1. Ouch! Anterior Knee Pain Dr Jonathan Mulford Sydney Orthopaedic Specialists Prince of Wales Private

2. It is Common 20-40% of all knee problems. Commonly 2 nd and 3 rd decade. 30% 0f teenages. 40% men and 60% women.

3. Common but difficult! Not well understood. Confusing terminology

4. Why is it a “PAIN”?

5. CONFUSING TERMINOLOGY Chondromalacia Patella Lateral patella overload Patellofemoral pain syndrome Patellofemoral Arthralgia

6. CAUSE OF PAIN DUE TO MULTIPLE FACTORS

7. B ETTER UNDERSTANDING OF ANATOMY AND BIOMECHANICS Bone

8. LOWER LIMB BONE ALIGNMENT AND ROTATIONAL PROFILE

9. STATIC SOFT TISSUE RESTRAINTS

10. DYNAMIC SOFT TISSUE RESTRAINTS

11. ANTERIOR KNEE PAIN, ACCORDING TO SITE. Allows to review commonest causes of knee pain

12. REFERRED ANTERIOR KNEE PAIN Hip Spine

13. Patella Tendon Tendinopathy Osgood Slatter Sindig-Larsen-Johanssen

14. Patella Tendinopathy

15. Osgood-Schlatter

16. Intra-articular Pathology/ Hoffa’s Fat Pad Plica Syndromes Hoffa’s Syndrome PVNS Meniscal Cyst/ Tear

17. Cyst

18. Medial Plicae

19. Hoffa

21. Bursitis Prepatellar Pes ancerine

23. Patella Instability Patellofemoral OA Patello-femoral pain syndrome (PFPS)

24. Patellofemoral pain syndrome “Chondromalacia”

25. Physiotherapy – Most improve

26. - Quadriceps excercise program utilising closed chain excercises - Trial patella taping

27. Acute Dislocation

28. Chronic Instability Requires investigating to determine best treatment.

29. OA

30. Diagnosis Not Clear Cut My Approach

31. Hx Age Occupation Sport Change in activity Trauma Instability

33. Examination Generalised laxity Lower Limb Alignment Feature of the patella – Height, – Size, – Mobility, – Tilt. Q angle Tracking – J sign

34. Investigation XR CT MRI

35. XR AP – exclude osteochondral pathology Lateral – patella alta, trochlea dysplasia Skyline – numerous measurements

38. CT

39. MRI

40. Arthroscopy

41. Surgical Treatment Options for Chronic Patella Instability

43. Trochleoplasty

46. Isolated Patellofemoral OA Often dysplastic with history instability Options include – Unloading procedures – Patellofemoral Arthroplasty

49. Thankyou