Ouch! Anterior Knee Pain

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Ouch!Anterior Knee Pain

• Dr Jonathan Mulford
• Sydney Orthopaedic Specialists
• Prince of Wales Private

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It is Common

• 20-40 of all knee problems.
• Commonly 2nd and 3rd decade.
• 30 0f teenages.
• 40 men and 60 women.

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Common but difficult!

• Not well understood.
• Confusing terminology

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Why is it a PAIN?
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Confusing Terminology

• Chondromalacia Patella
• Lateral patella overload
• Patellofemoral pain syndrome
• Patellofemoral Arthralgia

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Cause of Pain due to Multiple Factors
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Better Understanding of Anatomy and Biomechanics

• Bone

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Lower limb Bone Alignment and Rotational Profile
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Static Soft tissue Restraints
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Dynamic Soft Tissue Restraints
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Anterior Knee Pain,According to Site.

• Allows to review commonest causes of knee pain

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Referred Anterior Knee Pain

• Hip
• Spine

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Patella Tendon

• Tendinopathy
• Osgood Slatter
• Sindig-Larsen-Johanssen

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Patella Tendinopathy
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Osgood-Schlatter
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Intra-articular Pathology/ Hoffas Fat Pad

• Plica Syndromes
• Hoffas Syndrome
• PVNS
• Meniscal Cyst/ Tear

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Cyst
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Medial Plicae
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• Hoffa

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Bursitis

• Prepatellar
• Pes ancerine

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Patella

• Instability
• Patellofemoral OA
• Patello-femoral pain syndrome (PFPS)

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Patellofemoral pain syndromeChondromalacia
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Physiotherapy Most improve
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- Quadriceps excercise program utilising
closed chain excercises - Trial patella taping
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Acute Dislocation
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Chronic Instability

• Requires investigating to determine best
  treatment.

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OA
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Diagnosis Not Clear Cut

• My Approach

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Hx

• Age
• Occupation
• Sport
• Change in activity
• Trauma
• Instability

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Examination

• Generalised laxity
• Lower Limb Alignment
• Feature of the patella
• Height ,
• Size ,
• Mobility,
• Tilt .
• Q angle
• Tracking J sign

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Investigation

• XR
• CT
• MRI

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XR

• AP exclude osteochondral pathology
• Lateral patella alta, trochlea dysplasia
• Skyline numerous measurements

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CT
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MRI
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Arthroscopy
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Surgical Treatment Options for Chronic Patella
Instability
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Trochleoplasty
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Isolated Patellofemoral OA

• Often dysplastic with history instability
• Options include
• Unloading procedures
• Patellofemoral Arthroplasty

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Thankyou