APEX Knee Navigating Pearls and Pitfalls-Cartilage Injury with PF Instability: How do I Manage?

Video Transcription

Video Summary

Dr. Andreas Gomoll (Hospital for Special Surgery) reviews how patellofemoral instability commonly causes cartilage and osteochondral injury. Over 90% of patellar dislocations involve cartilage damage, and osteochondral fractures occur in up to 40%, often missed on x‑ray—so he recommends a low threshold for MRI, even in first-time dislocators, to identify loose bodies, define defects, and estimate recurrence risk. Treatment aims are dual: prevent recurrent instability (e.g., MPFL reconstruction when indicated) and preserve the joint by addressing cartilage lesions. Small defects outside key weight-bearing zones may be observed, but ridge-involving patellar defects and weight-bearing femoral condyle lesions should not be ignored. If a large fragment is present, repair is preferred—even cartilage-only fragments can heal in skeletally immature patients. Irreparable defects should be reconstructed based on size and subchondral bone status, using options such as OATS/OCA or cell-based techniques (noting limited support for patellar microfracture and stronger evidence for MACI). Insurance barriers affect some newer allograft products.

Asset Caption

Dr. Andreas Gomoll

Keywords

patellofemoral instability

patellar dislocation

cartilage and osteochondral injury

MRI evaluation for loose bodies

MPFL reconstruction

osteochondral defect reconstruction (OATS/OCA, MACI)