AANA Lab Course 910 - Patellofemoral Joint Preservation-Osteochondral Allograft-Dr. William D. Bugbee, M.D.

Osteochondral Allograft-Dr. William D. Bugbee, M.D.

Pdf Summary

This presentation by Dr. William Bugbee from Scripps Clinic focuses on fresh osteochondral allografting (OCA) as a treatment for patellofemoral (PF) joint lesions, a complex and challenging subset of knee pathology. Patellofemoral disease requires accurate correlation between pain and pathology, detailed physical examination, and clear definition of underlying factors such as osseous dysplasia, instability, malalignment, chondral damage, osteoarthritis (OA), and quadriceps or kinetic chain dysfunction.<br /><br />Cartilage injuries isolated to the PF joint are rare and usually occur alongside other background pathological conditions. OCA offers a unique ability to restore both cartilage and underlying bony deformities in the PF joint, including the trochlea, patella, and bipolar lesions. Indications for OCA include traumatic injuries (dislocations, fractures), osteochondritis dissecans (OCD), patellar chondrosis, dysplasia consequences, established OA, and failed previous OCA. <br /><br />Technical challenges arise from the complex anatomy of the PF joint, requiring precise surgical technique aided by specialized instruments. OCA provides durable repair since it replaces damaged cartilage with intact hyaline cartilage, often reducing the need for unloading or realignment surgeries.<br /><br />Dr. Bugbee’s treatment algorithm involves OCA alone for isolated trochlear lesions or isolated patella with mild dysplasia. Severe dysplasia and instability in the patella often require combined procedures, and chronic bipolar PF conditions necessitate ruling out patellofemoral arthroplasty (PFA).<br /><br />The presentation also reviews OCA graft survivorship with respect to anatomic location, diagnosis, patient age, and lesion size, emphasizing factors influencing long-term outcomes. Overall, fresh OCA is a powerful tool in managing complex PF joint lesions by simultaneously addressing cartilage loss and bony abnormalities to improve joint function and pain.

Keywords

osteochondral allografting

patellofemoral joint

knee pathology

cartilage repair

trochlear lesions

patellar chondrosis

osteochondritis dissecans

joint instability

bipolar lesions

surgical technique