Summary

Partial lateral facetectomy (PLF) is an effective surgical treatment option for PFOA as shown by meta-analysis of subjective and radiographic outcomes measures, and this study provides valuable insight into the use of PLF as a viable minimally invasive surgical option to treat PFOA in addition to other procedures such as lateral retinacular release and realignment procedures.

Abstract

Introduction

Surgical treatment for patellofemoral osteoarthritis (PFOA) consists of soft tissue, bony, and arthroplasty interventions. Partial lateral facetectomy (PLF) is a bone-reducing procedure, commonly done in conjunction with soft tissue and realignment procedures, that has grown in popularity after failure of conservative treatment due to its efficacy and minimally invasive nature. This systematic review and meta-analysis thus seeks to evaluate the efficacy of PLF in the absence of reviews on this topic.

Methods

A systematic review of three databases (PubMed, EMBASE, Scopus) was conducted, identifying studies that evaluated postoperative outcomes of PLF on patients who had PFOA. Pairwise meta-analysis was conducted between preoperative versus postoperative values of the Knee Society Score (KSS), a subjective outcome measure, and the Congruence Angle (CA), a radiographic outcome measure. Subgroup analysis was further performed on different concomitant procedures aside from PLF to determine the effect of these procedures on clinical outcomes.

Results

Ten studies were included in the meta-analysis, with 463 patients and 495 knees and a pooled mean follow-up of 63.2 months and pooled age of 56.3 years old. Six studies evaluated PLF with lateral release, two studies evaluated PLF with realignment procedures, one study evaluated PLF with lateral lengthening, and one study evaluated PLF with both lateral release and realignment. Postoperatively, four studies showed a significant improvement (p<0.01) in KSS of 34.45 (95%CI: 26.41 to 42.49), and five studies showed significant improvement (p<0.01) in CA of -9.39 (95%CI: -12.24 to -5.54). Subgroup analysis between PLF with lateral release versus PLF with lateral lengthening versus PLF with lateral release and realignment revealed statistically significant difference for KSS (p<0.01) but not for CA (p=0.65).

Conclusion

This study provides valuable insight into PLF as a surgical treatment option for PFOA, as it has shown to be an effective procedure using subjective and radiographic outcome measures. Current cohort studies have shown significant improvement in PFOA treatment, even in the context of long-term outcomes and severe PFOA, and provides valuable insight into the use of PLF as a viable minimally invasive surgical option to treat PFOA in addition to other procedures such as lateral retinacular release and realignment procedures.