role of arthroscopic surgery in the management of anterior knee pain syndrome

The aim of this work was to evaluate the role of arthroscopic surgery in the management of persistent anterior [patello-femoral] knee pain, which failed to respond to conservative treatment for at least six months. The study included 70 patients [48 females and 22 males]. The mean age at the time of the operation was 25 years [range 15-40 years]. The work was done in the period between August 1993 and August 1996. The average follow-up period was 2.5 years. Patients were classified into four groups according to the etiology of the pain: Group I [patellar tracking disorders, 26 patients], group II [idiopathic chondromalacia patellae, 25 patients], group III [osteochondrosis and osteochondral fractures, 9 patients] and group IV [other causes of AKP including synovial plica, 4 patients, and hypertrophy of the Hoffa's patellar fat pad, 6 patients]. Assessment was done by asking all patients to attend a special follow-up clinic. A simple classification was done based entirely on the patient's subjective rating. The result was considered good when neither symptoms nor restrictions of activities were present or when occasional pain after a strenuous effort was present. The result was considered fair when the patient had some pain, restriction of activity or mild residual instability, but the patient felt that the knee was better than preoperatively. In cases graded as poor, persistent symptoms [pain and/or instability] were present and the knee was unchanged or worse than preoperatively. In group I, the results were 20 good, 4 fair and 2 poor. In group II, the results were 6 good, 14 fair and 5 poor. In group III, the results were 6 good, 2 fair and one poor. In group IV, the results were 3 good, one fair, zero poor for synovial plica and 4 good, 2 fair, zero poor for Hoffa's syndrome. The study demonstrated that arthroscopy has a very useful role to play in the diagnosis and treatment of patients with persistent AKP syndrome who failed to respond to conservative management