For many years the apparent futility of all forms of conservative management of relatively severe arthritis of the knee joints has stimulated the search for a possible surgical procedure which is less radical than fusion or synovectomy of the involved joint. Every orthopedic surgeon can immediately recall the vast number of patients he has treated for arthritis of the knees who after traction, immobilization by casts in the position of function, physical therapy, vaccines and eradication of foci of infection would return at variable intervals complaining of pain on motion, stiffness and recurring deformity. Careful elicitation of the patient's complaints almost invariably results in the information that the greatest pain is localized in the anterior part of the knee and is aggravated by active attempts at extension. This motion when possible is almost invariably associated with subpatellar crepitation and not infrequently is associated with gross, irregular, cogwheel-like movements of the
BERKHEISER EJ. EXCISION OF THE PATELLA IN ARTHRITIS OF THE KNEE JOINT. JAMA. 1939;113(26):2303–2308. doi:10.1001/jama.1939.02800510025007
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