Objective： To retrospectively analyze the clinical effects of open surgery and arthroscopic minimally invasive treatment of patellofemoral osteoarthritis. Methods： From May 2012 to July 2017, A retrospective analysis was made of 67 patients (81 knees) with patellofemoral arthritis who met the inclusion criteria . 27 patients (36 knees) were in the arthroscopic group and 40 patients (45 knees) were in the incision group. Arthroscopic debridement, peripatellar denervation, lateral patellofemoral ligament release and patelloplasty were performed in the arthroscopic group, and partial patellectomy and lateral retinaculum extension were performed in the incision group. Kujala score, congruence angle (CA), tilt angle (TA) and lateral patellofemoral angle (LPA) were observed before and 1 year after operation.Results: (1) Two groups were followed up for 16 to 21 months, with an average of 18.49 (+2.27) months. (2) The Kujala score of one year after operation in both groups was better than that before operation (P < 0.01). (3) Kujala score of Wiberg type III patients was better than that of arthroscopic group one year after operation (P < 0.01). 4) CA and TA of two groups decreased significantly one year after operation, while LPA increased significantly (P < 0.01). The TA in the incision group was significantly smaller than that in the arthroscopic group one year after operation, while the LPA was significantly larger than that in the arthroscopic group (P < 0.05).Conclusion Open surgery and arthroscopic minimally invasive treatment of moderate to severe patellofemoral osteoarthritis can achieve satisfactory clinical efficacy, but Wiberg type III patients with open surgery is better than arthroscopic surgery, regardless of which operation in the treatment of lateral patellofemoral retinaculum ,we should pay attention to the patellofemoral coronal balance, to avoid the medial patellofemoral instability.