The Patellofemoral Arthroplasty: The Great Solution, the Great Problem



Unfortunately, many orthopedic surgeons believe that the definite solution for eliminating anterior knee pain in a young patient with multiple operations is the patellofemoral prosthesis (“The Great Solution”). But, they fail to ask themselves the most important question; what is causing the pain? When a patellofemoral prosthesis is implanted in these young patients without finding out the cause of the pain, a more serious problem could be created with a worse solution (“The Great Problem”). The cases we present spotlight this abuse.


Total Knee Arthroplasty Anterior Knee Pain Extensor Mechanism Quadriceps Tendon Trochlear Dysplasia 
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  1.  1.
    Biedert RM. Complicated case studies. In: Sanchis-Alfonso V, ed. Anterior Knee Pain and Patellar Instability. Springer: London; 2006.Google Scholar
  2.  2.
    Burnett RSJ, Berger RA, Della Valle CJ, et al. Extensor mechanism allograft reconstruction after total knee arthroplasty. J Bone Joint Surg. 2005;87-A:175-194.CrossRefGoogle Scholar
  3.  3.
    Burnett RSJ, Berger RA, Paprosky WG, et al. Extensor mechanism allograft reconstruction after total knee arthroplasty. A comparison of two techniques. J Bone Joint Surg. 2004;86-A:2694-2699.PubMedGoogle Scholar
  4.  4.
    Capozzi JD, Rhodes R, Chen D. Ethics in practice. Discussing treatment options. J Bone Joint Surg. 2009;91-A:740-742.CrossRefGoogle Scholar
  5.  5.
    Emerson RH Jr, Head WC, Malinin TI. Reconstruction of patellar tendon rupture after total knee arthroplasty with an extensor mechanism allograft. Clin Orthop Relat Res. 1990;260:154-161.PubMedGoogle Scholar
  6.  6.
    Emerson RH Jr, Head WC, Malinin TI. Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res. 1994;303:79-85.PubMedGoogle Scholar
  7.  7.
    Ficat P. Pathologie fémoro-patellaire. Paris: Masson & Cie; 1970.Google Scholar
  8.  8.
    Goodfellow JW, Hungerford DS, Woods C. Patellofemoral joint mechanics and pathology. Part 2. Chondromalacia patellae. J Bone Joint Surg. 1976;58-B:291-299.Google Scholar
  9.  9.
    Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral release. Am J Sports Med. 1988;16:383-388.PubMedCrossRefGoogle Scholar
  10. 10.
    Jamali AA, Emmerson BC, Chung C, et al. Fresh osteochondral allografts: results in the patellofemoral joint. Clin Orthop Relat Res. 2005;437:176-185.PubMedCrossRefGoogle Scholar
  11. 11.
    Leopold SS, Greidanus N, Paprosky WG, et al. High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg. 1999;81-A:1574-1579.Google Scholar
  12. 12.
    Lonner JH. Patellofemoral arthroplasty. In: Lotke PA, Lonner JH, eds. Knee Arthroplasty. Philadelphia: Lippincott Williams & Wilkins; 2009.Google Scholar
  13. 13.
    Malhotra R, Garg B, Logani V, et al. Management of extensor mechanism deficit as a consequence of patellar tendon loss in total knee arthroplasty. J Arthroplasty. 2008;23:1146-1151.PubMedCrossRefGoogle Scholar
  14. 14.
    Malhotra R, Sharma L, Kumar V, et al. Giant cell tumor of the patella and its management using a patella, patellar tendon, and tibial tubercle allograft. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):167-169.PubMedCrossRefGoogle Scholar
  15. 15.
    Matsumoto H, Kawakabo M, Otani T, et al. Extensive posttraumatic ossification of the patellar tendon. J Bone Joint Surg. 1999;81-B:34-36.CrossRefGoogle Scholar
  16. 16.
    Müller W. Das Knie. Heidelberg: Springer; 1982.Google Scholar
  17. 17.
    Nazarian DG, Booth RE Jr. Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res. 1999;367:123-129.PubMedCrossRefGoogle Scholar
  18. 18.
    Sanchis-Alfonso V, Monteagudo-Castro C, Roselló-Sastre E, et al. Value of the Hoffa fat pad in recellularization of allografts used to replace the ACL. Orthop Int. 1996;4:281-290.Google Scholar
  19. 19.
    Terry GC. The anatomy of the extensor mechanism. Clin Sports Med. 1989;8:163-177.PubMedGoogle Scholar
  20. 20.
    Torga-Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term follow-up. Clin Orthop Relat Res. 2006;444:193-200.PubMedCrossRefGoogle Scholar

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© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.International Patellofemoral Study Group, International ACL Study Group, Hospital 9 de Octubre, Hospital Arnau de Vilanova, School of MedicineCatholic University of ValenciaValenciaSpain

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