SCORE 33

21. ESWT

22. 8 years follow up post ESWT LYSHOLM SCORE 94

23. Secondary ON knee case 2 n 27 years young male came with second opinion with proved ON of medial femoral condyle, a large lesion. Ficat and Arlet grade III n Pain, instability and limp with pain in right knee. n ESWT given to right knee with excellent recovery. Lysholm score 8  80. n Developed Rt hip pain after 3 years with AVN

24. Osteochondritis Dissecans of medial femoral condyle

26. 12 years follow up post ESWT

27. Final outcome

28. Case 3 n Middle aged house wife having vague knee pain and swelling in both knee with giving way and occ locking episodes. n Point tenderness at medial femoral condyles and no evident instabilty. n Ficat and Arlet grade III n Not responding to routine Rx

29. Pre ESWT

30. MRI PIC

31. MRI of both knee

32. ESWT to both knee

33. 6 months f/u

34. X rays at 3 years post ESWT

35. 4 YRS FOLLOW UP

36. FINAL OUTCOME Lysholm score 24  94

37. Os Good Schlater’s dis

38. Os Good Schlater’s dis RSWT

39. Thanks www.eswtindia.com