TREATMENT OF PATELLOFEMORAL OSTEOARTHRITIS WITH INSALL PROXIMAL REALIGNMENT COMBINED WITH PARTIAL LATERAL FACETECTOMY

Abstract

Purpose: Our purpose was to study the 10-year results of a proximal soft-tissue procedure combined with a Lateral Patellar Facetectomy technique for an isolated osteoarthritis of patellofemoral joint.

Methods: The study group included 39 knees (30 patients). There were 19 female and 11 male patients. Mean age 52 years old (range 40–65). All patients were evaluated at a mean follow-up of 10 years. The indications for surgery were instability of patellofemoral joint with isolated arthritis. Patient outcome scores, patient demographics, and data from a physical examination, x-Ray and TC were collected before and after surgery. A release of the lateral patellofemoral ligament and a retinacular release were performed, leaving the synovial tissue intact to isolate the joint. The lower fibers of the vastus lateralis were released as well, and the release was carried down to the level of the tubercle. Medially, an imbrication of the medial retinacular tissue from the medial aspect of the quadriceps tendon to the proximal aspect of the tibial tubercle, as Insall described, was performed.

Results: At final follow-up, the results were excellent or good in 89% of the knees, fair in 7%, and poor in 3%. Subjective improvement was reported by 90% of patients. Follow-up radiographs showed slow progression of osteoarthritis in the patellofemoral and tibiofemoral compartments, but radiographic appearance did not always correlate with clinical symptoms. The success of this procedure depends largely on relief of pain.

Conclusions: proximal soft-tissue realignment combined with a Lateral Patellar Facetectomy for a severe isolated osteoarthritis of patellofemoral joint is a powerful way to correct malalignment and offload the lateral and distal parts of the patella. This technique relief pain and improved the activity level. Is an effective surgical treatment for middle-aged to elderly active patients with isolated lateral patellofemoral osteoarthritis who want to maintain activity level.