Arthritis of the patellofemoral joint is typically an extremely debilitating condition and is relatively common. Arthritic changes have been found radiographically in the patellofemoral compartment in isolation in 13.6% to 24% of women and in 11% to 15.4% of men in two studies of subjects who were more than fifty-five and sixty years old, respectively1,2. When only patients with symptomatic osteoarthritis of the knee were considered, the prevalence of isolated patellofemoral disease (in patients over fifty-five years old) ranged from 5% to 8%2,3. In a cadaver study of 100 individuals who were more than sixty-five years old at the time of death, 79% had evidence of patellofemoral osteoarthritis, although it was not in isolation4 . However, despite the frequency of patellofemoral arthritis, and its various predisposing conditions associated with anterior knee pain, it has historically proven to be relatively refractory to treatment. This is due, in part, to the complexity of the problem, and it reflects a possible previous lack of recognition of the subtleties of the biomechanics at this articulation. As our understanding of the disease and the biomechanics of the joint has improved, the management of patellofemoral arthritis and its antecedent conditions has also become more clearly defined. Corresponding to the spectrum of disease associated with the degeneration of the patellofemoral joint, a range of management options are currently available and they are continuing to be developed. Although there are areas of controversy, these current treatment modalities, when appropriately applied, are associated with increasingly successful patient outcomes5-9. There are many current areas of debate with regard to the management of patellofemoral arthritis, but an appreciation of the biomechanics and function of the patellofemoral joint underpins all modern interventions. Some of the current controversies include the precise indications for certain procedures and the types of soft-tissue and osseous realignment procedures10. Developments in chondrocyte culture and implantation have raised the issue of the use of such treatments in the patellofemoral joint8,9. The question of which patients and which conditions are best suited to these new treatments has also been raised by the recently improved results achieved with unicompartmental patellofemoral arthroplasties5,11,12. Finally, recent literature has been encouraging with regard to the use of total knee arthroplasty for the treatment of isolated patellofemoral arthritis in certain, particularly older, patients3,7,13. The objectives of this symposium, therefore, were to provide an overview of the current understanding of patellofemoral arthritis and of the issues regarding its management and to provide some indication as to how these can be expected to develop in the near future.



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