Podiatry Arena members do not see these ads

Hi all

Please advise.

I am curremtly treating a long distance athlete who presents with pain in his knee, "behind and towards the middle" of his patella, right leg.

Clinical examination revealed the following findings;[list=1][*]Abducted, everted gait[*]Functional Pes Plano-valgus[*]Hypermobility, especially at the STJ[*]Tibial retro-torsion on dynamic gait

I have diagnosed and am wanting to treat his chondromalacia patella (CMP) conservativley first, including physio and orthotics for both his running and day-to-day shoes. His orthopaedic sugeon wants however to perform an arthroscopy.

Clearly the conservative approach to CMP offers a great prognosis with follow up and compliance, yet the orthopod, according to the patient offers a compelling argumant for immediate arthroscopy.

It is the patients intention to be minimally off from training and so he is considering the arthroscopy. My argument of conservative managemnt offers a longer term approach and a good outcome yet with minimal time sacrifices in measurable results.

If it weren't for the fact that arthroscopy will offer little or no long term benefit, in my opinion, in this case, and the patient will eventually need orthotics anyway, with worsening of his symptoms, I would not be so persistent.

Any thoughts for or against either option? If against arthroscopy, please help with some compelling reasons to convice patient ortherwise (besides the obvious).

Thanks

Brandon Maggen