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Ouch!Anterior Knee Pain
Dr Jonathan MulfordSydney 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 PatellaLateral patella overload Patellofemoral pain syndromePatellofemoral 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
HipSpine
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Patella Tendon
•Tendinopathy
• Osgood Slatter
•Sindig-Larsen-Johanssen
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Patella Tendinopathy
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Intra-articular Pathology/ Hoffa’s Fat Pad
• Plica Syndromes
• Hoffa’s Syndrome
• PVNS
• Meniscal Cyst/ Tear
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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 syndrome“Chondromalacia”
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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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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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Surgical Treatment Options for Chronic Patella Instability
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Isolated Patellofemoral OA• Often dysplastic with history instability
• Options include –Unloading procedures–Patellofemoral Arthroplasty