1. 2 year history of knee pain
Henry B. Ellis MD

2. 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

10. 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?

11. From AL portal

12. Trochlea from AM portal

14. Treatment?

15. 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

16. Open Arthrotomy

17. Bone Graft – Proximal Tibia

19. 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

20. 4 months Post Op for HWR

21. Unstable lateral flap

23. Modified Microfracture?

24. 8 Month

27. 1 year Return to baseball No effusion No anterior knee pain
No mechanical symptoms
If symptoms returns?

28. scottishritehospital.org/sports TSRHC @TxScottishRite
Thank You
scottishritehospital.org/sports TSRHC @TxScottishRite