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W.B. Leadbetter

284

term) “comprehensiveknee surgeon”.However,

the advent of second and third generation

prosthetic design predicated upon years of total

joint design, refinements in operative technique,

and improved selection criteria have improved

the outcomes of isolated patellofemoral

arthroplasty [26, 27]. Likewise, biological

restoration is maturing in effectiveness with the

combination of unloading concepts and

improved biotechnology [28]. Yet, as we enter

the 21

millennium, the term “chondromalacia

patellae” remains firmly fixed in the clinical

diagnostic lexicon. Indeed, there still remains

what Grelsamer has dubbed a “Tower of

Babble” when one reads the literature of

patellofemoral pain and arthritis. Teige has

summarized the salient issues in this fashion:

1) bone architecture dictates where the force

vectors acting on the patella will be directed; 2)

abnormal skeletal alignment may alter the

displacementforcesactingonthepatellofemoral

joint, causing ligament failure with subsequent

instability; 3) skeletal malalignment may also

increase patellar facet loading leading to

arthrosis; 4) Increased joint loading with the

addition of subluxation may further increase

unit loading. Pain results from this excess load

and tension in the soft tissues or compression

of the articular surfaces; 5) treatment depends

on the primary pathology [30].

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