AANA Lab Course 913 - Advanced Knee Course-Patella Instability, Maltracking and Pain

Patella Instability, Maltracking and Pain_ A Case-Based Presentation

Pdf Summary

This presentation by Dr. Jason L. Koh, an orthopedic surgeon specializing in patellofemoral cases, focuses on diagnosis and treatment options for cartilage lesions and patellofemoral pain. Various patient cases illustrate common challenges, including athletes and professionals with knee pain, prior surgeries, and cartilage damage.<br /><br />Key treatment modalities reviewed include chondroplasty, microfracture (Mfx), osteochondral autograft transplantation system (OATS), matrix-induced autologous chondrocyte implantation (MACI), and unloading procedures such as the Fulkerson tibial tubercle osteotomy for realignment. The OATS procedure, particularly useful for focal full-thickness cartilage defects measuring 1-2.5 cm on the femoral condyles, trochlea, or patella, is demonstrated arthroscopically with detailed steps including drilling and plug insertion.<br /><br />Unloading via tibial tubercle osteotomy is effective primarily for lesions on the distal lateral facet of the patella or lateral trochlea and involves an oblique osteotomy with careful measurement and fixation using small screws. Important surgical pearls include avoiding over-medialization, protecting neurovascular structures, encouraging early range of motion, and minimizing weightbearing after surgery to reduce fracture risk.<br /><br />Outcomes from literature and personal experience show chondroplasty offers temporary relief; microfracture can aid small trochlear lesions; OATS yields excellent but size-limited results; and MACI shows promising early results in the US but remains less established. Lateral facetectomy and open patellar OATS are also options for specific cases.<br /><br />Emphasis is placed on recognizing the importance of alignment in patellofemoral pathology and thoughtfully selecting procedures. Challenges include potential need for secondary scopes and insurance coverage limitations. Overall, the approach combines lesion-specific cartilage repair techniques with realignment strategies tailored to individual patient anatomy and pathology.

Keywords

patellofemoral pain

cartilage lesions

chondroplasty

microfracture (Mfx)

osteochondral autograft transplantation system (OATS)

matrix-induced autologous chondrocyte implantation (MACI)

tibial tubercle osteotomy

patellar realignment

arthroscopic surgery

cartilage repair techniques