Patellofemoral Cartilage Repair

Abstract

Purpose of ReviewThis review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces.Recent FindingsRecent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients. While autologous chondrocyte implantation shows good and excellent outcomes for chondral lesions, osteochondral defects are adequately addressed with osteochondral allograft transplantation. In case of patellar malalignment, concomitant tibial tubercle osteotomy can significantly improve outcomes. Particulated cartilage and bone marrow aspirate concentrate are potential new alternative treatments for cartilage repair, currently in early clinical studies.SummaryDue to the frequency of concomitant anatomic abnormalities in the PFJ, a thorough clinical examination combined with careful indication for each procedure in each individual patient combined with meticulous surgical technique is central to achieve satisfying outcomes. Additional comparative studies of cartilage repair procedures, as well as investigation of newer techniques, are needed.

Resultados a mediano plazo del trasplante osteocondral autólogo en las lesiones del cartílago patelar

“…10 Para las lesiones mayores de 2 cm 2 podría emplearse el trasplante osteocondral alogénico o las terapias regenerativas. 9 Existen varias publicaciones que, al igual que nuestro estudio, avalan el trasplante osteocondral autólogo en la rótula con buenos resultados funcionales a corto, mediano y largo plazo. 3,5,6,8,10,11,12 Figueroa y colaboradores realizan un estudio prospectivo con un seguimiento medio de tres años, que incluye 10 pacientes con lesiones osteocondrales patelares grado IV de ICRS, tratados con trasplante osteocondral autólogo y encuentran una mejora estadísticamente significativa de la escala Lysholm, con 100% de resultados satisfactorios, 60% buenos y 40% excelentes.…”

Systematic Review of Patient Outcomes and Associated Predictors After Microfracture in the Patellofemoral Joint

“…An articular cartilage lesion of up to 4 cm 2 is an indication for microfracture in the knee, and many authors suggest a cutoff closer to 2 cm 2 for the PFJ. 27,28 Several authors recommend alternative procedures such as autologous chondrocyte implantation for lesions >2 to 3 cm in the PFJ because of concerns about durability and longevity of the repair tissue generated by microfracture in lesions of that size. 27–29 Our study was unable to substantiate those recommendations for the PFJ.…”

Cartilage Restoration of Patellofemoral Lesions: A Systematic Review

“…22 The first-line treatment is nonoperative management. 23,24 When this approach fails, the surgical management should be considered with the goals of restoring cartilage surface congruity, reestablishing normal patellofemoral biomechanics, alleviating symptoms, and improving function and quality of life. The choice of technique is influenced by the individual (e.g., age, activity level, body mass index and patellofemoral alignment) and morphological defect characteristics (e.g., location, size, depth, and containment).…”

“…The choice of technique is influenced by the individual (e.g., age, activity level, body mass index and patellofemoral alignment) and morphological defect characteristics (e.g., location, size, depth, and containment). 23 In the past decade, a variety of surgical options have emerged for treating symptomatic patellofemoral cartilage lesions, but a gold standard treatment has not been established yet. 1,8,9,23,[25][26][27] Even though there are many case series reporting improved clinical outcomes after a variety of cartilage repair procedures (including microfracture [MFx], autologous chondrocyte implantation [ACI], osteochondral allograft transplantation [OCA], and osteochondral autograft transfer [OAT]); there is a lack of randomized controlled trials or comparative studies in the patellofemoral joint (only one study comparing techniques 28 ).…”