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Treatment Options for Patellofemoral Arthritis

  • Non-Operative Management of Anterior Knee Pain (M Fredericson and T Besier, Section Editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

To present a synthesis of recent literature regarding the treatment of patellofemoral arthritis

Recent Findings

Risk factors of PFJ OA include patella malalignment or maltracking, injury to supportive structures including the MPFL, dysfunction of hamstring and quadriceps coordination, lower limb alignment, trochlear dysplasia, patellar trauma, or ACL surgery. Special physical exam maneuvers include patellar grind test, apprehension test, and lateral patellar tilt angle. Radiographs that should be obtained first-line include weight bearing bilateral AP, lateral, and Merchant views. CT and MRI are used to assess trochlear dysplasia, excessive patellar height, and TT-TG distance. Non-operative management options discussed include non-pharmacologic treatment (patient education, self-management, physical therapy, weight loss), ESWT, cold therapy, taping, bracing, and orthotics. Pharmacologic management options discussed include NSAIDs, acetaminophen, oral narcotics, and duloxetine. Injection therapies include glucocorticoids, hyaluronic acid, PRP, and other regenerative therapies (BMAC, adipose, or mesenchymal stem cells). Other treatment options include radiofrequency ablation and botulinum toxin. The algorithm for the surgical treatment of PFJ OA can begin with arthroscopic assessment of the PF articular cartilage to address mechanical symptoms and to evaluate/treat lateral soft tissue with or without overhanging lateral osteophytes. If patients fail to have symptomatic improvement, a TTO can be considered in those patients less than 50 years of age or active patients >50 years old. In patients with severe PFJ OA, refractory to the above treatments, PFA should be considered. While early PFA design and technique were less than encouraging, more recent implant design and surgical technique have demonstrated robust results in the literature.

Summary

Patellofemoral osteoarthritis is a challenging orthopedic problem to treat, in that it can often affect younger patients, with otherwise well-functioning knees. It is a unique entity compared to TF OA with distinct epidemiology, biomechanics and risk factors and treatment options.

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  1. Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063, USA

    Anne Kuwabara, Mark Cinque, Taylor Ray & Seth Lawrence Sherman

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  1. Anne Kuwabara
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Dr. Seth Sherman reports personal fees from Arthrex, personal fees from BioVentus, personal fees from Joint Restoration Foundation, personal fees from Kinamed, personal fees from NewClip, personal fees from Conmed, personal fees from Smith & Nephew, personal fees from Vericel, personal fees from Vivorte, personal fees from Reparel, personal fees from Sarcio, and personal fees from Epic Bio, outside the submitted work. Dr. Anne Kuwabara, Dr. Mark Cinque, and Ms. Taylor Ray do not have any disclosures.

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This article is part of the Topical Collection on Non-Operative Management of Anterior Knee Pain

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Kuwabara, A., Cinque, M., Ray, T. et al. Treatment Options for Patellofemoral Arthritis. Curr Rev Musculoskelet Med 15, 90–106 (2022). https://doi.org/10.1007/s12178-022-09740-z

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