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Patellofemoral Joint Problems

By 15 July 2012February 20th, 2024No Comments

Patellofemoral joint problems of unfortunately one of the most difficult conditions in orthopaedics to manage effectively. This is in a large part due to the fact that the patellofemoral articulation (kneecap joint) is one of the most biomechanically disadvantaged joints in the body. Massive shear forces are imparted to the joint during activities of daily living and it is virtually impossible to unload this joint.

Kneecap instability is most commonly a problem in teenage girls and often responds well to conservative treatment (physiotherapy and muscle strengthening with initial brace immobilisation for eight weeks). Diagnosis is based on a thorough clinical examination as well as specialised x-ray investigations, which may involve a CT scan. This problem tends to resolve as the patient ages and the ligaments become less lax. If a kneecap continues to dislocate repeatedly despite adequate conservative treatment, a cause needs to be identified. Surgical correction of the specific bone- or soft tissue abnormality may then be offered to the patient. While this type of surgery is performed by both surgeons at the Cape Joint Surgery, we view this as an option of last resort. There is a significant incidence of cartilage- or osteochondral fracture with patella dislocations and these injuries should therefore not be taken lightly, as early surgical management of these osteo-cartilaginous injuries is usually indicated.

Patellofemoral arthritis is a common finding and is one of the leading causes of anterior knee pain. If it occurs in combination with medial and lateral compartment arthritis of the knee joint, the appropriate surgical treatment is a total knee replacement. As a rule, the kneecap is not resurfaced during knee replacement procedures by any of the surgeons at the Cape Joint Surgery. Exceptions to this rule would include patients with inflammatory arthritis. We find consistently good results with this policy.

If patellofemoral arthritis occurs in isolation, this becomes an extremely difficult problem to treat. Once conservative treatment has been exhausted, arthroscopic debridement of unstable cartilage flaps as well as potential kneecap realignment through a lateral soft tissue release may be carried out. Cartilage regeneration procedures are not performed in patellofemoral arthritis, due to the fact that the joint can not be adequately unloaded in order to protect the repair. If these procedures should prove to be unsuccessful, isolated patellofemoral joint replacement may be performed. This procedure is only done for selected patients that fit specific criteria.

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