Introduction: Patellofemoral arthroplasty (PFA) is an established treatment of isolated patellofemoral osteoarthritis. We present our multi-surgeon, multi-implant series of patellofemoral joint arthroplasty performed over a ten year period.

Material & Results: his study was a retrospective review of all PFA performed in our unit over a ten year period from 1997 to 2006. The unit comprises seven specialist knee surgeons and numerous trainee surgeons. A total of 46 knees had the Lubinus implant (Waldemar Link), 30 knees had the FPV system (Wright Medical) and 25 knees had the Avon system (Stryker Howmedica).

101 arthroplasties in 91 patients were followed up for average period of 48.8 months (6–96 months). The average age was 57 years with female patients thrice as common as male patients. Concomitant procedures in the form of 23 lateral retinacular release or 6 osteochondral autograft transfer system (OATS) were performed. There were 6 complications with 2 infections and 4 stiff knees. Subsequent procedures included arthroscopic debridement (18), arthroscopic lateral retinacular release (8), tibial tuberosity transfer (3) and manipulation for stiffness (2). A total of 4 arthroplasties underwent revision to TKA, 2 for infection and 2 for progression of tibiofemoral osteoarthritis.

Conclusion: Thorough clinical history, physical examination and radiological investigation are essential before embarking on PFJ replacement. Other concomitant procedures like joint debridement, menisectomy or lateral retinacular release may be necessary to obtain optimum results. The necessity of revision surgeries in 31% of the cases of our study suggests that close follow-up of the patients is needed to address any concerns which can be easily resolved. PFJ replacement effectively addresses anterior knee pain, preserves the joint integrity, involves lesser surgical dissection and has good results of revision to TKA.

Revision ACL reconstruction is becoming more frequent especially in specialized centers, due to the large numbers of primary ACL procedures performed.

In two stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity.

It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments.

We describe a new technique for femoral and tibial tunnels impaction grafting in two stage ACL revisions, utilizing the OATS grafting instruments.

The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The inside punch of the harvester is tapped, this allows delivery of the graft in a controlled manner, and allows impaction into the tunnel. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel.