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Treatment of Symptomatic Deep Cartilage Defects of the Patella and Trochlea with and without Patellofemoral Malalignment: Basic Science and Treatment

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Anterior Knee Pain and Patellar Instability

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Abstract

Efficacious treatment of chondral and osteochondral defects of the patellofemoral surfaces represents an ongoing challenge for the orthopedic surgeon. Treatment options for such full-thickness cartilage defects are discussed in this chapter. Combination of different cartilage repair techniques and appropriate treatment of the underlying biomechanical factors should represent the adequate treatment strategy for these problematic lesions. “Traditional” resurfacing techniques have not stood well to time, based in large part on the poor biomechanical characteristics of the fibrocartilage reparative tissue. During the last decade, efforts have focused on ways to furnish a hyaline or hyaline-like gliding surface for full-thickness lesions. These burgeoning new methodologies embrace several surgical procedures: autologous osteochondral transplantation methods (including osteochondral mosaicplasty); chondrocyte implantation; periosteal and perichondrial resurfacement; allograft transplantation; and also tissue engineering. Experimental background, operative techniques, and clinical results of these new procedures are detailed in this overview.

The early and medium-term experiences with these techniques have provoked a cautious optimism among basic researchers and clinicians alike. Autologous osteochondral mosaicplasty can be an alternative in the treatment of small and medium-sized full-thickness lesions, not only the femorotibial surfaces but also in the patellofemoral junction. The major attractions of the mosaicplasty are the ease of the one-step procedure, relatively brief rehabilitation period, excellent clinical outcome, and low cost. Autologous chondrocyte transplantation represents a promising option in the treatment of larger full-thickness defects. It does require a relatively expensive two-step procedure and longer rehabilitation period, but it seems to be an appropriate treatment of larger defects as well. Similar to other techniques, patellotrochlear use of the chondrocyte transplantation results in less favorable clinical outcome compared with femoral condylar application.

Present recommendations for the transplantation of mushroom-shaped osteochondral allografts are elected cases of advanced degenerative lesions of the patellar surface. The possible indications for perichondrial flapping, biomaterials, and transplantation of engineered tissues have to be cleared.

Full-thickness cartilage damage of the patellotrochlear junction can involve associated problems, not infrequently traumatic or biomechanical in origin. Congenital shape anomalies of the patellotrochlear surfaces, traction malalignment problems, patellofemoral hyperpression, as well as posttraumatic disorders represent the most common background of symptomatic deep cartilage lesions of the patellofemoral junction. Recognition and treatment of these abnormalities are essential to ensure a favorable and enduring outcome. Effective treatment of full-thickness defects on the patellotrochlear surfaces requires careful patient selection, a comprehensive operative plan, and a well-organized treatment course.

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  1. Orthopaedic & Trauma Department, Uzsoki Hospital, Budapest, Hungary

    László Hangody MD, PhD, DSc & Ivan Udvarhelyi MD

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  1. László Hangody MD, PhD, DSc
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  2. Ivan Udvarhelyi MD
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  1. Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso MD, PhD (Member of the International Patellofemoral Study Group/Member of the ACL Study Group) (Member of the International Patellofemoral Study Group/Member of the ACL Study Group)

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Hangody, L., Udvarhelyi, I. (2006). Treatment of Symptomatic Deep Cartilage Defects of the Patella and Trochlea with and without Patellofemoral Malalignment: Basic Science and Treatment. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, London. https://doi.org/10.1007/1-84628-143-1_12

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