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Introduction
Radiographic prevalence of isolated patello
femoral arthritis was 14% in women and 15%
in men older than 60 years old according to
McAlindon [12]. Open and arthroscopic
procedures, which include subchondral drilling,
realignment procedures, patellectomy, patello
femoral arthroplasty and total knee replacement
could be purposed. The purpose of the study
was to investigate the intermediate-term results
of partial lateral patella facetectomy in patients
with lateral isolated patellofemoral arthritis.
Methods
We reviewed partial lateral facetectomy in
24 knees in 19 patients (14 female and 5 male).
These patients were operated between 2004
and 2009. The mean follow-up was 61.8 months
(range 36 to 90) with 3 years follow-up at least.
All patients had had failed conservative
treatment.All patients had physical examination
and standard radiographs before surgery and at
each follow-up. These included standard weight
bearing AP view, posterior-anterior weight
bearing view in 45° of knee flexion, a lateral
view in 30° of knee flexion and an axial view in
30° of knee flexion. We used the Iwano
radiographic evaluation scale [8] to grade the
severity of the patellofemoral osteoarthritis.
We used the Knee Society Score [7] before
surgery and at each follow-up.
The inclusion criteria were: isolated lateral
patellofemoral osteoarthritis, lateral patella
pain on physical examination and anterior
tuberosity-trochlear groove smaller than 16mm.
Patients with osteoarthritis in medial or lateral
compartment, medial or central patellofemoral
osteoarthritis, history of fracture, anterior
tuberosity-trochlear groove bigger than 16mm
were excluded.
Surgical technique
With the patient supine and under tourniquet
control, the knee was approached through a
lateral parapatellar incision.Alateral retinacular
release was done from the inferior to the
superior pole of the patella. We did not injure
the vastus lateralis. With the knee extended, the
patella and trochlear groove were observed for
cartilage lesions and checked for patellofemoral
congruency. About 1 to 1.5cm of lateral border
of the patella including osteophytes and 1 to
2mm of cartilage were resected with an
oscillating saw. We did a meticulous hemostasis
with bone wax if necessary. Low-molecular-
weight heparin was used prophylactically for
venous thromboembolism in all patients. Range
of motion and isometric quadriceps exercises
The partial Lateral
Facetectomy
E. Gancel, Y. Yercan, G. Demey,
S. Lustig, E. Servien, P. Neyret