Anterior Knee Pain in Anterior Knee Pain in AthletesAthletes

Jerome F. Wall, MD, FACSJerome F. Wall, MD, FACS

Anterior Knee Pain in AthletesAnterior Knee Pain in Athletes

• Most commonMost common

• Most disablingMost disabling

• Difficult to make Difficult to make accurate accurate diagnosisdiagnosis

• Long differential Long differential diagnosisdiagnosis

Anterior Knee Pain in AthletesAnterior Knee Pain in Athletes

• Response Related To:Response Related To:– Correct diagnosisCorrect diagnosis– Appropriate treatment Appropriate treatment

planplan– Appropriate Appropriate

rehabilitation programrehabilitation program

Clinical HistoryClinical History

• Gender:Gender:– Females 2X MalesFemales 2X Males

Clinical HistoryClinical History

• Age: YoungAge: Young– Stresses of growthStresses of growth

Clinical HistoryClinical History• Age:MiddleAge:Middle

– OveruseOveruse

Clinical HistoryClinical History

• Age: Mature Age: Mature – Lack of conditioningLack of conditioning

OnsetOnset

• Acute - TraumaticAcute - Traumatic– FractureFracture– DislocationDislocation

OnsetOnset

• Chronic - Overuse vs Chronic - Overuse vs MetabolicMetabolic

Nature of PainNature of Pain

• SharpSharp– Synovial or meniscalSynovial or meniscal

• ImpingementImpingement

– Loose bodiesLoose bodies

Nature of PainNature of Pain

• AchingAching– InflammatoryInflammatory

Nature of PainNature of Pain

• After ActivityAfter Activity– PatellaPatella– PlicaPlica

Site of PainSite of Pain

• Joint LineJoint Line

• Femoral CondyleFemoral Condyle

• PatellaPatella

Activity Activity RelatedRelated

• PositionalPositional

Activity RelatedActivity Related

• StairsStairs

Activity RelatedActivity Related

• Theatre SignTheatre Sign

AnatomyAnatomy

• Physical ExamPhysical Exam

• MethodicalMethodical

• PrecisePrecise

• ReproducibleReproducible

Physical ExamPhysical Exam

• ComparisonComparison

• MeasurementsMeasurements

• Bony & soft tissue Bony & soft tissue land marksland marks

DevelopmentalDevelopmental

• Bipartite patellaBipartite patella

• Osgood-SchlatterOsgood-Schlatter

Cystic AbnormalitiesCystic Abnormalities

• Meniscal cystMeniscal cyst

Cystic AbnormalitiesCystic Abnormalities

• Ganglion cystGanglion cyst

• Synovial osteochondrmatosisSynovial osteochondrmatosis

Inflammatory DisordersInflammatory Disorders

• BursitisBursitis– Pre-patellarPre-patellar

• TendinitisTendinitis– QuadricepsQuadriceps– PatellarPatellar

• Fat Pad SyndromeFat Pad Syndrome– TraumaticTraumatic– Post surgeryPost surgery

Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• ExamExam

Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• X-RaysX-Rays

Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• Cine MRICine MRI

Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• ArthroscopyArthroscopy

Surgical ProceduresSurgical Procedures

• Lateral Retinacular ReleaseLateral Retinacular Release

Surgical ProceduresSurgical Procedures

• Proximal RealignmentProximal Realignment– VMO PlicationVMO Plication

Surgical ProceduresSurgical Procedures

• Distal RealignmentDistal Realignment– Maquet ProcedureMaquet Procedure– Fulkerson OsteotomyFulkerson Osteotomy

Surgical Surgical ProceduresProcedures• PatellectomyPatellectomy

Anterior Knee Pain in Anterior Knee Pain in AthletesAthletes

Jerome F. Wall, MD, FACSJerome F. Wall, MD, FACS