Arthritis Cure

πŸ”₯+ Arthritis Cure 05 Jun 2020 Although osteoarthritis is the most common cause of thumb arthritis, rheumatoid arthritis can also affect the CMC joint, usually to a lesser extent ...Fingers drifting away from the thumb is a unique sign of rheumatoid arthritis. A Boutonniere deformity is a bent middle finger joint. A swan-neck deformity is a bent end of the finger and over-extended middle joint. Both are unique signs of rheumatoid arthritis.

Arthritis Cure A drug used to treat rheumatoid arthritis (RA) was effective in patients with moderate to severe eczema, according to a study conducted by ...

Arthritis Curehow to Arthritis Cure for Knee Surg Relat Res. 2012 Dec; 24(4): 193–200.
Published online 2012 Nov for 1 last update 2020/06/05 29. Published online 2012 Nov 29. doi:Β 10.5792/ksrr.2012.24.4.193
PMCID: PMC3526755
PMID: 23269956
Young-Mo Kim, MD, PhD and Yong-Bum Joo, MD, PhD

Young-Mo Kim

Department of Orthopedic Surgery, Research Institue for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea.

Find articles by Young-Mo Kim

Arthritis Curehow to Arthritis Cure for Yong-Bum Joo

Department of Orthopedic Surgery, Research Institue for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea.

Find articles by Yong-Bum Joo
Department of Orthopedic Surgery, Research Institue for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea.
Corresponding author.
Correspondence to: Young-Mo Kim, MD. Department of Orthopedic Surgery, Research Institue for Medical Sciences, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 301-040, Korea. Tel: +82-42-280-8485, Fax: +82-42-252-7098, [email protected]
Received 2011 Dec 4; Revised 2012 Jul 2; Accepted 2012 Aug 8.
Copyright © 2012. The Korean Knee Society
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.

Abstract

Patellofemoral arthritis is a fairly common disease, and it has been gaining interest with increasing number of studies due to its diverse treatment methods. Patellofemoral arthritis has a broad range of management options according to the characteristics of individual diseases. Identifying whether patellofemoral arthritis is the primary cause of knee pain and is compartment arthritis is necessary for establishing an adequate treatment method. Through investigation of the literature, the issues of recent knowledge of femoropatella arthritis and the diagnosis and treatment of which were studied.

Keywords: Patellofemoral arthritis, Diagnosis, Treatment

Introduction

Unicompartmental arthritis of the knee generally refers to not only tibiofemoral arthritis but also to disorders of the patella and the cartilage. In particular, isolated patellofemoral arthritis is a relatively common disorder for which there has been increasing research regarding its treatment methods.

Arthritis Curehow to Arthritis Cure for Patellofemoral arthritis occurs due to the loss of the cartilage of the patella and the trochlear groove in approximately half of the patients diagnosed with degenerative arthritis of the knee. Isolated patellofemoral arthritis is not rare and radiographic evidence of deformity can be observed in 17.1-34% of female patients and 18.5-19% of male patients in the age of ≥55 or ≥60 years old according to some studies1,2). Noble and Hamblen2) reported patellofemoral osteoarthritis in 79% of 100 cadavers aged ≥65 years. In spite of its prevalence, treatment of this painful disorder is challenging due to the diversity of causes of the disorder and the lack of knowledge on articular regeneration. It has been reported that valgus knee alignment accelerates lateral patellofemoral arthritis and dysplasia of the patella or trochlea, malrotation of the tibia. Direction or force of the quadriceps femoris can also influence the progression of this disease.

Patellofemoral arthritis, a common cause of anterior knee pain, has been known to be refractory to treatment. This can be attributed to the complexity of the patellofemoral joint structure and insufficient recognition of the biomechanics of the joint. In this article, I will discuss the diagnosis and treatment options of patellofemoral arthritis based on recent studies on the biomechanics of the patellofemoral joint and disorders associated with patellofemoral arthritis.

Pathophysiology

The patellofemoral joint is a unique and complex structure consisting of static elements (ligaments and bones) and dynamic elements (neuromuscular system). The primary soft tissue static stability of the joint is provided by the medial and lateral patellofemoral and patellotibial complexes3). The stability of the joint is also influenced by lower limb alignment including varus/valgus femorotibial alignment and rotational variances of the femur. In addition, the relation of the knee to the pelvic position and strength is another important stabilizer for the knee. Therefore, patellofemoral joint abnormality can be associated with one or combination of these factors4).

The articular cartilage of the patella is similar to that of other joints in that it contains a solid phase and a fluid phase that is mostly composed of collagen and glycosaminoglycans. The solid phase is somewhat permeable and when the articular surface is under load, the fluid gradually redistributes itself within the solid matrix5). Therefore, the pressure within the fluid is strongly associated with the cushioning effect of the articular cartilage and the low friction coefficient of articular surfaces. Any damage to the articular surfaces causes a loss of pressure within the fluid phase, which subsequently results in higher stresses on the collagen fibers and more vulnerability leading to possible breakdown6).

Patellofemoral arthritis results from the loss of articular cartilage of the patella and the trochlear groove the 1 last update 2020/06/05 and chondral wear is most prevalent in the lateral patellar facet4). This indicates that the lateral patellar facet is more often overloaded than the central or medial aspect of the patella. Considering that lateral facet arthritis can be caused by malalignment or tilt, arthritis can naturally be associated with malalignment or tilt. Furthermore, the patellofemoral joint is affected by the extensor mechanism of the knee including the quadriceps femoris, patellar bone, and ligaments. Malalignment of the extensor mechanism can result in anterior knee pain due to overload on the lateral aspect of the knee, patellar subluxation or tilt, abnormal Q-angle, or torsion of the distal femur, all of which are good indications for tibial tubercle osteotomy or patellofemoral joint replacement.Patellofemoral arthritis results from the loss of articular cartilage of the patella and the trochlear groove and chondral wear is most prevalent in the lateral patellar facet4). This indicates that the lateral patellar facet is more often overloaded than the central or medial aspect of the patella. Considering that lateral facet arthritis can be caused by malalignment or tilt, arthritis can naturally be associated with malalignment or tilt. Furthermore, the patellofemoral joint is affected by the extensor mechanism of the knee including the quadriceps femoris, patellar bone, and ligaments. Malalignment of the extensor mechanism can result in anterior knee pain due to overload on the lateral aspect of the knee, patellar subluxation or tilt, abnormal Q-angle, or torsion of the distal femur, all of which are good indications for tibial tubercle osteotomy or patellofemoral joint replacement.

Other abnormal mechanisms related to patellofemoral joint pain include trochlear dysplasia which is observed in 78% of knees with isolated patellofemoral arthritis (Fig. 1)5,7,8). Degeneration of the patellofemoral joint can develop secondary to abnormal stress on the patella caused by patella alta, increased Q-angle combined with secondary soft tissue problems, a weakened or hypoplastic vastus medialis obliqus combined with contracture of the lateral retinaculum, or deficiency of the medial patellofemoral ligament. Articular fractures of the patella and trochlea caused by micro-trauma or macro-trauma is a risk factor for arthritis, which is indicated for isolated treatment of patellofemoral joint arthritis that progresses faster than other joint arthritides. Other causes include instability, osteoarthritis, inflammatory arthritis, obesity, and genetic quality of the cartilage9).

Arthritis Curehow to Arthritis Cure for Dejour''s test (positive when patients complained of pain during knee extension with patella compression).

Physical examination is nonspecific but often reveals crepitus and effusion. Leslie and Bentley11) reported that quadriceps wasting over than 2 cm, effusion, and retropatellar crepitus are the most important clinical findings for the detection of chondromalacia patellae. Tenderness over the medial or lateral patellar facet is a major sign of patellofemoral arthritis12). The examiner places fingers under the lateral or medial border of the patella and applies pressure on the patellar facet to elicit clinically significant pain in the patellofemoral joint (the source of pain during this test has been controversial because 1) pain is felt in the early stage of the test when stress is placed on all soft tissues between the skin and the bone including the retinaculum and synovium, and 2) high flexion of the knee is required for the detection of proximal lesions). The site of articular lesion can be determined according to the degree of flexion where pain is most elicited when pressure is applied on the patellofemoral articular surface: the distal the lesion is located, the lower the degree of flexion where pain occurs. Furthermore, the patient''s medical history and physical, radiographic, and arthroscopic examinations and determine the direction of osteotomy in the tibial tubercle.

3) Autologous chondrocyte implantation

The etiology and cause of arthritis should be precisely analyzed prior to autologous chondrocyte implantation for cartilage defects. The diagnosis and correction of the underlying abnormalities are crucial to the success of the procedure. In 1994, Brittberg et al.21) reported that autologous chondrocyte implantation was successful only in 2 out of 7 cases. Thereafter, restoration of adequate patellar tracking through realignment of the extensor mechanism has been considered necessary. Peterson et al.22) obtained excellent results in 11 out of 17 patients after autologous chondrocyte implantation with patellar realignment. Thus, it is of utmost importance to address the fundamental cause before beginning treatment of cartilage defects.

As mentioned above, the site of patellar cartilage lesion is important for the success of tibial tubercle osteotomy. Patients with a lesion in the inferior pole or the lateral facet of the patella can obtain more satisfying results than those with a lesion in the proximal pole, medial facet or diffuse of the patella. A lesion at the center of the trochlea is related to an articular lesion in the medial aspect of the patella, which has been associated with poor outcomes.

The success of autologous chondrocyte implantation depends on the support, follow-up, joint stability, cartilage defect size, severity of cartilage defect, and concomitant arthritis. In patients with mechanical axis deviation over than 2° or a large cartilage defect, valgus or varus osteotomy should be performed prior to restoration of the cartilage of the weight-bearing area.

In a prospective cohort study by Minas and Bryant9), 45 patients were followed up for 7 years after autologous chondrocyte implantation for the treatment of isolated patellar cartilage defect, isolated trochlear cartilage defect, or both defects. The mean age of the patients at the time of surgery was 36.9 years (range, 15 to 54 years). The mean follow-up period was 47.5 months (range, 24 to 86 months). The patient survey showed that 71% of the patients were satisfied with the results, 16% had no complaints, and 13% were unsatisfied. Overall, the results were rated as good or excellent in 71% of the patients, fair in 22%, and poor in 7%. The most significant improvement in motor function was observed in patients with severe knee defects. The cost effectiveness of the procedure, long-term follow-up results, and comparison with other treatment methods should be addressed in future studies.

Arthritis Curehow to Arthritis Cure for 4) Patellectomy

The theoretical basis of patellectomy is that chronic pain related to severe defects of the patella and the cartilage can be resolved through removal of the patella, the source of the pain. Weaver et al.23) reported that 87% of the cases showed good results during the 3 to 12 years of follow-up period after longitudinal semipatellectomy, total patellectomy, and the modified Trillat procedure for the treatment of patellofemoral arthritis secondary to malalignment. On the other hand, side effects of the procedure have also been reported in a variety of studies. Lennox et al.24) reported that 54% of 83 cases with patellar arthritis including patellofemoral arthritis (25 cases) achieved pain relief following patellectomy and the muscle strength of the quadriceps femoris was 60% of the normal value. Furthermore, the procedure can result in chronic weakness in extension, extension lag, or trochlear wear due to the contact with a tendon over time.

In general, patellectomy can be considered as an option when 1) the alignment of the extensor mechanism is normal and the femoral trochlea is intact in spite of severe patellar arthritis, 2) anatomical reduction is impossible due to severe comminuted fracture of the patella, 3) patellar tracking is normal in the presence of severe chondromalacia patella, or 4) realignment procedure resulted in poor outcome ( for 1 last update 2020/06/05 Fig. 4Fig. 4). However, patellectomy should be regarded as a salvage procedure.

(A) Simple radiographs of a patient diagnosed with patellofemoral arthritis after patellar fracture. (B) Intraoperative gross photos and postoperative radiographs after patellectomy.

5) Patellofemoral replacement

The first patellofemoral replacement procedure was performed using a screw-on Vitallium patellar shell by McKeever25) in 1955. This procedure was further developed later and Lubinus26) introduced a patellofemoral replacement prosthesis in 1979. In the 1 last update 2020/06/05 the early days of patellofemoral replacement, the results were unsatisfactory due to the problems related to patient selection, surgical technique, lack of understanding of the extensor mechanism, and durability. Tauro et al.27) reported a 50% failure rate at 8 years after patellofemoral replacement, which was attributed to prolonged malalignment, polyethylene wear, impingement, and progression of arthritis in the other initially unaffected compartments.The first patellofemoral replacement procedure was performed using a screw-on Vitallium patellar shell by McKeever25) in 1955. This procedure was further developed later and Lubinus26) introduced a patellofemoral replacement prosthesis in 1979. In the early days of patellofemoral replacement, the results were unsatisfactory due to the problems related to patient selection, surgical technique, lack of understanding of the extensor mechanism, and durability. Tauro et al.27) reported a 50% failure rate at 8 years after patellofemoral replacement, which was attributed to prolonged malalignment, polyethylene wear, impingement, and progression of arthritis in the other initially unaffected compartments.

Arthritis Curehow to Arthritis Cure for However, prosthesis design has evolved to produce improved outcomes thereafter28,29). The femoral flange is shallow and broad to promote stable fixation of the patella to the femoral trochlea. The medial side of the patellar component is uniquely concave to avoid impingement on the femoral component in flexion. This design improvement has contributed to the ruling out of the potential risk of early polyethylene wear and malalignment, which in turn caused a low complication rate and improved ROM (Fig. 5). Patellofemoral replacement is primarily indicated in patients who are young for total knee arthroplasty or have isolated patellofemoral arthritis. In general, patellectomy produces unsatisfactory results in these patients or poor results in 47% of patients. In addition, patellofemoral replacement is advantageous for maintaining the biomechanics of the knee joint while preserving the menisci and cruciate ligaments compared to total knee arthroplasty.

Postoperative simple radiographs after patellofemoral replacement in a the 1 last update 2020/06/05 patient diagnosed with patellar malunion.Postoperative simple radiographs after patellofemoral replacement in a patient diagnosed with patellar malunion.

Arthritis Curehow to Arthritis Cure for

6) Total knee arthroplasty

Total knee arthroplasty has been established as an effective treatment for isolated for 1 last update 2020/06/05 patellofemoral arthritis in elderly patients30,31). Laskin and van Steijn30) compared the results of total knee arthroplasty between 53 patients with isolated patellofemoral arthritis and those with tricompartment arthritis. At a mean of 7.4 years after surgery, 53 patients obtained significant improvement in symptoms although anterior knee pain remained in 7%. In addition, total knee arthroplasty resulted in better outcomes than patellectomy. Thus, total knee arthroplasty appears to be the most proven and predictable procedure for the treatment of patellofemoral arthritis in older patients. However, the disadvantages of the procedure should be taken into account including larger surgical area compared to the lesion size and extensive tissue loss.Total knee arthroplasty has been established as an effective treatment for isolated patellofemoral arthritis in elderly patients30,31). Laskin and van Steijn30) compared the results of total knee arthroplasty between 53 patients with isolated patellofemoral arthritis and those with tricompartment arthritis. At a mean of 7.4 years after surgery, 53 patients obtained significant improvement in symptoms although anterior knee pain remained in 7%. In addition, total knee arthroplasty resulted in better outcomes than patellectomy. Thus, total knee arthroplasty appears to be the most proven and predictable procedure for the treatment of patellofemoral arthritis in older patients. However, the disadvantages of the procedure should be taken into account including larger surgical area compared to the lesion size and extensive tissue loss.

Conclusions

A broad range of management options is available for patellofemoral arthritis depending on the patient's symptoms and conditions. In patients with anterior knee pain, determination of the cause of the disorder is essential. Whether the pain is primary or secondary and whether the arthritis is isolated or combined should be identified prior to treatment planning.

Ongoing improvement has been reported regarding patellofemoral arthritis treatment. However, sufficient treatment results have not been reported for comparison studies and there is no consensus among the authors of different studies. An agreement on the ultimate treatment method will require more quality clinical studies on the cause of patellofemoral arthritis and long-term treatment results. The controversy over the treatment methods for patellofemoral arthritis is not fully resolved and there are many exciting areas of progress.

Isolated patellofemoral arthritis is asymptomatic and does not require treatment in most cases. Sufficient strength of the quadriceps femoris appears crucial for achieving good treatment results. The incidence of total knee arthroplasty would gradually decrease with the improvement of patellofemoral replacement techniques. Finally, it should be noted that patellofemoral replacement is a viable treatment option for elderly patients.

References

1. Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM. The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res. 2002;(402):206–212. [PubMed] [Google the 1 last update 2020/06/05 Scholar][Google Scholar]
2. Noble J, Hamblen DL. The pathology of the degenerate meniscus lesion. J Bone Joint Surg Br. 1975;57:180–186. [PubMed] [Google Scholar]
3. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med. 2002;21:499–519. [PubMed] [Google Scholar]
4. Saleh KJ, Arendt EA, Eldridge J, Fulkerson JP, Minas T, Mulhall KJ. Symposium Operative treatment of patellofemoral arthritis. J Bone Joint Surg Am. 2005;87:659–671. [PubMed] Arthritis Curehow to Arthritis Cure for [Google Scholar]
5. Mow VC, Kuei SC, Lai WM, Armstrong CG. Biphasic creep and stress relaxation of articular cartilage in compression? Theory and experiments. J Biomech Eng. 1980;102:73–84.J Biomech Eng. 1980;102:73–84. [PubMed] [Google Scholar]
6. Ateshian GA, Hung CT. Patellofemoral joint biomechanics and tissue engineering. Clin Orthop Relat Res. 2005;(436):81–90. Arthritis Curehow to Arthritis Cure for [PMC free article] [PubMed] [Google Scholar][Google Scholar]
7. Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports for 1 last update 2020/06/05 Med Arthrosc. 2007;15:39–46.Sports Med Arthrosc. 2007;15:39–46. [PubMed] [Google Scholar]
8. Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee the 1 for 1 last update 2020/06/05 last update 2020/06/05 Surg Sports Traumatol Arthrosc. Knee Surg Sports Traumatol Arthrosc. 2006;14:235–240.Knee the 1 last update 2020/06/05 Surg Sports Traumatol Arthrosc. Knee Surg Sports Traumatol Arthrosc. 2006;14:235–240. [PubMed] [Google Scholar]
9. Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res. 2005;(436):30–39. [PubMed] [Google Scholar]
10. Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res. 1990;(252):190–197. [PubMed] [Google Scholar]
11. Arthritis Curehow to Arthritis Cure for Leslie IJ, Bentley G. Arthroscopy in the diagnosis of chondromalacia patellae. Ann Rheum Dis. 1978;37:540–547. [PMC free article] [PubMed] [Google Scholar]
12. Grelsamer for 1 last update 2020/06/05 RP. Patellar malalignment. J Bone Joint Surg Am. 2000;82:1639–1650. [PubMed] [Google Scholar]Grelsamer RP. Patellar malalignment. J Bone Joint Surg Am. 2000;82:1639–1650. [PubMed] [Google Scholar]
13. Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg the 1 last update 2020/06/05 Am. J Bone Joint Surg Am. 1974;56:1391–1396. [PubMed] [Google the 1 last update 2020/06/05 Scholar][Google Scholar]
14. Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. Arthritis Curehow to Arthritis Cure for J Bone Joint Surg Am. 1988;70:1479–1483. [PubMed] [Google Scholar]
15. Anderson JW, Nicolosi RJ, Borzelleca JF. Glucosamine effects in humans: a review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food Chem for 1 last update 2020/06/05 Toxicol. Food Chem Toxicol. 2005;43:187–201. [PubMed] [Google Scholar]
16. Clarke S, Lock V, Duddy J, Sharif M, Newman JH, Kirwan JR. Intra-articular hylan G-F 20 (Synvisc) in the management of patellofemoral osteoarthritis of the knee (POAK) Arthritis Curehow to Arthritis Cure for Knee. 2005;12:57–62. [PubMed] [Google Scholar]
17. Fulkerson JP. Alternatives to patellofemoral arthroplasty. Clin Orthop Relat Res. 2005;(436):76–80. [PubMed] [Google Scholar]
18. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med. 1998;26:59–65. [PubMed] [Google Scholar]
19. Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984;66:715–724. [PubMed] [Google Scholar]
20. Kuroda R, Kambic H, Valdevit A, Andrish JT. Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study. Am J the 1 last update 2020/06/05 Sports Med. Am J Sports Med. 2001;29:403–409. [PubMed] [Google Scholar]
21. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994; the 1 last update 2020/06/05 331331:889–895. [PubMed] [Google Scholar]
22. Arthritis Curehow to Arthritis Cure for Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;(374):212–234. [PubMed] [Google Scholar]
23. Weaver JK, Wieder D, Derkash RS. Patellofemoral arthritis resulting from malalignment. A long-term evaluation of treatment options. Orthop Rev. 1991;20:1075–1081. [PubMed] [Google Scholar]
24. Arthritis Curehow to Arthritis Cure for Lennox IA, Cobb AG, Knowles J, Bentley G. Knee function after patellectomy A 12- to 48-year follow-up. J Bone Joint Surg Br. 1994;76:485–487. [PubMed] Arthritis Curehow to Arthritis Cure for [Google Scholar]
25. Arthritis Curehow to Arthritis Cure for McKeever DC. Patellar prosthesis. J Bone Joint Surg Am. 1955; for 1 last update 2020/06/05 3737:1074–1084. [PubMed] [Google Scholar]
26. Lubinus HH. Patella glide bearing total replacement. Orthopedics. 1979;2:119–127. [PubMed] [Google for 1 last update 2020/06/05 Scholar][Google Scholar]
27. Tauro B, Ackroyd CE, Newman JH, Shah NA. The Lubinus patellofemoral arthroplasty. A five- to ten-year prospective study. J Bone Joint Surg Br. 2001;83:696–701. [PubMed] Arthritis Curehow to Arthritis Cure for [Google Scholar]
28. Arthritis Curehow to Arthritis Cure for Kooijman HJ, Driessen AP, van Horn JR. Long-term results of patellofemoral arthroplasty. A report of 56 arthroplasties with 17 years of follow-up. J Bone Joint Surg Br. 2003;85:836–840. [PubMed] [Google Scholar]
29. Krajca-Radcliffe JB, Coker TP. Patellofemoral arthroplasty. A 2- to 18-year followup study. Clin Orthop Relat Res. 1996;(330):143–151. [PubMed] [Google Scholar]
30. Laskin RS, van Steijn M. Total knee replacement for patients with patellofemoral arthritis. Arthritis Curehow to Arthritis Cure for Clin Orthop Relat Res. 1999;(367):89–95. [PubMed] [Google Scholar]
31. Mont MA, Haas S, Mullick T, Hungerford DS. Total knee arthroplasty for patellofemoral arthritis. J Bone Joint Surg Am. 2002;84:1977–1981. [PubMed] [Google Scholar]

Articles from Knee Surgery & Related Research are provided here courtesy of Korean Knee Society