AANA Lab Course 913 - Advanced Knee Course-The Patellofemoral Cartilage Dilemma_ Let Me Help You Faculty Lecture

The Patellofemoral Cartilage Dilemma_ Let Me Help You Faculty Lecture_ Seth L. Sherman, MD

Pdf Summary

This presentation by Dr. Seth L. Sherman addresses the complexity of patellofemoral cartilage lesions, emphasizing that such lesions are common and often asymptomatic, thus not warranting overtreatment. Incidental cartilage defects detected by MRI or arthroscopy should not be treated solely based on imaging, to avoid causing iatrogenic harm and unnecessarily complicated, morbid interventions.<br /><br />Patellofemoral cartilage damage frequently arises from biomechanical overload, chronic patella maltracking, instability, trauma, or early degenerative changes. Management requires a thorough assessment of limb alignment, patella stability, and cartilage status, integrating patient history, physical exam, imaging, and diagnostic arthroscopy for accurate decision-making.<br /><br />Non-operative treatment, including NSAIDs, biologic injections, bracing, and targeted rehabilitation, is the first-line approach. A staging arthroscopy can clarify lesion extent and guide surgical planning. Surgical options range from debridement and marrow stimulation to osteochondral autograft transfer (OATS), cell-based repairs such as autologous chondrocyte implantation (ACI), osteochondral allografts, and partial joint replacements. Patellar cartilage lesions notoriously respond poorly to marrow stimulation alone.<br /><br />Critical in surgical planning is addressing underlying malalignment and instability, often with tibial tubercle osteotomy (TTO), medial patellofemoral ligament (MPFL) reconstruction, and lateral retinacular lengthening. Combined alignment correction and cartilage restoration yield better outcomes than isolated cartilage procedures.<br /><br />Advanced cell-based therapies—including 3rd generation matrix-induced ACI and particulated juvenile articular cartilage (PJAC)—show promising medium-term outcomes with improved cartilage quality and patient function. However, treatment choices should be individualized, especially considering patient age, joint condition, and prior treatments.<br /><br />Dr. Sherman advocates for a conservative, staged approach—avoiding aggressive surgery unless clearly indicated—underscoring that damage should be treated thoughtfully to preserve joint function and "not burn bridges" for future interventions. The patellofemoral joint is complex; management demands humility, ongoing learning, and respect for joint biomechanics to optimize patient outcomes.

Keywords

patellofemoral cartilage lesions

asymptomatic cartilage defects

MRI and arthroscopy diagnosis

biomechanical overload

patella maltracking

non-operative treatment

surgical cartilage restoration

tibial tubercle osteotomy

medial patellofemoral ligament reconstruction

cell-based cartilage therapies