chapter 13: Surgical Treatment of Patellofemoral Chondrosis and Arthrosis

"Act as the creator of a statue that is to be made beautiful: cut away here, smooth there, make this line lighter, the other purer, until a lovely face has grown upon the work."

Plotinus, 270 AD

"To the creator there is no poverty and no poor, in­different place"

Rilke, 1934

Historically, there have been many operations designed to treat patients with patellar arthrosis. Surgical alternatives range from arthroscopic debridement to patellofemoral joint arthroplasty. The primary goal of this textbook is to enhance accurate decision making before any treatment for a patellofemoral disorder, with emphasis on surgical procedures that are likely to correct a specific, defined mechanical disorder as deter­mined by careful clinical evaluation and appropriate studies.

Expanded knowledge of anatomy, physiology, and disease process permits improved surgical care of patients with patellofemoral disorders. New imaging techniques have enhanced the understanding of patellofemoral dysfunction from the mechanical and anatomic perspectives. Arthroscopy is helpful in the diagnosis and treatment of some patellofemoral disorders. Surgical intervention can be tailored more specifically now to each patient, thanks to improved diagnostic techniques. Although a surgeon can deter­mine appropriate surgical correction of patellofemoral disorders more accurately than in the past, it is perhaps even more important that he/she can cure more patients with­out surgery and avoid operating on patellofemoral pain patients who do not have a spe­cific, correctable, mechanical disorder.

It is imperative that a full course of nonoperative treatment has been tried before contemplating surgery. Nonetheless, once articular degeneration has progressed to a point that arthrosis has caused chronic disability and persistent pain, surgical inter­vention may become necessary.

Surgical treatment alternatives are different for patellofemoral pain patients with ad­vanced patellar arthrosis as compared with patients with minimal cartilage softening or fibrillation. One can best evaluate patellofemoral articular cartilage conditions by ra­diographic studies and arthroscopy. Radiographic evaluation of such patients has been reviewed in Chapter 4.




Inside Chapter 13: