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Knee Pain Management: A Case Study in Shared Decision Making

Learn how a 67 y/o patient with persistent left knee pain post-arthroscopy was managed through a shared decision process, considering options like steroids, biologics, hyaluronic acid, and potential medial UKA. Explore treatment choices and their implications to improve patient outcomes.

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Knee Pain Management: A Case Study in Shared Decision Making

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  1. Thomas M. DeBerardino, MD Professor of Orthopaedic Surgery, Baylor College of Medicine Co-Director, Baylor-BRIO Texas Sports Medicine Fellowship Medical Director, Burkhart Research Institute for Orthopaedics TSAOG Orthopaedics

  2. History • 67 y/o w/ left knee pain s/p arthroscopy (7/31/18) • Did not offer preop biologics so A’scope could help with macroscopic disease and mechanical symptoms of catching and pseudo-locking • Partial medial and lateral meniscectomies, chondroplasty of MTP chondral flap lesion with hypertrophic plica and fat pad debridement • Patient considered potential candidate for medial UKA down the road but unable to use crutches now as he is s/p more recent right shoulder RCR with tuberosity fracture • Still with persistent left knee effusions and some isolated medial pain

  3. What to Do?

  4. Treatment Options

  5. Treatment Options • Steroids

  6. Treatment Options • Steroids • Biologics

  7. Treatment Options • Steroids • Biologics • HA

  8. Treatment Options • Steroids • Biologics • HA • UKA

  9. Vote for Your Preference • Steroids • Biologics • HA • UKA

  10. What I did… • Shared Decision process lead to left knee ACP injection, 6 weeks after knee scope on 9/4/18 • Goal- buy more time before more invasive surgery, medial UKA • Cannot be on crutches or a walker for several more months with healing rotator cuff repair

  11. What I did…and why • Steroids not great option since patellofemoral and lateral compartments are essentially normal. No sense putting “RoundUp” in his knee and chemically “cook” all his good cartilage • Patient now has NO left medial knee pain, his right shoulder is working through cuff rehab postoperatively • He is happy he had an option to help with his left knee to at least temporize his symptoms without burning any bridges and still potentially undergo left knee medial UKA in the future

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