Orthop Clin N Am 39 (2008) ix Preface Wayne B. Leadbetter, MD Guest Editor ‘‘There are no heroes in patellofemoral surgery.’’ dBlazina, 1979 The operative treatment of the painful degenerative patellofemoral joint is challenging and controversial. This remains true despite long recognition that the refractory advanced stages of isolated patellofemoral chondrosis and arthrosis can and frequently do create prominent patient disability and limb dysfunction. In the past, too often the legacy of patellofemoral surgery has been one of ill-timed operations applied with inadequate rationale, resulting in iatragenic outcomes. This had often left surgeons with the jaded view that ‘‘no patellofemoral complaints get better.’’ The worn patellofemoral joint was relegated to the fate of benign neglect, patellectomy, or eventual total joint replacement. Fortunately, times are changing. The renewed priority shown by orthopedic surgeons, researchers, rehabilitation specialists, biomechanists, and biotechnology innovators on conserving the patellofemoral joint, the so-called ‘‘forgotten joint,’’ has grown exponentially in the current literature. The multiple factors that contribute to the onset of patellofemoral degeneration and arthritis have been better defined, including the importance of patellofemoral dysplasia and instability, extensor mechanism malalignment, and overall limb malalignment. These insights, along with recent advances in articular cartilage restoration techniques and isolated prosthetic resurfacing, offer more options for individualizing patellofemoral operative care. While Balzina’s wise council should be cause to stop and be sure that our reach does not exceed our grasp, today’s orthopedic surgeon is better equipped to cope with patellofemoral disorders. The contributors to this issue have been engaged leaders in trying to prevent misadventures in patellofemoral arthritic surgery for both surgeon and patient while at the same time encouraging advances in operative approach. It is our intention to provide a balanced pragmatic understanding of how to better advise and surgically treat the patient with symptomatic, disabiling, patellofemoral disease who has truly failed all reasonable alternatives. Wayne B. Leadbetter, MD Center for Joint Preservation and Replacement Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore 2401 West Belvedere Avenue Baltimore, MD 21215 E-mail address:
[email protected] 0030-5898/08/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ocl.2008.03.006 orthopedic.theclinics.com Orthop Clin N Am 39 (2008) 269–274 The Pathophysiology of Patellofemoral Arthritis Ronald P. Grelsamer, MDa,*, David Dejour, MDb, Jason Gould, MDc a Patellofemoral Reconstruction, The Mount Sinai Medical Center, Box 1188, 5 East 98th Street, New York, NY 10029, USA b Corolyon Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France c Department of Orthopedic Surgery, The Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029, USA Faced with a patient suffering from patellofemoral arthritis, the surgeon must determine the pathophysiology of the condition, because different causes of patellofemoral arthritis demand different treatments. Specifically, before elaborating a treatment plan, the surgeon, to best of his or her ability, must determine whether the patellofemoral arthritis truly is isolated to the patellofemoral compartment, and, if so, if it is likely to remain isolated for the foreseeable future. For the purposes of this article, the term ‘‘arthritis’’ refers to a full-thickness loss of articular cartilage. The articular cartilage of the patella is similar to all oth