Surgical treatment of isolated patellofemoral osteoarthritis

Isolated patellofemoral osteoarthritis in the healthy middle-aged population is a challenging problem. Fifty-one knees in 50 patients with isolated patellofemoral osteoarthritis were treated by partial lateral facetectomy, lateral release, and medialization of the tibial tubercle. The minimum followup was 7 months (mean, 20.2 months; range, 7-32 months). Preoperative radiographs showed Ahlback Grades III and IV lateral patellofemoral joint space narrowing. The mean age of the patients was 60.1 years (range, 46-81 years). The subjective outcome was based on the WOMAC and the McCarroll score. Postero-anterior flexion weightbearing views, lateral views, and 45 degrees axial views were taken. According to the WOMAC score, the scores improved considerably by 2.34 points with respect to pain and by 1.63 points with respect to function. The Insall-Salvati index decreased considerably but still remained in the physiologic range. The majority of these patients experienced improvement in their patellofemoral symptoms. However, the clinical outcome was not better in comparison to other surgical procedures. After the short followup, we would not recommend combined lateral facetectomy, lateral release, and medialization of the tibial tubercle until longer results are available.