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Treatment of isolated patellofemoral osteoarthritis with lateral facetectomy plus Insall’s realignment procedure: long-term follow-up

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



To assess the long-term results of lateral facetectomy plus Insall’s realignment procedure to treat isolated patellofemoral osteoarthritis.


All consecutive patients undergoing this procedure with a follow-up between 10 and 14 years were included in this study. Subjects were excluded if they had previous patellar dislocation, patellar fracture, tibiofemoral osteoarthritis (except mild cases) or follow-up <10 or >14 years. Failure cases (need for total knee arthroplasty) of this surgical procedure before 10 years of follow-up were considered in the overall failure rate. Clinical, functional and radiographic outcomes were obtained at baseline and compared to postoperative values.


Forty-three patients (mean (SD) age 59.7 (8.1) years) had a follow-up between 10 and 14 years and were finally included in this study. The failure rate in the whole series and included patients was 26.4 and 16.3 %, respectively, for a mean (SD) follow-up of 9.2 (3.2) years and 11.7 (1.4) years, respectively. Patellofemoral pain (p < 0.0001), need for NSAIDs (p < 0.0001), longitudinal (p < 0.0001) and transversal (p < 0.0001) patellar glide tests, Zholen’s sign (p = 0.0007) and knee effusion (p = 0.02) significantly improved in the follow-up. Postoperative Knee Society Score (KSS) anatomical (p < 0.0001), functional (p < 0.0001) and total (p < 0.0001) scores and Kujala’s score (p = 0.001) were significantly higher compared to preoperative values. The patellar tilt (p = 0.001) and shift (p = 0.04) significantly improved postoperatively, whereas the patellofemoral osteoarthritis was not modified (n.s.) with respect to preoperative assessment.


The lateral facetectomy plus Insall’s realignment procedure was a successful treatment for isolated patellofemoral osteoarthritis from a clinical, functional and radiographic point of view in the long-term follow-up.

Level of evidence

Prospective case series, Level IV.

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The authors thank Sergi Mojal PhD for his excellent work in the statistical analysis.

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Correspondence to Ferran Montserrat.

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Montserrat, F., Alentorn-Geli, E., León, V. et al. Treatment of isolated patellofemoral osteoarthritis with lateral facetectomy plus Insall’s realignment procedure: long-term follow-up. Knee Surg Sports Traumatol Arthrosc 21, 2572–2577 (2013).

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