PATELLOFEMORAL PAIN AND ARTICULAR INJURY: WHAT CAN WE DO? Adam B Yanke
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1 PATELLOFEMORAL PAIN AND ARTICULAR INJURY: WHAT CAN WE DO? Adam B Yanke
2 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
3 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
4 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
5 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
6 Effusions? Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
7 Effusions? Prior Traumatic History Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
8 Instability Effusions? Pain Prior Traumatic History Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
9 Instability Effusions? Pain Prior Traumatic History Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
10 Instability Pain Effusions? Structural Abnormality Overload/ Maltracking Prior Traumatic History Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
11 Instability Pain Effusions? Structural Abnormality Overload/ Maltracking Prior Traumatic History Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
12 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
13 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
14 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
15 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
16 Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
17 Recognize Evaluate Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain Treat
18 Therapy Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
19 Therapy Abductors & Gluts Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
20 Therapy Abductors & Gluts Closed Chain Quads Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
21 Therapy Abductors & Gluts Closed Chain Quads Core Chronic Repetitive History: - Can t pinpoint when its happening - Difficulty with squatting or stairs - Anterior knee pain
22 21 y/o M, Hx of multiple L knee surgeries for Mx and loose bodies now with anterior knee pain Pt cannot get into prayer position Cannot play soccer or even do recreational workouts due to anterior knee pain and swelling Poor single leg squat No instability/apprehension
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27 PT HA x 3 Steroid x 2 Failed, next?
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29 Debridement - 13% had pre op articular damage on x-ray - 20% had localized defect - Full thickness lesion found in 11% of knees - 55% were >2cm2
30 Debridement Patients Biopsied 34% Implantation Rate 174 Not Implanted 90 Implanted 55% Implantation Rate 44 met inclusion 54 met inclusion
31 Debridement Patients Biopsied 34% Implantation Rate 174 Not Implanted 90 Implanted 55% Implantation Rate 44 met inclusion 54 met inclusion
32 Debridement Patients Biopsied 34% Implantation Rate 174 Not Implanted 90 Implanted 55% Implantation Rate 44 met inclusion 54 met inclusion
33 Debridement - First step mandatory
34 Debridement - First step mandatory Microfracture
35 Debridement - First step mandatory Microfracture
36 Microfracture OA Graft 28% Failure 55% survival at 15 years
37 Microfracture OA Graft ACI 80% success > 4 years
38 Microfracture OA Graft ACI AMZ - Cole - Minas - Peterson - Farr - Henderson +
39 Microfracture OA Graft ACI AMZ mm (Ferrandez) mm (Furguson) - Fulkerson 15mm (Fulkerson)
40 Microfracture OA Graft ACI AMZ + Don t medialize if normal TT-TG - 10mm (Ferrandez) mm (Furguson) - Fulkerson 15mm (Fulkerson)
41 Microfracture OA Graft ACI AMZ + Don t medialize if normal TT-TG - 10mm (Ferrandez) mm (Furguson) - Fulkerson 15mm (Fulkerson)
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48 REHABILITATION
49 REHABILITATION THANK YOU!
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