AANA Fellowship Education - Patellofemoral Complex: Trauma or Born to be Bad?-Patellofemoral Complex: Trauma or Born to be Bad?

Video Transcription

Video Summary

The webinar opens the ANA Fellowship Education Series on “Patellofemoral Complex Trauma,” outlining a program on instability, trochleoplasty, and cartilage restoration, followed by case discussion.<br /><br />Dr. Mio Tanaka reviews patellar instability as an individualized anatomic problem requiring assessment of soft-tissue deficiency and bony malalignment (TT–TG distance, patella alta), plus trochlear dysplasia and cartilage injury. She explains evolving concepts from MPFL to the medial patellofemoral complex (MPFC), emphasizing accurate femoral tunnel placement (using Schöttle’s point and a true lateral fluoroscopic view) and avoiding overtensioning, which can increase contact pressures and risk arthrosis. She notes MPFC reconstruction treats only soft-tissue deficiency; malalignment may require tibial tubercle osteotomy (TTO): medialization typically when TT–TG >20 mm, distalization when Caton-Deschamps Index (CDI) >1.4 (with higher complication risk), and anteriorization to offload lateral facet chondral lesions.<br /><br />Dr. Tom Carter discusses cartilage transplantation in the patellofemoral joint. He discourages trochlear microfracture due to poor durability, reviews MACI and newer options (biocartilage, Cartiform), and stresses evaluating subchondral bone and correcting risk factors (dysplasia, alta, maltracking). He highlights fresh osteochondral allograft (OCA) as versatile for size/shape and for bone loss or larger/failed lesions, describing technical pearls (6–8 mm bone, avoid proud grafts, avoid impaction). He cites survivorship data showing good mid- to long-term outcomes, though bipolar and revision cases have lower survival.<br /><br />Dr. Lee Pace argues trochlear dysplasia is the dominant risk factor for recurrent instability and is linked to early chondral damage. He advocates elevating trochleoplasty as a primary, problem-focused procedure in severe dysplasia (e.g., persistent instability in flexion, flat/convex trochlea; low/negative lateral trochlear inclination), typically combined with soft-tissue balancing. He reviews thin-flap trochleoplasty technique and European outcome data showing high satisfaction and durable stability.<br /><br />The panel then debates complex revision cases, highlighting decision-making between trochleoplasty, cartilage restoration, and patellofemoral arthroplasty when cartilage is compromised.

Asset Caption

Laith M. Jazrawi, M.D. | Thomas R. Carter, M.D. | J. Lee Pace, M.D. | Miho J. Tanaka, M.D., M.A.

Keywords

patellofemoral complex trauma

patellar instability

medial patellofemoral complex (MPFC) reconstruction

MPFL femoral tunnel placement (Schöttle’s point)

tibial tubercle osteotomy (TTO)

TT–TG distance

patella alta (Caton-Deschamps Index)

trochlear dysplasia and trochleoplasty

patellofemoral cartilage restoration (MACI/OCA)

revision patellofemoral surgery decision-making