Partial lateral patellar facetectomy is beneficial for patients with patellofemoral osteoarthritis: A systematic review and meta-analysis.

Abstract

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. 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 a subjective outcome measure (Knee Society Score (KSS)) and radiographic outcome measure (Congruence Angle (CA)). Subgroup analysis was performed on different concomitant procedures aside from PLF to determine their effect on clinical outcomes. Ten studies were included in this review, with 463 patients and 495 knees and a pooled mean follow-up of 63.2 months and age of 56.3 years. Six studies investigated PLF with lateral release, two with realignment procedures, one with lateral lengthening, and one with both lateral release and realignment. Five studies found significant improvement (p < 0.01) in KSS (34.45; 95%CI: 26.41 to 42.49, and four studies reported significant improvement (p < 0.01) in CA (-10.31; 95%CI: 13.80 to -6.81). Subgroup analysis showed a significant difference in KSS between PLF with lateral release, lateral lengthening, and realignment (p < 0.01) but not for CA (p = 0.65). PLF is an effective treatment for PFOA 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.