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

2. 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

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

4. Clinical History Gender:Gender: –Females 2X Males

5. Clinical History Age: YoungAge: Young –Stresses of growth

6. Clinical History Age:MiddleAge:Middle –Overuse

7. Clinical History Age: MatureAge: Mature –Lack of conditioning

8. Onset Acute - TraumaticAcute - Traumatic –Fracture –Dislocation

9. Onset Chronic - Overuse vs MetabolicChronic - Overuse vs Metabolic

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

11. Nature of Pain AchingAching –Inflammatory

12. Nature of Pain After ActivityAfter Activity –Patella –Plica

13. Site of Pain Joint LineJoint Line Femoral CondyleFemoral Condyle PatellaPatella

14. Activity Related PositionalPositional

15. Activity Related StairsStairs

16. Activity Related Theatre SignTheatre Sign

17. Anatomy Physical ExamPhysical Exam MethodicalMethodical PrecisePrecise ReproducibleReproducible

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

19. Developmental Bipartite patellaBipartite patella Osgood-SchlatterOsgood-Schlatter

20. Cystic Abnormalities Meniscal cystMeniscal cyst

21. Cystic Abnormalities Ganglion cystGanglion cyst Synovial osteochondrmatosisSynovial osteochondrmatosis

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

23. Patellar Femoral Incongruencies ExamExam

24. Patellar Femoral Incongruencies X-RaysX-Rays

25. Patellar Femoral Incongruencies Cine MRICine MRI

26. Patellar Femoral Incongruencies ArthroscopyArthroscopy

27. Surgical Procedures Lateral Retinacular ReleaseLateral Retinacular Release

28. Surgical Procedures Proximal RealignmentProximal Realignment –VMO Plication

29. Surgical Procedures Distal RealignmentDistal Realignment –Maquet Procedure –Fulkerson Osteotomy

30. Surgical Procedures PatellectomyPatellectomy

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