anterior knee pain in athletes jerome f. wall, md, facs
TRANSCRIPT
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Anterior Knee Pain in Anterior Knee Pain in AthletesAthletes
Jerome F. Wall, MD, FACSJerome F. Wall, MD, FACS
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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
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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
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Clinical HistoryClinical History
• Gender:Gender:– Females 2X MalesFemales 2X Males
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Clinical HistoryClinical History
• Age: YoungAge: Young– Stresses of growthStresses of growth
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Clinical HistoryClinical History• Age:MiddleAge:Middle
– OveruseOveruse
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Clinical HistoryClinical History
• Age: Mature Age: Mature – Lack of conditioningLack of conditioning
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OnsetOnset
• Acute - TraumaticAcute - Traumatic– FractureFracture– DislocationDislocation
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OnsetOnset
• Chronic - Overuse vs Chronic - Overuse vs MetabolicMetabolic
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Nature of PainNature of Pain
• SharpSharp– Synovial or meniscalSynovial or meniscal
• ImpingementImpingement
– Loose bodiesLoose bodies
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Nature of PainNature of Pain
• AchingAching– InflammatoryInflammatory
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Nature of PainNature of Pain
• After ActivityAfter Activity– PatellaPatella– PlicaPlica
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Site of PainSite of Pain
• Joint LineJoint Line
• Femoral CondyleFemoral Condyle
• PatellaPatella
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Activity Activity RelatedRelated
• PositionalPositional
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Activity RelatedActivity Related
• StairsStairs
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Activity RelatedActivity Related
• Theatre SignTheatre Sign
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AnatomyAnatomy
• Physical ExamPhysical Exam
• MethodicalMethodical
• PrecisePrecise
• ReproducibleReproducible
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Physical ExamPhysical Exam
• ComparisonComparison
• MeasurementsMeasurements
• Bony & soft tissue Bony & soft tissue land marksland marks
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DevelopmentalDevelopmental
• Bipartite patellaBipartite patella
• Osgood-SchlatterOsgood-Schlatter
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Cystic AbnormalitiesCystic Abnormalities
• Meniscal cystMeniscal cyst
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Cystic AbnormalitiesCystic Abnormalities
• Ganglion cystGanglion cyst
• Synovial osteochondrmatosisSynovial osteochondrmatosis
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Inflammatory DisordersInflammatory Disorders
• BursitisBursitis– Pre-patellarPre-patellar
• TendinitisTendinitis– QuadricepsQuadriceps– PatellarPatellar
• Fat Pad SyndromeFat Pad Syndrome– TraumaticTraumatic– Post surgeryPost surgery
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Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• ExamExam
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Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• X-RaysX-Rays
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Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• Cine MRICine MRI
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Patellar Femoral Patellar Femoral IncongruenciesIncongruencies• ArthroscopyArthroscopy
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Surgical ProceduresSurgical Procedures
• Lateral Retinacular ReleaseLateral Retinacular Release
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Surgical ProceduresSurgical Procedures
• Proximal RealignmentProximal Realignment– VMO PlicationVMO Plication
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Surgical ProceduresSurgical Procedures
• Distal RealignmentDistal Realignment– Maquet ProcedureMaquet Procedure– Fulkerson OsteotomyFulkerson Osteotomy
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Surgical Surgical ProceduresProcedures• PatellectomyPatellectomy
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Anterior Knee Pain in Anterior Knee Pain in AthletesAthletes
Jerome F. Wall, MD, FACSJerome F. Wall, MD, FACS