AANA Lab Course 910 - Patellofemoral Joint Preservation-Introduction to Patellofemoral Joint Preservation-Dr. Jack Farr II, M.D.

Introduction to Patellofemoral Joint Preservation-Dr. Jack Farr II, M.D.

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This document, presented by Jack Farr, M.D., provides an in-depth overview of patellofemoral (PF) joint preservation, focusing on the diagnosis and treatment of cartilage lesions in the knee's PF joint. PF chondral pathology, including chondrosis, is common and often causes pain and/or instability. Epidemiological data show a high prevalence of PF chondral lesions in patients undergoing knee arthroscopy and in professional athletes, with lesions frequently involving the patella and trochlea.<br /><br />The diagnosis of PF joint pathology involves assessing pain, instability, and correlating clinical findings with biomechanical factors such as muscle strength, gait abnormalities, limb alignment, soft tissue stability, and trochlear morphology. Specific clinical tests and imaging (X-ray, MRI, CT) are used to evaluate these factors, including patella tilt, alignment, and chondral lesion characteristics.<br /><br />Pain from PF chondral lesions is diagnosed by exclusion since articular cartilage is aneural; the pain typically originates from surrounding soft tissues, nerves, or bone. Understanding the cause of chondral lesions—such as patellar instability, subluxation, direct impact, or osteochondritis dissecans—is essential to guide treatment.<br /><br />Treatment is patient- and pathology-specific, based on the concept of demand matching. It targets mechanical factors and chondral defects, avoiding treatment in cases of poorly defined pain or systemic issues. Mapping of chondral damage helps guide surgical approach.<br /><br />Common concomitant surgical procedures include lateral retinacular lengthening for patellar tilt or subluxation, tibial tuberosity osteotomy to adjust PF stress distribution, and medial patellar restraint reconstruction for instability. Surgical details focus on optimizing soft tissue balance without extensive bone drilling and ensuring proper graft positioning.<br /><br />In sum, PF joint preservation requires comprehensive evaluation of biomechanical and structural factors, precise diagnosis, and tailored surgical intervention to address pain and restore joint function.

Keywords

patellofemoral joint preservation

cartilage lesions

PF chondral pathology

patellar instability

knee arthroscopy

biomechanical assessment

imaging techniques (X-ray, MRI, CT)

lateral retinacular lengthening

tibial tuberosity osteotomy

medial patellar restraint reconstruction