The role of patellectomy in the treatment of patellofemoral disorders is a subject of controversy. The popularity of this procedure was great initially when there was little understanding of its biomechanics. Today, indications for patellectomy have narrowed with the knowledge that the patella is vital to the normal function of the knee joint; now more emphasis is placed on its preservation.

Major functions of the patella include lengthening the quadriceps lever arm, thereby facilitating knee extension (8,10,11,14,15); decreasing the compressive stresses on the patellofemoral joint; and providing a smooth, nearly frictionless surface that is resistant to wear (16). Patellectomy has been shown to alter knee-joint mechanics. Clinically, the most apparent effect of patellectomy is a decrease in the quadriceps muscle lever arm, necessitating a 30% increase in force to maintain the same torque during knee extension (10,11). We believe that every effort should be made to preserve the patella and have found that alternatives to patellectomy exist (12,13).

Patellectomy has been described as the treatment for a variety of patellofemoral disorders (7,9,13,15). Primary patellectomy is often the treatment of choice for cases of trauma with severe comminution not amenable to osteosynthesis, and for rare tumors of the patella. However, when evaluating patellar fractures consideration should first be given to obtaining an adequate reduction with internal fixation. Partial patellectomy is the surgical procedure chosen for comminuted fractures of the patella that are not amenable to osteosynthesis but in which one pole of the patella can be saved. In the debate over which pole of the patella to save, we recommend saving the pole with the greatest amount of articular cartilage, irrespective of which pole this is. Better results and postoperative function are obtained if more of the patella can be saved (5,6,17).

Despite the limited indications as a primary procedure, patellectomy can be a useful secondary or “salvage” procedure. Satisfactory results have been described for the following disorders:

The indication for patellectomy in these conditions is limited to those cases with persistent pain and disability not relieved by other avenues of treatment, including vigorous rehabilitation, medical treatment, arthroscopic surgery, and surgery to realign the extensor mechanism. If pain and disability continue despite these measures, a patellectomy may be considered.

A complete history and physical examination are required as part of the preoperative evaluation. Radiographs obtained should include anteroposterior, lateral, and Merchant views of the knee. The diagnosis of patellar pain is made after other causes of knee pain are ruled out. Other treatment options should be exhausted, including rehabilitation, medical treatment, and limited surgical management. If pain and disability persist, a patellectomy may be considered.