AANA Lab Course 910 - Patellofemoral Joint Preservation-Patellofemoral Cartilage Restoration- When to Treat and NOT Treat-Dr. Seth L. Sherman, M.D.

Patellofemoral Cartilage Restoration- When to Treat and NOT Treat-Dr. Seth L. Sherman, M.D.

Pdf Summary

This presentation by Dr. Seth L. Sherman focuses on patellofemoral cartilage restoration, emphasizing when to treat cartilage lesions and when to avoid intervention. Patellofemoral cartilage lesions are common, found in up to 60% of arthroscopies, yet most are asymptomatic and do not heal spontaneously. Treatment decisions are complex, requiring consideration of lesion-specific factors (size, location, depth), joint and limb characteristics (alignment, stability), and patient-specific factors (age, activity, compliance, expectations).<br /><br />Not all cartilage injuries warrant surgery; incidental lesions seen on imaging often do not correlate with symptoms and overtreatment can cause harm, turning a benign issue into a debilitating condition. The key principle is to treat the patient’s symptoms and clinical findings, not just imaging results.<br /><br />Proper patellofemoral biomechanics and alignment are crucial to normal joint function; maltracking and instability contribute to symptoms and cartilage deterioration. Accurate assessment of alignment (using threshold values) is essential, as correcting malalignment, often with procedures like tibial tubercle osteotomy (TTO), improves cartilage restoration outcomes, especially for patellar lesions.<br /><br />Treatment ranges from nonoperative measures (rehabilitation, biologics, NSAIDs) to surgical options like debridement, microfracture, osteochondral autograft/allografts, and cell-based cartilage repair. A staging arthroscopy is recommended to correlate clinical and imaging findings before major surgery and to gauge patient compliance and response to conservative treatment.<br /><br />Indications to treat cartilage include large (3-4 cm), full-thickness defects, unstable flaps, younger high-demand patients with traumatic and symptomatic lesions, especially if biological effusions or mechanical symptoms are present. Smaller, partial-thickness lesions in older, low-demand, minimally symptomatic patients are often better managed conservatively.<br /><br />The presentation highlights managing joint homeostasis by addressing alignment and stability first and being mindful of the limitations of cartilage restoration. Cases with bipolar arthritis or complex instability may exceed the scope of cartilage restoration. Ultimately, a cautious, individualized approach is advocated—avoiding unnecessary surgeries, “not burning bridges,” and continuing to learn in this evolving field.

Keywords

patellofemoral cartilage restoration

cartilage lesions

treatment indications

joint alignment

patellar maltracking

tibial tubercle osteotomy

nonoperative management

surgical cartilage repair

staging arthroscopy

patient-specific factors