Errors and complications in patellofemoral surgery

There are different treatment options to address different patellofemoral problems each with their pearls and pitfalls. When considering a surgical procedure for a patient with anterior knee pain, you have to follow an algorithm to approach the problem and select the best treatment option (Fig. 38.1). In younger patients with isolated patellofemoral arthrosis, replacement of the joint surfaces becomes a serious consideration. As newer prosthesis designs begin to give better results, one must reconsider alternative means of treatment, weighing the advantages and disadvantages. The main surgical options (after basic procedures such as debridement, release and realignment have been tried and have failed) include anterior or anteromedial transfer of the tibial tubercle to shift contact stress and unload the patellofemoral joint, removal of the patella (patellectomy), and articular cartilage resurfacing either by osteochondral transfer or by cartilage cell implantation. Most important, however, the surgeon must be sure to identify any other possible source of pain and treat those first.