Patellofemoral ArthritisDespite the relatively high rate of incidence of patellofemoral
arthritis, it has traditionally been resistant to treatment. Because
of the numerous factors at work with normal functioning of the
patellofemoral joint, determining the the cause of abnormal functioning has proven difficult. Further complicating the matter, is the multitude of opinions concerning the best course of action to treatment the condition. This article reviews many ways that patellofemoral arthritis may be approached and the precise conditions that favor one treatment plan over another. It is hoped that as understanding of the condition and the complexities involved grow, so too will the ability to treat the condition.
Patellofemoral arthritis is often managed with nonsurgical treatment
initially. Therapy programs using stretching and strengthening
techniques to maintain motion and function have been shown to
effectively mitigate the symptoms of the condition. Anti-inflammatory
medications and corticosteroid injections may provide additional
support to correct the problem. Current testing is also beginning to
highlight the effectiveness of patellar sleeves, braces, or taping in
managing the condition.
For those whose arthritis fails to respond to these conservative
treatments, there exist many surgical options. Lateral facetectomy has
historically proven to be a simple, effective means of treatment for
middle-aged to elderly patients who wish to maintain their activity
level. Lateral release, though not recommended in cases of
instability, has also demonstrated effectiveness in resolving
conditions that involve patellar tilt without subluxation. Though not
fit for younger patient populations, total knee arthroplasty has
long-proved an effective way of managing the condition. The procedure
remains the most proven and predictable single procedure for older
patients with patellofemoral disease.
But recent studies have also drawn attention to the effectiveness of
autologous chondrocyte implantation. As with the other surgical
procedures for patellofemoral arthritis, implantation requires careful
diagnosis of the underlying causes and accurate identification of
positive surgical conditions concerning the architecture of the joint
space and durability of the surrounding cartilage. But with proper
suture technique and soft-tissue tensioning, implantation can restore
articular surface shape as well as normal movement and glide.
Tibial tubercle transfer is another procedure that has gained recent
attention. Though complications and concerns have traditionally
cautioned against its use, early studies are beginning to suggest the
niche role the procedure may have in cases where lesions are also
present. Younger patients have proven particularly well-suited for the
procedure as the incidence of skin necrosis and nonunion are greatly
reduced. With appropriately selected patients, tibial tubercle
transfer offers the ability to resume one's activity level with much
These advances offer hope that the difficulty that has surrounded the
management of patellofemoral arthritis may be minimized in the future
and may improve outcomes that have typically been less than optimal.
Reuven B. Minkowitz, MD, Joseph A. Bosco III, MD. Patellofemoral
Arthritis. In Bulletin of the NYU Hospital for Joint Diseases. 2010.
Vol. 68. Supplement 1. Pp. S13-S21.
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