Good clinical outcomes after patellar cartilage repair with no evidence for inferior results in complex cases with the need for additional patellofemoral realignment procedures: a systematic review

Abstract

Purpose Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature analysed clinical results after regenerative cartilage repair of the patella with a special focus on the assessment and treatment of existing patellofemoral malalignment. Methods A systematic review was conducted to identify articles reporting clinical results after cartilage regenerative surgeries of the patella using the PubMed and Scopus database. The extracted data included patient-reported outcome measures (PROMS) and whether cartilage repair was performed alone or in combination with concomitant surgeries of underlying patellofemoral co-pathologies. In cases of isolated cartilage repair, specific exclusion criteria regarding underlying co-pathologies were screened. In cases of concomitant surgeries, the type of surgeries and their specific indications were extracted. Results A total of 35 original articles were included out of which 27 (77%) were cohort studies with level IV evidence. The most frequently used technique for cartilage restoration of the patella was autologous chondrocyte implantation (ACI). Results after isolated cartilage repair alone were reported by 15 (43%) studies. Of those studies, 9 (60%) excluded patients with underlying patellofemoral malalignment a priori and 6 (40%) did not analyse underlying co-pathologies at all. Among the studies including combined surgeries, the most frequently reported concomitant procedures were release of the lateral retinaculum, reconstruction of the medial patellofemoral ligament (MPFL), and osteotomy of the tibial tubercle. In summary, these studies showed lower preoperative PROMS but similar final PROMS in comparison with the studies reporting on isolated cartilage repair. The most frequently used PROMS were the IKDC-, Lysholm- and the Modified Cincinnati Score. Conclusion This comprehensive literature review demonstrated good clinical outcomes after patellar cartilage repair with no evidence of minor results even in complex cases with the need for additional patellofemoral realignment procedures. However, a meaningful statistical comparison between isolated patellar cartilage repair and combined co-procedures is not possible due to very heterogeneous patient cohorts and a lack of analysis of specific subgroups in recent literature. Level of evidence Level IV.

Autologous minced cartilage repair for chondral and osteochondral lesions of the knee joint demonstrates good postoperative outcomes and low reoperation rates at minimum five‐year follow‐up

“…Second, as consecutive patients were included and inclusion criteria were not limited to isolated cartilage defects, the heterogeneity of the study population might pose a limitation. However, a recent systematic review demonstrated good clinical outcomes after cartilage repair at the patellofemoral joint even in complex cases [ 5 ]. Third, the majority of the cartilage defects were located at the patella or femoral condyle and only a few at the trochlea or tibia.…”

“…Osteochondral autograft transfer system (OATS), autologous chondrocyte implantation (ACI), matrix-assisted chondrocyte implantation (MACI) or several cartilage repair techniques using scafolds (natural or synthetic) are contemporarily the most commonly therapies for medium to large defects [7,22]. ACI and MACI are purported to generate hyaline or hyaline-like cartilage, with low associated reoperation rates and favourable clinical outcomes even in complex cases [5,7,18,29,49]. However, the two-step approach of ACI and MACI, which requires laboratory cell cultivation, results in a high inancial and clinical burden.…”

Autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction: similar short-term results in comparison with isolated cartilage repair in ligament intact joints

“…However, recent literature has also demonstrated that analysis and, if applicable, therapy of possible co‐factors are crucial for good postoperative results. Accordingly, the importance of the coronal leg axis for the treatment of defects at the femoral condyles and the importance of patellofemoral alignment for the patellofemoral location have been emphasized [3, 5, 11, 32].…”

Osteoarticular Open Flake Fracture Refixation: The “Parachute” Technique

“… 5 Satisfactory results have been published after autologous chondrocyte implantation in cases of large defects. 6 , 7 For smaller defects with substantial bone loss, autologous osteochondral transplantation may be a reasonable treatment option. 5 , 6 …”