eMedicine Specialties > Orthopedic Surgery > Knee

Patellofemoral Arthritis: Multimedia

Author: Kathleen A Hogan, MD, Fellow in Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital
Coauthor(s): H Del Schutte, Jr, MD, Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Sep 12, 2008

Multimedia

Patellofemoral arthritis. The sulcus angle is the...
(Enlarge Image)
Media file 1: Patellofemoral arthritis. The sulcus angle is the angle formed by the condyles and the sulcus. This is a measurement of trochlear depth. A finding greater than 138° indicates the presence of patellofemoral dysplasia.
[ CLOSE WINDOW ]
Patellofemoral arthritis. The sulcus angle is the...

Patellofemoral arthritis. The sulcus angle is the angle formed by the condyles and the sulcus. This is a measurement of trochlear depth. A finding greater than 138° indicates the presence of patellofemoral dysplasia.

Patellofemoral arthritis. The patellofemoral inde...
(Enlarge Image)
Media file 2: Patellofemoral arthritis. The patellofemoral index is the ratio of M, the closest distance between the articular ridge and the medial condyle, and L, the closest distance between the lateral facet and condyle.
[ CLOSE WINDOW ]
Patellofemoral arthritis. The patellofemoral inde...

Patellofemoral arthritis. The patellofemoral index is the ratio of M, the closest distance between the articular ridge and the medial condyle, and L, the closest distance between the lateral facet and condyle.

Patellofemoral arthritis. The lateral patellofemo...
(Enlarge Image)
Media file 3: Patellofemoral arthritis. The lateral patellofemoral angle is the angle between the intercondylar line and the lateral facet.
[ CLOSE WINDOW ]
Patellofemoral arthritis. The lateral patellofemo...

Patellofemoral arthritis. The lateral patellofemoral angle is the angle between the intercondylar line and the lateral facet.

Patellofemoral arthritis. The Insall-Salvati rati...
(Enlarge Image)
Media file 4: Patellofemoral arthritis. The Insall-Salvati ratio is used to assess the position of the patella and determine if the patella alta or patella baja is present. The ratio of the height of the patella to the length of the patella tendon should be 1:1.
[ CLOSE WINDOW ]
Patellofemoral arthritis. The Insall-Salvati rati...

Patellofemoral arthritis. The Insall-Salvati ratio is used to assess the position of the patella and determine if the patella alta or patella baja is present. The ratio of the height of the patella to the length of the patella tendon should be 1:1.

Patellofemoral arthritis. Anteroposterior, latera...
(Enlarge Image)
Media file 5: Patellofemoral arthritis. Anteroposterior, lateral, and patellar views of an arthritic knee demonstrate severe patellofemoral arthritis. This patient subsequently underwent total knee arthroplasty.
[ CLOSE WINDOW ]
Patellofemoral arthritis. Anteroposterior, latera...

Patellofemoral arthritis. Anteroposterior, lateral, and patellar views of an arthritic knee demonstrate severe patellofemoral arthritis. This patient subsequently underwent total knee arthroplasty.

Patellofemoral arthritis. Poor bone quality of th...
(Enlarge Image)
Media file 6: Patellofemoral arthritis. Poor bone quality of the patella made a patella resurfacing procedure impossible in this patient who underwent total knee arthroscopy for severe arthritis.
[ CLOSE WINDOW ]
Patellofemoral arthritis. Poor bone quality of th...

Patellofemoral arthritis. Poor bone quality of the patella made a patella resurfacing procedure impossible in this patient who underwent total knee arthroscopy for severe arthritis.

Patellofemoral arthritis. This patient had severe...
(Enlarge Image)
Media file 7: Patellofemoral arthritis. This patient had severe medial compartment arthritis but a relatively normal patellofemoral joint. Therefore, patellofemoral resurfacing was not performed at the time of surgery.
[ CLOSE WINDOW ]
Patellofemoral arthritis. This patient had severe...

Patellofemoral arthritis. This patient had severe medial compartment arthritis but a relatively normal patellofemoral joint. Therefore, patellofemoral resurfacing was not performed at the time of surgery.

Patellofemoral arthritis.
(Enlarge Image)
Media file 8: Patellofemoral arthritis.
[ CLOSE WINDOW ]
Patellofemoral arthritis.

Patellofemoral arthritis.

More on Patellofemoral Arthritis

Overview: Patellofemoral Arthritis
Workup: Patellofemoral Arthritis
Treatment: Patellofemoral Arthritis
Follow-up: Patellofemoral Arthritis
Multimedia: Patellofemoral Arthritis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Kelly MA, Insall JN. Historical perspectives of chondromalacia patellae. Orthop Clin North Am. Oct 1992;23(4):517-21. [Medline].

  2. Outerbridge RE. The etiology of chondromalacia patellae. 1961. Clin Orthop. Aug 2001;(389):5-8. [Medline].

  3. Herzog W, Diet S, Suter E, et al. Material and functional properties of articular cartilage and patellofemoral contact mechanics in an experimental model of osteoarthritis. J Biomech. Dec 1998;31(12):1137-45. [Medline].

  4. Jarvela T, Paakkala T, Kannus P, Jarvinen M. The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with a bone- patellar tendon-bone autograft. Am J Sports Med. Jan-Feb 2001;29(1):18-24. [Medline].

  5. Kujala UM, Kettunen J, Paananen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum. Apr 1995;38(4):539-46. [Medline].

  6. Nagamine R, Miura H, Inoue Y, et al. Malposition of the tibial tubercle during flexion in knees with patellofemoral arthritis. Skeletal Radiol. Oct 1997;26(10):597-601. [Medline].

  7. Froimson MI, Ratcliffe A, Gardner TR, Mow VC. Differences in patellofemoral joint cartilage material properties and their significance to the etiology of cartilage surface fibrillation. Osteoarthritis Cartilage. Nov 1997;5(6):377-86. [Medline].

  8. Herberhold C, Stammberger T, Faber S, et al. An MR-based technique for quantifying the deformation of articular cartilage during mechanical loading in an intact cadaver joint. Magn Reson Med. May 1998;39(5):843-50. [Medline].

  9. Herberhold C, Faber S, Stammberger T, et al. In situ measurement of articular cartilage deformation in intact femoropatellar joints under static loading. J Biomech. Dec 1999;32(12):1287-95. [Medline].

  10. Mizuno Y, Kumagai M, Mattessich SM, et al. Q-angle influences tibiofemoral and patellofemoral kinematics. J Orthop Res. Sep 2001;19(5):834-40. [Medline].

  11. Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. Jun 1984;66(5):715-24. [Medline].

  12. Goodfellow J, Hungerford DS, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br. Aug 1976;58(3):287-90. [Medline].

  13. Johnson LL, van Dyk GE, Green JR 3rd, et al. Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy. May-Jun 1998;14(4):347-59. [Medline].

  14. Grelsamer RP, Weinstein CH. Applied biomechanics of the patella. Clin Orthop. Aug 2001;(389):9-14. [Medline].

  15. Merchant AC. Patellofemoral imaging. Clin Orthop. Aug 2001;(389):15-21. [Medline].

  16. Kirkley A, Birmingham TB, Litchfield RB, et al. A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine. Available at http://content.nejm.org/cgi/content/short/359/11/1097?query=TOC. Accessed September 11, 2008.

  17. Marx RG. Arthroscopic Surgery for Osteoarthritis of the Knee?. New England Journal of Medicine. Available at http://content.nejm.org/cgi/content/short/359/11/1169?query=TOC. Accessed September 11, 2008.

  18. Barclay L, Nghiem HT. Arthroscopic Surgery May Not Be Helpful for Knee Osteoarthritis. Medscape. Available at http://www.medscape.com/viewarticle/580300. Accessed September 11, 2008.

  19. Grande DA, Singh IJ, Pugh J. Healing of experimentally produced lesions in articular cartilage following chondrocyte transplantation. Anat Rec. Jun 1987;218(2):142-8. [Medline].

  20. Brittberg M, Lindahl A, Nilsson A. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. Oct 6 1994;331(14):889-95. [Medline].

  21. Peterson L, Minas T, Brittberg M. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003;85-A Suppl 2:17-24. [Medline].

  22. Hangody L, Fules P. Autologous osteochondral mosaicplasty for the treatment of full- thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am. 2003;85-A Suppl 2:25-32. [Medline].

  23. Bentley G, Biant LC, Carrington RW. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. Mar 2003;85(2):223-30. [Medline].

  24. Ghazavi MT, Pritzker KP, Davis AM. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. Nov 1997;79(6):1008-13. [Medline].

  25. Fitzpatrick PL, Morgan DA. Fresh osteochondral allografts: a 6-10-year review. Aust N Z J Surg. Aug 1998;68(8):573-9. [Medline].

  26. Chu CR, Convery FR, Akeson WH. Articular cartilage transplantation. Clinical results in the knee. Clin Orthop. Mar 1999;(360):159-68. [Medline].

  27. Shasha N, Krywulak S, Backstein D. Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am. 2003;85-A Suppl 2:33-9. [Medline].

  28. Watkins MP, Harris BA, Wender S, et al. Effect of patellectomy on the function of the quadriceps and hamstrings. J Bone Joint Surg Am. Mar 1983;65(3):390-5. [Medline].

  29. Garr EL, Moskowitz RW, Davis W. Degenerative changes following experimental patellectomy in the rabbit. Clin Orthop. May 1973;92:296-304. [Medline].

  30. Ackroyd CE, Polyzoides AJ. Patellectomy for osteoarthritis. A study of eighty-one patients followed from two to twenty-two years. J Bone Joint Surg Br. Aug 1978;60-B(3):353-7. [Medline].

  31. Feller JA, Bartlett RJ. Patellectomy and osteoarthritis: arthroscopic findings following previous patellectomy. Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):159-61. [Medline].

  32. Joshi AB, Lee CM, Markovic L, et al. Total knee arthroplasty after patellectomy. J Bone Joint Surg Br. Nov 1994;76(6):926-9. [Medline].

  33. Paletta GA Jr, Laskin RS. Total knee arthroplasty after a previous patellectomy. J Bone Joint Surg Am. Nov 1995;77(11):1708-12. [Medline].

  34. Kolettis GT, Stern SH. Patellar resurfacing for patellofemoral arthritis. Orthop Clin North Am. Oct 1992;23(4):665-73. [Medline].

  35. Petrie RS, Hanssen AD, Osmon DR, Ilstrup D. Metal-backed patellar component failure in total knee arthroplasty: a possible risk for late infection. Am J Orthop. Mar 1998;27(3):172-6. [Medline].

  36. Krajca-Radcliffe JB, Coker TP. Patellofemoral arthroplasty. A 2- to 18-year followup study. Clin Orthop. Sep 1996;(330):143-51. [Medline].

  37. Cartier P, Sanouiller JL, Grelsamer R. Patellofemoral arthroplasty. 2-12-year follow-up study. J Arthroplasty. Mar 1990;5(1):49-55. [Medline].

  38. Argenson JN, Guillaume JM, Aubaniac JM. Is there a place for patellofemoral arthroplasty?. Clin Orthop. Dec 1995;(321):162-7. [Medline].

  39. Laskin RS, van Steijn M. Total knee replacement for patients with patellofemoral arthritis. Clin Orthop. Oct 1999;(367):89-95. [Medline].

  40. Healy WL, Wasilewski SA, Takei R, Oberlander M. Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors. J Arthroplasty. Apr 1995;10(2):197-201. [Medline].

  41. Ikejiani CE, Leighton R, Petrie DP. Comparison of patellar resurfacing versus nonresurfacing in total knee arthroplasty. Can J Surg. Feb 2000;43(1):35-8. [Medline].

  42. Kim BS, Reitman RD, Schai PA, Scott RD. Selective patellar nonresurfacing in total knee arthroplasty. 10 year results. Clin Orthop. Oct 1999;(367):81-8. [Medline].

  43. Pollo FE, Jackson RW, Koeter S, et al. Walking, chair rising, and stair climbing after total knee arthroplasty: patellar resurfacing versus nonresurfacing. Am J Knee Surg. Spring 2000;13(2):103-8; discussion 108-9. [Medline].

  44. [Best Evidence] Smith AJ, Wood DJ, Li MG. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system. J Bone Joint Surg Br. Jan 2008;90(1):43-9. [Medline].

  45. Tanzer M, McLean CA, Laxer E, et al. Effect of femoral component designs on the contact and tracking characteristics of the unresurfaced patella in total knee arthroplasty. Can J Surg. Apr 2001;44(2):127-33. [Medline].

  46. Schroeder-Boersch H, Scheller G, Fischer J, Jani L. Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study. Arch Orthop Trauma Surg. 1998;117(1-2):73-8. [Medline].

  47. Kawakubo M, Matsumoto H, Otani T, Fujikawa K. Radiographic changes in the patella after total knee arthroplasty without resurfacing the patella. Comparison of osteoarthrosis and rheumatoid arthritis. Bull Hosp Jt Dis. 1997;56(4):237-44. [Medline].

  48. Boyd AD Jr, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am. May 1993;75(5):674-81. [Medline].

  49. Lonner JH. Patellofemoral arthroplasty: the impact of design on outcomes. Orthop Clin North Am. Jul 2008;39(3):347-54. [Medline].

  50. Bayne O, Cameron HU. Total knee arthroplasty following patellectomy. Clin Orthop. Jun 1984;(186):112-4. [Medline].

  51. Boegard T, Rudling O, Petersson IF, Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint. Ann Rheum Dis. Jul 1998;57(7):401-7. [Medline].

  52. Cooper C, McAlindon T, Snow S, et al. Mechanical and constitutional risk factors for symptomatic knee osteoarthritis: differences between medial tibiofemoral and patellofemoral disease. J Rheumatol. Feb 1994;21(2):307-13. [Medline].

  53. Delanois RE, McGrath MS, Ulrich SD, Marker DR, Seyler TM, Bonutti PM, et al. Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am. Jul 2008;39(3):381-8. [Medline].

  54. Elahi S, Cahue S, Felson DT, et al. The association between varus-valgus alignment and patellofemoral osteoarthritis. Arthritis Rheum. Aug 2000;43(8):1874-80. [Medline].

  55. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg Br. Mar 1996;78(2):226-8. [Medline].

  56. Gigante A, Pasquinelli FM, Paladini P, et al. The effects of patellar taping on patellofemoral incongruence. A computed tomography study. Am J Sports Med. Jan-Feb 2001;29(1):88-92. [Medline].

  57. Hendrix MR, Ackroyd CE, Lonner JH. Revision Patellofemoral Arthroplasty Three- to Seven-Year Follow-Up. J Arthroplasty. Mar 12 2008;[Medline].

  58. Kannus P, Natri A, Paakkala T. An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am. Mar 1999;81(3):355-63. [Medline].

  59. Kerrigan DC, Lelas JL, Karvosky ME. Women''s shoes and knee osteoarthritis. Lancet. Apr 7 2001;357(9262):1097-8. [Medline].

  60. McAlindon T, Zhang Y, Hannan M, et al. Are risk factors for patellofemoral and tibiofemoral knee osteoarthritis different?. J Rheumatol. Feb 1996;23(2):332-7. [Medline].

  61. Minas T, Nehrer S. Current Concepts in the Treatment of Articular Carilage Defects. Orthopaedics. 1997;20:525-538.

  62. Nicol SG, Loveridge JM, Weale AE, Ackroyd CE, Newman JH. Arthritis progression after patellofemoral joint replacement. Knee. Aug 2006;13(4):290-5. [Medline].

  63. Post W, Fulkerson J. Arthritis of the patellofemoral joint. Knee Surg. 1:995-1023.

[ CLOSE WINDOW ]

Further Reading

AAOS clinical guideline on osteoarthritis of the knee (phase II).
American Academy of Orthopaedic Surgeons - Medical Specialty Society.  2003.  15 pages.  NGC:003374

Review criteria for knee surgery.
Washington State Department of Labor and Industries - State/Local Government Agency [U.S.].  1991 Jan (revised 2004 Jan).  7 pages.  NGC:003482

Total knee replacement.
National Institutes of Health (NIH) Consensus Development Panel on Total Knee Replacement - Independent Expert Panel.  2004 Feb 17.  18 pages.  NGC:003622
 
Imaging after total knee arthroplasty.
American College of Radiology - Medical Specialty Society.  2006.  7 pages.  NGC:005538

[ CLOSE WINDOW ]

Keywords

patellofemoral arthritis, anterior knee pain, chondromalacia patellae, osteoarthritis, arthritis of the patella, arthritis of the kneecap, patellofemoral pain syndrome, patellofemoral pain, kneecap, joint disease, chondromalacia, knee pain, patellofemoral syndrome, patellofemoral joint syndromes, total knee arthroplasty, TKA, total knee reconstruction, TKR

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Kathleen A Hogan, MD, Fellow in Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital
Kathleen A Hogan, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

H Del Schutte, Jr, MD, Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina
H Del Schutte, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, American Medical Association, American Orthopaedic Association, California Medical Association, Orthopaedic Research Society, South Carolina Medical Association, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

Charles T Mehlman, DO, MPH, Director, Musculoskeletal Outcomes Research, Associate Professor, Division of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center
Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.