Patellofemoral syndrome a paradigm for current surgical strategies.

The literature regarding suggested treatments for patellofemoral problems is often conflicting and confusing. In this discussion I present the approach I take in evaluating and considering surgery for patients with any of a wide variety of anterior knee pain problems. It has been useful to concentrate on the biomechanics--the mechanical consequence to each tissue affected by any surgical change. In the proposed paradigm, it is assumed that pain is the result of an abnormal load--related either to tension or compression--being applied to each tissue in question. The challenge is to understand how and why that abnormal load was generated. It is essential to make an independent assessment of the condition of the lower limb skeleton, the patellofemoral ligaments, and the trochlear and patellar articular cartilage in each patient. While only a long book can address this subject in detail, this discussion provides a guide for formulating an analysis of the key issues when planning the operative treatment of patellofemoral pain and dysfunction.