Diagnosis and Management of Patellofemoral Cartilage Injuries (2023 Annual Meeting)-Patellofemoral Cases

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Video Summary

The discussion presents two challenging patellofemoral knee cases. The first involves a 28-year-old woman with recurrent large knee effusions and pain after MPFL reconstruction. Despite multiple cortisone injections, she had persistent inflammation attributed to synovitis possibly triggered by cartilage damage. Diagnostic arthroscopy, synovectomy, and eventual autologous chondrocyte implantation combined with an osteotomy led to symptom improvement and effusion resolution, though long-term durability remains uncertain. The panel debated injection alternatives and cell-based therapy viability amid a biologically hostile joint environment. The second case features a 16-year-old female with chronic retropatellar pain, normal imaging aside from cartilage heterogeneity, and no instability. Prior arthroscopy and physical therapy failed to relieve symptoms. A patellofemoral offloading brace provided diagnostic relief, leading to an isolated tibial tubercle osteotomy, resulting in significant pain improvement. The group highlighted the complexity of diagnosis, treatment options including hydro-dissection of the fat pad, and the role of braces and osteotomy in selected patients with difficult patellofemoral disorders.

Keywords

patellofemoral knee disorders

MPFL reconstruction complications

autologous chondrocyte implantation

tibial tubercle osteotomy

patellofemoral pain management