AANA Knee Arthroscopy - September 2024-Cartilage Injury with PF Instability: How do I Manage?

Video Transcription

Video Summary

Dr. Andreas Gamal of the Hospital for Special Surgery discusses the relationship between osteochondral defects, cartilage repair, and patella-femoral instability, emphasizing the high prevalence of cartilage damage following patella dislocations—over 90%, with osteochondral fractures in up to 40%. He highlights the importance of early MRI for all patella dislocation patients to assess cartilage damage, loose bodies, and recurrence risk rather than defaulting to conservative treatment. Treatment decisions aim to prevent recurrence and preserve the joint, with repair preferred over removal when possible. Small, non-weight-bearing defects may be ignored, but larger or weight-bearing defects need repair or reconstruction. Various repair techniques include microfracture (generally discouraged in the patella), osteochondral autografts/allografts, juvenile allograft cartilage (PJAG), perforated allograft cartilage, and matrix-induced autologous chondrocyte implantation (MACI), with MACI having the strongest evidence. Insurance coverage for advanced treatments remains challenging. Dr. Gamal stresses individualized treatment based on defect size and bone condition to optimize outcomes and prevent repeat dislocations.

Asset Caption

Dr. Andreas Gomoll

Keywords

osteochondral defects

cartilage repair

patella-femoral instability

patella dislocations

MRI assessment

matrix-induced autologous chondrocyte implantation