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E. Gancel, Y. Yercan, G. Demey, S. Lustig, E. Servien, P. Neyret
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were initiated as soon as possible and weight
bearing was allowed the first week post
operatively.
Results
On the 19 patients who underwent partial
lateral facetectomy, 3 were lost of follow-up.
One patient required total knee arthroplasty
during our follow-up (2 years after the first
surgery).
The total knee society score improved from a
mean of 68.6 points (range 25 to 80)
preoperatively to a mean of 84.6 points at the
time of the final follow-up (range 70 to 100).
The functional score improved from 89.8 points
(range 26 to 100) before surgery to 93.5 points
at last follow-up (range 50 to 100).
Patellofemoral arthritis was present in all knees
preoperatively. Five knees had
stage 1
patello
femoral osteoarthritis, eight had a
stage 2
, six a
stage 3
and seven a
stage 4
. At latest follow-up,
five knees had a stage 2, six a stage 3 and nine
a stage 4 (fig. 1). Before surgery, no patient had
radiological osteoarthritis on tibiofemoral
component. During follow-up, 2 patients had
tibiofemoral osteoarthritis which one received
a total knee arthroplasty.
Discussion
Many operative techniques have been
advocated for patellofemoral arthritis. Anterior
or anteromedialization of tibial tubercle [6, 9,
19, 20], lateral retinacular release [1], partial
lateral facetectomy of the patella [13, 14, 18,
21, 22], patellofemoral joint replacement [2,
10] or total knee arthroplasty [4, 5, 11, 15, 16,
17] could be purposed. We think that the partial
lateral facetectomy of the patella is a reliable
surgical method compared with other choices
in selected cases.
Mc Caroll [13] was the first to describe the
results of partial lateral facetectomy in
57 patients. Martens [14] obtained 90% good
results in 20 patients treated by this procedure.
Yercan [22] described good results with a
8 years mean follow-up. For him, ideal
candidates for this procedure are relatively
young and active patients who have High
physical demands and want to maintain their
active lifestyles. According to Wetzels [21],
partial lateral patellectomy satisfied in half of
the cases at 10 years follow-up.
Anterior elevation or anteromedialization of
tibial tubercle could be purposed to decrease
patellofemoral contact joint pressure but there’s
no consensus on the optimal elevation. High
rate of complication is described [3].
Partial facetectomy can be associated with
tibial tubercle medialization if anterior
tuberosity-trochlear groove was higher than
16mm. We didn’t associated facetectomy with
reconstruction of medial patellofemoral
ligament.
Arthroplasty (patellofemoral arthroplasty or
total knee replacement) can treated patello
femoral osteoarthritis. Patellofemoral arthro
plasty shows better results recent years but this
Fig. 1 : Patellofemoral osteoarthritis grade four at 6 years follow-up.