Patellofemoral Osteoarthritis: Partial Lateral Patellar Facetectomy

  • E. Carlos Rodríguez-Merchán
  • Alexander D. Liddle


Partial lateral facetectomy is a relatively easy and efficacious surgical treatment for middle-aged to elderly active patients with isolated lateral patellofemoral osteoarthritis (OA) who require pain relief and maintenance of level of activity but who wish to avoid arthroplasty. It can be performed arthroscopically or open. The indications are isolated patellofemoral OA in patients with an overhanging lateral facet of the patella with anterolateral knee pain and lack of response to conservative treatment. A satisfactory outcome after lateral patellar facetectomy for isolated patellofemoral OA can be foreseen in about half of the cases at 10 years follow-up; patellofemoral arthroplasty (PFA) or total knee arthroplasty (TKA) may be performed with no special considerations in patients who do not achieve adequate pain relief following partial lateral facetectomy.


Patellofemoral joint Osteoarthritis Lateral facet Partial lateral facetectomy 


  1. 1.
    Walker T, Perkinson B, Mihalko WM. Patellofemoral arthroplasty: the other unicompartmental knee replacement. J Bone Joint Surg Am. 2012;94:1712–20.CrossRefGoogle Scholar
  2. 2.
    Lüring C, Tingart M, Drescher W, Springorum HR, Kraft CN, Rath B. Therapy of isolated arthritis in the patellofemoral joint: are there evidence-based options? Orthopade. 2011;40:902–6.CrossRefGoogle Scholar
  3. 3.
    Duncan R, Peat G, Thomas E, Wood L, Hay E, Croft P. Does isolated patellofemoral osteoarthritis matter? Osteoarthr Cartil. 2009;17:1151–5.CrossRefGoogle Scholar
  4. 4.
    Becker R, Röpke M, Krull A, Musahl V, Nebelung W. Surgical treatment of isolated patellofemoral osteoarthritis. Clin Orthop Relat Res. 2008;466:443–9.CrossRefGoogle Scholar
  5. 5.
    Callaghan MJ, Parkes MJ, Hutchinson CE, et al. A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions. Ann Rheum Dis. 2015;74:1164–70.CrossRefGoogle Scholar
  6. 6.
    Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30:857–65.CrossRefGoogle Scholar
  7. 7.
    Lun VM, Wiley JP, Meeuwisse HH, Yanagawa TL. Effectiveness of patellar bracing for treatment of patella-femoral pain syndrome. Clin J Sport Med. 2005;15:235–40.CrossRefGoogle Scholar
  8. 8.
    Arroll B, Goodyear-Smith F. Corticosteroid injections form osteoarthritis of the knee: meta-analysis. BMJ. 2004;328:869.CrossRefGoogle Scholar
  9. 9.
    Rodriguez-Merchan EC. Intra-articular injections of hyaluronic acid and other drugs in the knee joint. HSS J. 2013;9:180–2.CrossRefGoogle Scholar
  10. 10.
    Ferrari MB, Sanchez G, Chahla J, Moatshe G, LaPrade RF. Arthroscopic patellar lateral facetectomy. Arthrosc Tech. 2017;6:e357–62.CrossRefGoogle Scholar
  11. 11.
    Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthritis with special reference to its relationship to femortibial osteoarthritis and etiologic factors. Clin Orthop Relat Res. 1990;252:190–7.Google Scholar
  12. 12.
    Schiphof D, van Middlekoop M, de Klerk BM, et al. Crepitus is the first indication of patellofemoral osteoarthritis (and not of tibiofemoral osteoarthritis). Osteoarthr Cartil. 2014;22:631–8.CrossRefGoogle Scholar
  13. 13.
    Mills K, Hunter DJ. Patellofemoral joint osteoarthritis: an individualized pathomechanical approach to management. Best Pract Res Clin Rheumatol. 2014;28:73–91.CrossRefGoogle Scholar
  14. 14.
    Hutt J, Dodd M, Bourke H, Bell J. Outcomes of total knee replacement after patellofemoral arthroplasty. J Knee Surg. 2013;26:219–24.PubMedGoogle Scholar
  15. 15.
    Sancis-Alfonso V, Koh JL. Joint-preserving osteotomies for isolated Patellofemoral osteoarthritis: alternatives to arthroplasty. Am J Orthop. 2017;46:139–45.Google Scholar
  16. 16.
    Martens M, De Rycke J. Facetectomy of the patella in patellofemoral osteoarthritis. Acta Orthop Belg. 1990;56:563–7.PubMedGoogle Scholar
  17. 17.
    Wetzels T, Bellemans J. Patellofemoral osteoarthritis treated by partial lateral facetectomy: results at long-term follow up. Knee. 2012;19:411–5.CrossRefGoogle Scholar
  18. 18.
    Rodriguez-Merchan EC. Surgical treatment of isolated patellofemoral osteoarthritis. HSS J. 2014;10:79–82.CrossRefGoogle Scholar
  19. 19.
    Paulos LE, O’Connor DL, Karistinos A. Partial lateral patellar facetectomy for treatment of arthritis due to lateral patellar compression syndrome. Arthroscopy. 2008;24:547–53.CrossRefGoogle Scholar
  20. 20.
    Yercan HS, Ait Si Selmi T, Neyret P. The treatment of patellofemoral osteoarthritis with partial lateral facetectomy. Clin Orthop Relat Res. 2005;436:14–9.CrossRefGoogle Scholar
  21. 21.
    López-Franco M, Murciano-Antón MA, Fernández-Aceñero MJ, De Lucas-Villarrubia JC, López-Martín N, Gómez-Barrena E. Evaluation of a minimally aggressive method of patellofemoral osteoarthritis treatment at 10 years minimum follow-up. Knee. 2013;20:476–81.CrossRefGoogle Scholar
  22. 22.
    Montserrat F, Alentorn-Geli E, León V, Ginés-Cespedosa A, Rigol P. Treatment of isolated patellofemoral osteoarthritis with lateral facetectomy plus Insall’s realignment procedure: long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2013;21:2572–7.CrossRefGoogle Scholar
  23. 23.
    Montserrat F, Alentorn-Geli E, León V, Ginés-Cespedosa A, Rigol P. Partial lateral facetectomy plus Insall’s procedure for the treatment of isolated patellofemoral osteoarthritis: survival analysis. Knee Surg Sports Traumatol Arthrosc. 2014;22:88–96.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • E. Carlos Rodríguez-Merchán
    • 1
  • Alexander D. Liddle
    • 2
  1. 1.Department of Orthopaedic Surgery“La Paz” University Hospital-IdiPazMadridSpain
  2. 2.University College London, Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic HospitalStanmoreUK

Personalised recommendations