Surgical treatment of posttraumatic arthritis of patellofemoral joint

Introduction: Posttraumatic arthritis of the patellofemoral joint is a serious medical problem, especially among young and middle-aged people and active athletes. According to various studies, the incidence of posttraumatic changes in the patellofemoral joint ranges from 10% to 40%, which confirms the relevance of surgical treatment.

Objective: to improve the results of surgical treatment of post-traumatic osteoarthritis of the patellofemoral joint with lateral patellar hyperpression using arthroscopic lateral patellar release.

Materials and Methods: Fifty-four patients aged 20 to 70 years (M±σ 50.7±13.3 years) with lateral patellar hyperpressure syndrome participated in the study. Patients were divided into 2 groups: 39 patients who underwent surgical treatment and 15 patients who were treated conservatively. All patients were questioned using the VAS and KOOS scales.

Results: The VAS scale score in group 1 patients had a faster decrease in pain score in dynamics (from 6,5 to 1,56; 74%) compared to that in group 2 patients. Total KOOS scale score in patients of group 1 in dynamics increased in earlier terms (from 36,12 to 80,09; 121,73%) in comparison with the index of patients of group 2. By the end of follow-up in both groups, statistically reliable improvement of VAS and KOOS scores was noted. Surgical intervention, including dissection of the lateral supporting ligament of the patella, provided faster pain relief (VAS score) and improved functional status with increased activity levels (in daily life and sports) and quality of life (KOOS score) compared with conservative treatment.

Conclusion: The analysis of the results of surgical treatment of post-traumatic patellofemoral joint arthritis showed positive outcomes and a significant improvement in the clinical indicators of the knee joint, as well as a reduction in pain levels at earlier stages compared to conservative treatment.

1. C. Arias and S. Lustig. Physiopathology of patello-femoral osteoarthritis: current concepts. J. ISAKOS. 2024; 9 (4): 806–813. https://doi.org/10.1016/j.jisako.2024.06.004

2. A. G. Schache et al. Patellofemoral joint loading and early osteoarthritis after ACL reconstruction. J. Orthop. Res. 2023; 41 (7): 1419–1429. https://doi.org/10.1002/jor.25504

3. Department of Physical Education and Sport Sciences, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran., S. H. Hosseini, S. Ghobadi Nezhad, and Department of Sport Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran. Morphological Differences of Knee Extensor Muscles Between Women With and Without Lateral Patellar Compression Syndrome. Sci. J. Rehab. Med. 2022; 11 (5): 754–769. https://doi.org/10.32598/SJRM.11.5.7

4. B. Siljander, M. Tompkins, and J. P. Martinez-Cano. A Review of the Lateral Patellofemoral Joint: Anatomy, Biomechanics, and Surgical Procedures. JAAOS Glob. Res. Rev. 2022; 6: 7. https://doi.org/10.5435/JAAOSGlobal-D-21-00255

5. L. Minghao, S. Zhenxing, L. Qiang, and C. Guoqing. Lateral Retinacular Release for Treatment of Excessive Lateral Pressure Syndrome: The Capsule-Uncut Immaculate (CUI) Technique. Arthrosc. Tech. 2023; 11 (12): e1991–e1996. https://doi.org/10.1016/j.eats.2023.07.018

6. R. L. Martin et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J. Orthop. Sports Phys. Ther. 2021; 51 (4): CPG1–CPG80. https://doi.org/10.2519/jospt.2021.0302

7. N. E. Lankhorst, S. M. A. Bierma-Zeinstra, and M. Van Middelkoop. Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review. J. Orthop. Sports Phys. Ther. 2012; 42 (2): 81–94. https://doi.org/10.2519/jospt.2012.3803

8. Y.-P. Yang et al. Novel method for diagnosing lateral patellar compression syndrome using X-ray: a retrospective case-control study. Ann. Transl. Med. 2021; 9 (6): 445–445. https://doi.org/10.21037/atm-20-6410

9. Healthcare Institution " et al. Assessment of knee joint function in patients after total knee arthroplasty using the koos scale. J. Grodno State Med. Univ. 2018; 16 (6): 666–672. https://doi.org/10.25298/2221-8785-2018-16-6-666-672

10. Khabeez A.A., Kalinsky B.М., Gritsyuk A.A., Lychagin A.V., Lychagin I.A., diagnosis of post-traumatic arthritis of the patellofemoral joint in patients after patellar osteosynthesis. Department of Traumatology and Orthopedics. 2025; 1: 51-58 https://doi.org/10.17238/2226-2016-2024-1-51-58

11. C. Chillemi, M. Guerrisi, C. Paglialunga, F. Salate Santone, and M. Osimani. Latarjet procedure for anterior shoulder instability: a 24-year follow-up study. Arch. Orthop. Trauma Surg. 2021; 141 (2): 189–196. https://doi.org/10.1007/s00402-020-03426-2

12. J. A. Wallis, L. Roddy, J. Bottrell, S. Parslow, and N. F. Taylor, “A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain. Phys. Ther. 2021; 101 (3): pzab021. https://doi.org/10.1093/ptj/pzab021

13. R. A. Van Der Heijden, N. E. Lankhorst, R. Van Linschoten, S. M. Bierma-Zeinstra, and M. Van Middelkoop, Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst. Rev. 2021; 1. https://doi.org/10.1002/14651858.CD010387.pub2

14. J. Grgic, A. Garofolini, J. Orazem, F. Sabol, B. J. Schoenfeld, and Z. Pedisic, Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med. 2020; 50 (11): 1983–1999. https://doi.org/10.1007/s40279-020-01331-7

15. E. I. Solod, N. V. Zagorodniy, A. F. Lazarev, M. B. Tsykunov, M. A. Abdulhabirov, and V. H. Hijazin, Surgical treatment and rehabilitation capabilities of patients with patellar fractures. NN Priorov J. Traumatol. Orthop., 2019; 26 (1): 11–16. https://doi.org/10.17116/vto201901111

16. M. J. Tanaka, Editorial Commentary: Handling the (Contact) Pressure in Patellofemoral Surgery: The Role of Lateral Retinacular Release. J. Arthrosc. Relat. Surg. 2022; 38 (3): 965–966. https://doi.org/10.1016/j.arthro.2021.10.010

17. N. Yi, H. Yuan, Y. Zhang, W. Yang, and C. Zhuang, Arthroscopic release of lateral patellar retinaculum for patellofemoral arthrosis. BMC Surg. 2025; 25 (1): 164. https://doi.org/10.1186/s12893-025-02907-8

18. F. Migliorini et al., “Isolated Arthroscopic Lateral Retinacular Release for Lateral Patellar Compression Syndrome. Life. 2021; 11 (4): 295. https://doi.org/10.3390/life11040295

19. N. Yi, H. Yuan, Y. Zhang, W. Yang, and C. Zhuang, Arthroscopic release of lateral patellar retinaculum for patellofemoral arthrosis. BMC Surg. 2025; 25 (1): 164. https://doi.org/10.1186/s12893-025-02907-8

20. Said Firas Main M., Akhtyamov Il'dar Fuatovich, Kudryavtsev Aleksei Igorevich, and Nuriakhmetov Ainur Nafikovich. Etiopathogenic bases for patellofemoral arthritis development. Kazanskii meditsinskii zhurnal. 2018; 99 (2): 270-278

21. Said F. M., Akhtyamov I. F., Kudryavtsev A. I., Helo M. J. Modern tendencies in the treatment of patellofemoral arthrosis. Medical News of North Caucasus. 2018; 13 (4): 685-691. https://doi.org/10.14300/mnnc.2018.13138

22. Said F.M., Akhtyamov I.F., Kudryavtsev A.I., Khelo M.D., and Al'-Lami M.A.. Treatment experience of patellofemoral arthritis (clinical case). Practical Medicine. 2018; 16 (7-1): 85-89. https://doi.org/10.32000/2072-1757-2018-16-7-85-89