knee

Fat Pad Syndrome

Definition

 

Hoffa's syndrome

- impingement of the fat pad with knee ROM

 

Epidemiology

 

Rare

Diagnosis of exclusion

 

Theory

 

May be more prevalent in patients with intact ligamentum mucosum

 

Diagnosis

 

Hoffa's sign

- apply pressure to fat pad each side of patella tendon with knee in flexion

- extend knee

Knee

ApproachesPosterior approach knee

 

Medial Parapatellar

Medial

Lateral

Posterior

Modified Posterior

 

Medial Parapatellar Approach

 

Indications

 

Synovectomy 

Patellectomy 

TKR

 

Technique

 

PVNS

Definition

 

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

 

Epidemiology

 

Age: 20 - 50

Sex: M > F

 

Types

 

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

 

Synovial Chondromatosis

DefinitionSynovial Chondromatosis Knee MRI

 

Chondroid Metaplasia of synovium affecting large joints

 

Nodules of hyaline cartilage

- formed in the subsynovial layer of joint capsules

 

Epidemiology

 

Rare lesion

Most common in 20's and 30's

Sex: M > F (2:1)

Monoarticular

 

Site

 

Mass Behind Knee

DDxPosterior knee mass

 

Baker's Cyst

Popliteal Anerysm

Soft tissue sarcoma

Osteosarcoma / Parosteal OS

Hemangioma / AVM

 

Note:

 

Always do xray for calcification

A Bakers cyst / aneurysm can be calcified

 

 

 

Patellar tendonitis

Definition

 

Patellar Tendinitis

 

Epidemiology

 

Most common in athletes

- especially if involved in running, jumping and kicking

- over use injury

 

Basketball players

 

Aetiology

 

Chronic overload v inferior patella impingement

 

Schmidt et al Am J Sports Med

- dynamic MRI in patients with jumper's knee v controls

- no evidence of impingemnt

Knee & Foot

Principles

 

Foot

 

A little equinus is better than calcaneus

A little valgus is better than varus

A little varus is better than severe valgus

TA lengthening is most over used operation in CP

 

Knee

 

A little knee flexion is better than recurvatum

 

Knees

 

Problems

 

Tight hamstrings