2 year history of knee pain Henry B. Ellis MD

15 yo healthy male Remote history with direct blow to patella 3 yrs ago Fall onto patella playing baseball Treated by other orthopaedic XR and MRI negative 2 year history of anterior knee pain Now with mechanical symptoms and effusions Unable to return to baseball

Treatment Considerations Role for non-operative care? How do you protect trochlear/patellar lesions if treated non-operatively (limited ROM?) Related to remote history of direct impact with negative immediate post injury MRI?

From AL portal

Trochlea from AM portal

Treatment?

Treatment Considerations Open vs. Arthroscopic? Screws vs. pins? Metal vs. Bio Screws? Metal Screw removal? If so, when? Role of biologics? Use of autologous bone? Iliac crest vs. tibia? Consideration of primary osteochondral allograft

Open Arthrotomy

Bone Graft – Proximal Tibia

Open Arthrotomy with Grafting and Fixation Hinged Lesion Proximal Tibial Autologous Bone Graft Bone Marrow Concentrate 3 Accutrack Micro Screws Post Operative Protocol Weeks 0-2 Locked in Extension Non-weight bearing Patellar Mobs Weeks 2-6 WBAT locked in extension 0-90 x 2 weeks then FROM Isometric and quad sets in extension Weeks 6-12 Begin closed chain strengthening Wean Brace

4 months Post Op for HWR

Unstable lateral flap

Modified Microfracture?

8 Month

1 year Return to baseball No effusion No anterior knee pain No mechanical symptoms If symptoms returns?

scottishritehospital.org/sports TSRHC @TxScottishRite Thank You Henry.Ellis@tsrh.org 214-384-9797 scottishritehospital.org/sports TSRHC @TxScottishRite