Advanced Concepts in Patellofemoral Surgery (AANA22)-Patella Cartilage Lesions: When to Address and When Would PFJ Be Best

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Video Summary

This detailed discussion addresses patellar cartilage injuries, focusing on when surgery is necessary and available treatment options. Cartilage damage often results from trauma, patellar instability, malalignment, or previous improper surgeries. While X-rays may appear normal, MRI is essential for detecting cartilage lesions. Not all lesions require surgery; some patients remain functional despite severe cartilage loss.<br /><br />Treatment strategies range from debridement and unloading in small lesions, to repair techniques such as fixation of fragments, particulated juvenile cartilage, matrix-induced autologous chondrocyte implantation (MACI), and osteochondral allografts, tailored based on bone quality and lesion size. MACI and particulated cartilage show promising results but are limited by cost and insurance coverage. Osteochondral allografts are effective for large, bone-involved defects, although technically demanding and costly.<br /><br />For patients with patellofemoral arthritis or severe cartilage loss, patellofemoral replacement is an option, requiring sufficient bone stock. Surgical procedures, like medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy, address instability and maltracking while preserving cartilage.<br /><br />Imaging techniques, especially MRI, are critical for assessing biomechanics, including patellar tendon alignment and tubercle position. Surgical decisions consider individual anatomy, risk factors like hyperlaxity or high BMI, and surgical risks. Postoperative rehabilitation is slow and requires close monitoring, with patient goals often centered on pain-free walking.

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Sabrina Strickland, M.D.

Keywords

patellar cartilage injuries

surgery indications

MRI diagnosis

cartilage repair techniques

MACI

osteochondral allografts

patellofemoral replacement