Dr. Peter McEwen - M.B.B.S. F.R.A.C.S(Ortho).F.A.Ortho.A.DipModLang - Surgery Knee Dr. Peter McEwen - Surgery Knee: (123) 456789
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Non Articular Conditions about the Knee

There are many potential pain generators about the knee. The mechanical intra-articular conditions that require surgical treatment are a subset of all the potential pain generators around the knee. Non Articular Conditions (NACS) are:

  1. Very common
  2. Frequently coexist with intra-articular pathologies
  3. Often respond well to simple non-surgical treatment
  4. Are often aggravated by surgical treatment of intra-articular pathologies
  5. Negatively impact on the results of surgical treatment of intra-articular pathologies
  6. Should be diagnosed and treated before surgical treatment of intra-articular pathologies

A list of common NACS that cause knee pain includes:

  1. Spinal stenosis
  2. Hip pathology (hip pathology frequently causes knee pain especially but no exclusively in children)
  3. Bursitis
  4. Insertional tendonitis

Hamstring tightness which can be quantified by measuring the knee extension angle (normal is less than 20 degrees) causes medial knee pain at the pes anserinus insertion on the tibia and is overwhelmingly the most common missed pathology I see in my rooms. It frequently coexists with knee OA and has a definite negative effect on TKR. Diagnostic criteria are a knee extension angle > 20 degrees and tenderness over the pes insertion (3 fingerbreadths below the joint line on the subcutaneous surface of the tibia. The condition responds rapidly to hamstring stretching and is best done prior to any surgery.

Knee Extension Angle. Supine with contralateral hip extended. Ipsilateral hip flexed 90 degrees. Knee extended until patient uncomfortable.

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