Ouch!Anterior Knee Pain

Dr Jonathan MulfordSydney Orthopaedic Specialists

Prince of Wales Private

It is Common• 20-40% of all knee

problems.

• Commonly 2nd and 3rd decade.

• 30% 0f teenages.

• 40% men and 60% women.

Common but difficult!

• Not well understood.

• Confusing terminology

Why is it a “PAIN”?

CONFUSING TERMINOLOGY

Chondromalacia PatellaLateral patella overload Patellofemoral pain syndromePatellofemoral Arthralgia

CAUSE OF PAIN DUE TO MULTIPLE FACTORS

BETTER UNDERSTANDING OF ANATOMY AND BIOMECHANICS

Bone

LOWER LIMB BONE ALIGNMENT AND ROTATIONAL PROFILE

STATIC SOFT TISSUE RESTRAINTS

DYNAMIC SOFT TISSUE RESTRAINTS

ANTERIOR KNEE PAIN,ACCORDING TO SITE.

Allows to review commonest causes of knee pain

REFERRED ANTERIOR KNEE PAIN

HipSpine

Patella Tendon

•Tendinopathy

• Osgood Slatter

•Sindig-Larsen-Johanssen

Patella Tendinopathy

Osgood-Schlatter

Intra-articular Pathology/ Hoffa’s Fat Pad

• Plica Syndromes

• Hoffa’s Syndrome

• PVNS

• Meniscal Cyst/ Tear

Cyst

Medial Plicae

• Hoffa

Bursitis• Prepatellar• Pes ancerine

Patella

• Instability• Patellofemoral OA• Patello-femoral pain syndrome

(PFPS)

Patellofemoral pain syndrome“Chondromalacia”

Physiotherapy – Most improve

- Quadriceps excercise program utilising closed chain excercises

- Trial patella taping

Acute Dislocation

Chronic Instability

• Requires investigating to determine best treatment.

OA

Diagnosis Not Clear Cut

• My Approach

Hx

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

Examination• Generalised laxity• Lower Limb Alignment• Feature of the patella– Height ,– Size , –Mobility, – Tilt .

• Q angle• Tracking – J sign

Investigation

• XR • CT• MRI

XR

• AP – exclude osteochondral pathology

• Lateral – patella alta, trochlea dysplasia

• Skyline – numerous measurements

CT

MRI

Arthroscopy

Surgical Treatment Options for Chronic Patella Instability

Trochleoplasty

Isolated Patellofemoral OA• Often dysplastic with history instability

• Options include –Unloading procedures–Patellofemoral Arthroplasty

Thankyou