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Anterior Knee Pain: A Diagnostic Conundrum Brian Sabb, DO J. David Blaha, MD  Department of Orthopaedic Surgery
Disclosure of Commercial Interest ,[object Object]
Objectives ,[object Object],[object Object],[object Object]
Anterior Knee Pain Anatomical Categorization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prepatellar Bursitis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prepatellar Bursitis PD PD FAT SAT
Prepatellar Bursitis PD PD FAT SAT T2 FAT SAT
Quadriceps Fat Pad Edema ,[object Object],[object Object],[object Object],Shabshin, Skeletal Radiology. 2006 May; 35(5): 269-74  Roth, AJR. 2004 Jun;182(6):1383-7
Quadriceps Fat Pad Edema PD PD FAT SAT T2 FAT SAT
Infrapatellar Fat Pad of Hoffa ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hoffa’s Disease ,[object Object],[object Object],[object Object],[object Object]
Hoffa’s Disease PD PD FAT SAT
Localized Nodular Synovitis ,[object Object],[object Object],[object Object],[object Object]
Localized Nodular Synovitis PD PD FAT SAT T2 FAT SAT
Pigmented Villonodular Synovitis (PVNS) ,[object Object],[object Object],[object Object],[object Object]
Pigmented Villonodular Synovitis (PVNS) PD PD FAT SAT T2 FAT SAT
Intraarticular Chondroma ,[object Object],[object Object],[object Object],[object Object]
Intraarticular Chondroma PD PD FAT SAT T2 FAT SAT
Infrapatellar Plica Injury ,[object Object],[object Object],[object Object],Cothran, AJR 2003; 180(5): 1443-1447
Infrapatellar Plica Injury PD PD FAT SAT T2 FAT SAT
Extensor Mechanism Pathology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patellar Tendinosis ,[object Object],[object Object],[object Object],[object Object]
Patellar Tendinosis PD PD FAT SAT T2 FAT SAT
Patellar Tendon Tear ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complete Patellar Tendon Tear PD FAT SAT Longitudinal Ultrasound
Quadriceps Tendon Tear ,[object Object],[object Object],[object Object],[object Object],[object Object]
Quadriceps Tendon Tear Full thickness tear by MR with diastasis of fibers filled by  high T2  fluid and and by longitudinal US with  hypoechoic  fluid PD FAT SAT
PD FAT SAT Complete Quadriceps Tendon Tear PD Note: patella baja
Intrinsic Patellar Tendon  Lesion: Gout ,[object Object],[object Object]
Gout of The Patellar Tendon PD PD FAT SAT T2 FAT SAT T2 FAT SAT T2 FAT SAT
Gout of The Patellar Tendon by US Intratendinous Crystals Peripheral hyperemia Shadowing
Enthesopathy of The Patella ,[object Object],[object Object],[object Object],[object Object],[object Object]
Psoriasis PD PD FAT SAT PD FAT SAT
Ankylosing Spondylitis
Ankylosing Spondylitis PD PD FAT SAT T2 FAT SAT T1 Extensive bone marrow edema and associated enthesitis
Reactive Arthritis
Osgood Schlatter Disease ,[object Object],[object Object]
Sequela of  Osgood Schlatter PD PD FAT SAT T2 FAT SAT T1 Note the irregularity and edema causing recurrent and chronic pain
Patellar Malalignment ,[object Object],[object Object],[object Object]
Transient Patellar Dislocation ,[object Object],[object Object],[object Object],[object Object]
Transient Patellar Dislocation Lateral femoral condyle T2 FAT SAT Medial patella
Excessive Lateral Pressure    Syndrome (ELPS) ,[object Object],[object Object],[object Object],[object Object]
January 2001 at 27 years old August 2005  at 31 years old Excessive Lateral Pressure Syndrome T2 FAT SAT T2 FAT SAT The OA renders treatment/surgery less effective Suggest the diagnosis based on the tilt; prior to OA Images courtesy of Mark Schweitzer, MD
Patellar Tendon-Lateral Femoral Condyle Friction Syndrome ,[object Object],[object Object],[object Object],[object Object],Chung, Skeletal Radiology 2001 Nov; 39: 694-697
Patellar Tendon Lateral Femoral  Condyle Friction Syndrome PD FAT SAT Cor FAT SAT T2 FAT SAT The alta allows for the contact between the tendon and the femoral condyle
Patellar Abnormalities ,[object Object],[object Object],[object Object]
Bipartite Patella ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipartite Patella PD FAT SAT T2 FAT SAT Cor T2 FAT SAT Note the accessory ossicle is typically  superolateral Bone marrow edema and cystic changes correlate with pain Cor T1
Multipartite Patella T2 FAT SAT Cor T2 FAT SAT Cor T2 FAT SAT T1 Note the typical  superolateral  fragments
Patellar Fracture ,[object Object],[object Object],[object Object],[object Object]
Patellar Fracture
Patellar Fracture Axial CT showing a lipohemarthrosis
Corresponding Author: Brian Sabb [email_address]

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Anterior Knee Pain By Dr. Brian Sabb

Notas del editor

  1. Decrease the lateralization of the patella