The Etiology of Chondromalacia Patellae

Outerbridge, R. E.

doi:10.1302/0301-620x.43b4.752

Cited by 2,240 publications

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“…The present findings are also relevant to discussions of the pathology of chondromalacia patellae (0wre, 1936;Wiles, Andrews, and Devas, 1956;Outerbridge, 1961;Bentley, 1970), since they show that the appearance of the patellar articular surface in patients with this clinical condition needs to be assessed in terms of how far it differs quantitatively or qualitatively from that in specimens matched by age and sex from amongst the general population.…”

Section: 'Minimal Fibrillation'mentioning

confidence: 63%

Quantitative aspects of patello-femoral cartilage fibrillation in Liverpool necropsies.

Meachim¹,

Emery²

1974

Annals of the Rheumatic Diseases

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The significance of ageing as a possible factor contributing to the pathogenesis of osteoarthrosis is debatable (Byers, Contepomi, and Farkas, 1970); moreover, the matter may require separate consideration for the hip, knee, and other joints. Necropsy studies of the incidence, natural history, and severity of age-related cartilage lesions in various joints are relevant to this question. Age changes in the hip, knee, and other joints have been studied by Heine (1926), in the knee joint by 0wre (1936) and Bennett, Waine, and Bauer (1942), in the elbow by Goodfellow and Bullough (1967), and in the hip by Byers and others (1970). These previous studies have been based mainly on a qualitative assessment of the state of the articular surfaces, the results being expressed, for example, in terms of a grading system such as that devised by Collins (1949). The present study, in contrast, is based on a quantitative method in which the results are expressed as a percentage of the articular surface area affected by destructive cartilage changes. The patello-femoral component of the knee joint was selected for study by this method, since the slight curvature of the patellar surface makes this articulation suitable for quantitation by a point-counting technique. Previous studies, with the exception of that by Goodfellow and Bullough (1967), mostly seem to have relied mainly on naked-eye inspection of unstained surfaces. The present study, in contrast, was made on surfaces which had been painted with indian ink, since such preparations make cartilage lesions more readily apparent (Bullough and Goodfellow, 1968;Meachim, 1972a) and facilitate point-counting of the various types of surface change. Naked-eye examination was supplemented by stereomicroscopy of the surface and, where indicated, by transmitted light microscopy of tangential surface slices (Meachim, 1972a). Material and methodsThe study was made on the patello-femoral articulation of one or both knee joints from a random series of necropsies within the city of Liverpool on 98 white subjects (53 male; 45 female) whose ages ranged from 4 weeks to 94 years. Persons dying from accidents and persons dying outside hospital suddenly or unexpectedly from natural causes were included as far as possible. Joints showing evidence ofprevious inflammatory disease, disuse atrophy, surgery such as meniscectomy, old injury, or injury from a recent accident were excluded. Quantitative data were obtained from indian ink preparations of the left patellar articular surface in all of the 98 subjects, from the opposing left femoral articular surface in 83 of them (43 male; 40 female), and also from the contralateral right patellar surface in thirty of the adults (14 men and 16 women). SURFACE QUANTITATIONIndian ink preparations were made by the method previously described (Meachim, 1972a). The painted articular surfaces were then examined by the unaided naked eye, by study of photographic prints at a magnification of x2, by stereomicroscopy enface at a magnification of x 10, and, where indic...

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Section: 'Minimal Fibrillation'mentioning

confidence: 63%

Quantitative aspects of patello-femoral cartilage fibrillation in Liverpool necropsies.

Meachim¹,

Emery²

1974

Annals of the Rheumatic Diseases

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“…The modified Outerbridge classification was defined as follows: Grade 0, normal cartilage; Grade 1, cartilage softening and swelling; Grade 2, fissures not reaching subchondral bone; Grade 3, fissures to subchondral bone; and Grade 4, exposed subchondral bone [34,35]. Studies were required to include at least 30 patients, have at least 1 year of followup, and compare either ACI or OAT with another treatment method.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Focal Articular Cartilage Defects in the Knee

Magnussen¹,

Dunn²,

Carey³

et al. 2008

Clinical Orthopaedics &Amp; Related Research

199

131

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We asked whether autologous chondrocyte implantation or osteochondral autograft transfer yields better clinical outcomes compared with one another or with traditional abrasive techniques for treatment of isolated articular cartilage defects and whether lesion size influences this clinical outcome. We performed a literature search and identified five randomized, controlled trials and one prospective comparative trial evaluating these treatment techniques in 421 patients. The operative procedures included autologous chondrocyte implantation, osteochondral autograft transfer, matrix-induced autologous chondrocyte implantation, and microfracture. Minimum followup was 1 year (mean, 1.7 years; range, 1-3 years). All studies documented greater than 95% followup for clinical outcome measures. No technique consistently had superior results compared with the others. Outcomes for microfracture tended to be worse in larger lesions. All studies reported improvement in clinical outcome measures in all treatment groups when compared with preoperative assessment; however, no control (nonoperative) groups were used in any of the studies. A large prospective trial investigating these techniques with the addition of a control group would be the best way to definitively address the clinical questions.

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“…Irregular fissures, ulcerations, and broad erosions are well depicted with arthroscopy. These alterations can be classified into 5 stages: stage 0 = normal cartilage; stage 1 = cartilage swelling; stage 2 = superficial fragmentation and fissuring; stage 3 = deep fragmentation and fissuring; and stage 4 = erosion of cartilage down to the bone (51). Later still, tears in the meniscus, large defects of the cartilage, exposure of subchondral bone, and the formation of cysts and osteophytes can be detccted (52).…”

Section: Anatomic Alterations Of Articular Cartilage Accessible To Immentioning

confidence: 99%