Long-term follow-up study on the Maquet procedure with special reference to the causes of failure.

Thirty-nine patients with symptomatic osteoarthrosis (OA) of the patellofemoral joint were treated with 42 anterior tibial tubercle elevations, also known as the Maquet procedure. The patients all had symptomatic OA of the patellofemoral joint that fell into one of three categories: old patellar fracture, chronic patellar subluxation, or postpatellectomy pain. In the latter group, the OA was manifested by erosions of trochlear articular cartilage from the articulating quadriceps tendon-patellar ligament suture line. All 39 patients had a 1.5-2.5-cm tibial tubercle elevation with medial displacement, as necessary, to centralize their patellofemoral mechanisms. Follow-up period averaged 6.1 years. Seventy-nine percent (33 of 42 procedures) had good to excellent results. There was a major complication rate of 7%. Six of the nine failures were attributable to social/psychiatric reasons. Previously unrecognized tibiofemoral OA was the reason for poor results in two of the other failures, and one failure was unexplained. Patients with long-standing symptoms caused by patellofemoral OA should preoperatively be psychologically evaluated and diagnostically arthroscoped before the Maquet procedure is carried out.