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Objective To investigate the clinical results of three-grade surgery of realignment of patellofemoral joint under real time knee arthroscopic monitoring.Methods 102 patients (143 knees) aged 9 to 27 (mean 16.7) with patellofemoral disorders were treated with knee arthroscopy from January 2005 to August 2011.Three grades realignment operations of patellofemoral joint includes: 1.Release of lateral reticulum; 2.Grade 1 operation plus medial reticulum augmentation suturing; 3.Grade 2 operation plus inferomedial tibial tubercle translation osteotomy fixed with 3 screws.All cases were treated under arthroscopic monitoring.Patella and femoral trochlear groove should match during 0-120 degree knee flexion after realignment.Patients were followed-up with Lysholm score and clinical data were analyzed at the same time.Results Out of 102 cases (143 knees), 37 patients (43 knees) took grade 1 operation, 24 patients (33 knees) took grade 2 operation and 41 patients (57 knees) took grade 3 operation.Patients were followed-up for 8-70 months (mean 57.5 months).Lysholm score was 88-100 (mean 95.7).No relapse of dislocation was found at the time of follow-up.5 cases (8 knees) aged 23-27 years (mean 25.2 years) have anterior knee pain after surgery.Clinical data showed patellofemoral cartilage injury for all cases at the time of surgery.Conclusion Diagnosis and realignment operation under direct monitoring of arthroscopy are important principles for treatment of patellofemoral disorder.Three-grade realignment operation can achieve precise matching ofpatellofemoral joint under arthroscopic monitoring.Postoperative follow-up result is good to excellent to most patients.Patients with elder age and with patellofemoral chondral lesion could have poor medium-term follow-up result, and this may indicate that elder age combined with chondral lesion is an indication for surgery while may got relatively poor surgical result.