A rational approach to the treatment of patellofemoral pain.

Chondromalacia of the patella should be considered a separate entity and not the necessary precursor of osteoarthrosis. It is rarely associated with significant discomfort. Isolated softening, fibrillation of the central medial facet, and a diagnosis of chondromalacia of the patella should be limited, in our view, to isolated fibrillation occurring in the central medial facet and is probably asymptomatic. Symptomatic patellar pain can be treated by realignment if the patella is malaligned, by lateral release and synovial fringe excision if there is an anomalous facet or synovial fringe entrapment syndrome, and by drilling and curettage and stress-relieving operations (if necessary) if there is an osteochondral injury. For osteoarthrosis stress can be relieved on a permanent basis by the Maquet anterior tibial tubercle advancement operation. We recommend approaching patellofemoral pain by establishing a specific diagnosis and applying a specific treatment.