AANA Lab Course 910 - Patellofemoral Joint Preservation-Patellofemoral Cases-Dr. Brian R. Waterman, M.D.

Patellofemoral Cases-Dr. Brian R. Waterman, M.D.

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This document presents clinical case studies and management considerations for patellofemoral disorders, specifically focusing on patellar instability and cartilage pathology.<br /><br />Case 1 describes a 14-year-old female with a 7-8 year history of bilateral knee pain and patellar instability, complicated by previous guided growth surgery and epiphysiodesis with hardware. Physical examination revealed abnormal knee contour, patella alta, lateral patellar tracking with a positive J sign, and significant lateral patellar translation. Imaging showed elevated TT-TG (19 mm) and TT-PCL (20 mm) distances, patella height index (Caton-Deschamps ratio 2), trochlear dysplasia, and compromised MPFL integrity. The plan involved assessing surgical options such as anteromedialization (AMZ) tibial tubercle osteotomy, lateral retinacular lengthening, and possible repair techniques including patellar tendon tenodesis with distal osteotomies.<br /><br />Case 2 involves two patients:<br /><br />- A 31-year-old female roller derby athlete with chronic bilateral knee pain post-ACL reconstruction. Examination showed effusion, physiologic valgus, limited extension, and chondral defects (Grade III/IV) with bone edema in both knees. Imaging indicated normal patella height and TT-TG distances (15-17 mm). Management included staged bilateral autologous chondrocyte implantation (ACI) and tibial tubercle osteotomy (TTO).<br /><br />- A 29-year-old male military police officer with a year and a half of atraumatic knee pain and mechanical symptoms, treated unsuccessfully with conservative measures.<br /><br />Overall, the presentation emphasizes the interplay of anatomical factors (alignment, trochlea morphology, patellar height, TT-TG), soft tissue constraints (MPFL), and cartilage status in guiding diagnosis and surgical planning. Treatment is individualized based on radiographic measurements, ligament competence, cartilage health, and patient activity level. Surgical techniques such as AMZ tubercle osteotomy, MPFL repair, lateral retinacular lengthening, and cartilage restoration are highlighted. The talk concludes by recognizing the demands of elite athletes and the importance of comprehensive evaluation for successful outcomes in patellofemoral instability and cartilage pathology.

Keywords

patellofemoral disorders

patellar instability

cartilage pathology

anteromedialization tibial tubercle osteotomy

lateral retinacular lengthening

MPFL repair

autologous chondrocyte implantation

trochlear dysplasia

TT-TG distance

patellar tendon tenodesis