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Medial unicompartmental knee arthroplasty (UKA) has increased in popularity for the ​treatment of end-stage anteromedial osteoarthritis in part secondary to its quicker recovery, improved function, and decreased risk of medical complications over total knee arthroplasty (TKA). However, despite the success of medial UKA, dilemma still exists over certain patient characteristics as to suitability for undergoing the procedure. In addition to patient age, body mass index (BMI), and the presence, or lack thereof, of an anterior cruciate ligament (ACL), one of the most contentious issues surrounding suitability for medial UKA is the preoperative status of the patellofemoral joint (PFJ). This review aims to look at the historical factors leading to the current dilemma as well as recent evidence surrounding anterior knee pain and preoperative PFJ arthritis on the survivability and outcomes of medial UKA. This article will also evaluate other PFJ factors possibly affecting the outcome of medial UKA such as lateral patellar subluxation and lateral facet grooving, future perspectives that may influence the utilization of medial UKA such as cementless implants, and the choice of mobile versus fixed bearing articulations., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Adolph Lombardi, Jr., MD reports a relationship with Zimmer Biomet that includes: consulting or advisory. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Total Joint Orthopedics that includes: consulting or advisory. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Firstkind that includes: funding grants. Adolph Lombardi, Jr., MD reports a relationship with Parvizi Surgical Innovations Research Institute that includes: equity or stocks and funding grants. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Recovery Rx that includes: funding grants. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with SPR Therapeutics Inc that includes: funding grants. Adolph Lombardi, Jr., MD (JIS Research Institute) reports a relationship with Prescribe Fit that includes: equity or stocks and funding grants. Adolph Lombardi, Jr., MD reports a relationship with Smith and Nephew Inc that includes: funding grants. Adolph Lombardi, Jr., MD reports a relationship with SI-BONE Inc that includes: funding grants. Adolph Lombardi, Jr., MD reports a relationship with JIS Ventures that includes: equity or stocks. Adolph Lombardi, Jr., MD reports a relationship with Joint Development Corporation that includes: equity or stocks. Adolph Lombardi, Jr., MD reports a relationship with Operation Walk USA that includes: board membership. Adolph Lombardi, Jr., MD reports a relationship with Central Ohio Orthopaedic Management Company that includes: board membership. Adolph Lombardi, Jr. MD reports a relationship with Current Concepts in Joint Replacement that includes: board membership. Keith Berend, MD reports a relationship with Medacta USA INC that includes: speaking and lecture fees. Keith Berend, MD reports a relationship with Smith and Nephew Inc that includes: funding grants and speaking and lecture fees. Keith Berend, MD (JIS Research Institute) reports a relationship with Zimmer Biomet that includes: funding grants. Keith Berend (JIS Research Institute) reports a relationship with Total Joint Orthopedics that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Firstkind that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Parvizi Surgical Innovations Research Institute that includes: equity or stocks and funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Recovery Rx that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with Prescribe Fit that includes: equity or stocks and funding grants. Keith Berend, MD reports a relationship with SPR Therapeutics that includes: funding grants. Keith Berend, MD (JIS Research Institute) reports a relationship with SI-BONE Inc that includes: funding grants. Keith Berend, MD reports a relationship with JIS Ventures that includes: equity or stocks. Keith Berend, MD reports a relationship with Joint Development Corporation that includes: equity or stocks. Adolph Lombardi, Jr., MD has patent with royalties paid to Zimmer Biomet. Adolph Lombardi, Jr., MD has patent with royalties paid to Innomed. Publications Editorial Boards (Adolph Lombardi, Jr., MD): Journal of Arthroplasty; Journal of Bone and Joint Surgery; Clinical Orthopaedics and Related Research; Journal of the American Academy of Orthopaedic Surgeons; Journal of Orthopaedics and Traumatology; Surgical Technology International; The Knee; The Bone & Joint Journal Publications Editorial Boards (Keith Berend, MD): Journal of Arthroplasty; Reconstructive Review. Todd Bertrand, MD, MBA; Patricia Melvin, MD, MBS have no known competing financial interests or personal relationships to declare that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)