Skip to main content
SpringerLink
Log in

Early osteoarthritis of the patellofemoral joint

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Patellofemoral joint cartilage lesions are associated with a variety of clinical situations including blunt trauma, lateral patella dislocations, or as a secondary development in the setting of abnormal joint loading. There is a need for more clarity on how to best address these lesions. Most specifically, when is it necessary to surgically treat these lesions of the patella and trochlea and which technique to use? This review will focus on the spectrum of patellofemoral disease/injury and their treatment strategies, with special emphasis on cartilage damage and early osteoarthritis. Chapter sections will review the most common scenarios of cartilage damage in the patellofemoral joint, with an attempt to summarize current treatment, their outcomes, remaining challenges and unanswered questions.

Level of evidence V.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

This figure was generously provided by Dr. Mario Ronga

Fig. 2

Figures were generously provided by Dr. Andreas Gomoll

Similar content being viewed by others

References

  1. Arnbjornsson A, Egund N, Rydling O (1992) The natural history of recurrent dislocation of the patella: long-term results of conservative and operative treatment. J Bone Joint Surg (Br) 74:140–142

    CAS  Google Scholar 

  2. Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, Imhoff AB, Schottle PB (2014) Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22:2591–2598

    Article  PubMed  Google Scholar 

  3. Beaufils P, Thaunat M, Pujol N, Scheffler S, Rossi R, Carmont M (2012) Trochleoplasty in major trochlear dysplasia: current concepts. Sports Med Arthrosc Rehabil Ther Technol 4:7

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bentley G, Biant L, Carrington R, Akmal M, Goldberg A, Williams A, Skinner J, Pringle J (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg (Br) 85-B:223–230

    Article  Google Scholar 

  5. Bremer Hinckel B, Arendt EA, Ntagiopoulos PG, Dejour D (2016) Trochleoplasty: historical overview and Dejour technique. Oper Tech Sports Med 23:114–122

    Article  Google Scholar 

  6. Dejour D, Byn P, Ntagiopoulos PG (2013) The Lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. Int Orthop 37:433–439

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  PubMed  Google Scholar 

  8. Dhollander A, Moens K, Van der Maas J, Verdonk P, Almqvist KF, Victor J (2014) Treatment of patellofemoral cartilage defects in the knee by autologous matrix-induced chondrogenesis (AMIC). Acta Orthop Belg 80:251–259

    PubMed  Google Scholar 

  9. Duthon VB (2015) Acute traumatic patellar dislocation. Orthop Traumatol Surg Res 101:S59–S67

    Article  CAS  PubMed  Google Scholar 

  10. Farr J 2nd (2008) Autologous chondrocyte implantation and anteromedialization in the treatment of patellofemoral chondrosis. Orthop Clin North Am 39:329–335

    Article  PubMed  Google Scholar 

  11. Farr S, Huyer D, Sadoghi P, Kaipel M, Grill F, Ganger R (2014) Prevalence of osteoarthritis and clinical results after the Elmslie–Trillat procedure: a retrospective long-term follow-up. Int Orthop 38:61–66

    Article  PubMed  PubMed Central  Google Scholar 

  12. Federico DJ, Reider B (1997) Results of isolated patellar debridement for patellofemoral pain in patients with normal patellar alignment. Am J Sports Med 25:663–669

    Article  CAS  PubMed  Google Scholar 

  13. Filardo G, Kon E, Andriolo L, Di Martino A, Zaffagnini S, Marcacci M (2014) Treatment of “patellofemoral”cartilage lesions with matrix-assisted autologous chondrocyte transplantation: a comparison of patellar and trochlear lesions. Am J Sports Med 42:626–634

    Article  PubMed  Google Scholar 

  14. Gigante A, Enea D, Greco F, Bait C, Denti M, Schonhuber H, Volpi P (2009) Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population. Knee Surg Sports Traumatol Arthrosc 17:2–10

    Article  PubMed  Google Scholar 

  15. Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 64:423–428

    CAS  PubMed  Google Scholar 

  16. Gracitelli GC, Meric G, Pulido PA, Gortz S, De Young AJ, Bugbee WD (2015) Fresh osteochondral allograft transplantation for isolated patellar cartilage injury. Am J Sports Med 43:879–884

    Article  PubMed  Google Scholar 

  17. Grelsamer RP, Dejour D, Gould J (2008) The pathophysiology of patellofemoral arthritis. Orthop Clin North Am 39:269–274

    Article  PubMed  Google Scholar 

  18. Insall J, Falvo KA, Wise DW (1976) Chondromalacia patellae. A prospective study. J Bone Joint Surg Am 58:1–8

    CAS  PubMed  Google Scholar 

  19. Joshi N, Reverte-Vinaixa M, Diaz-Ferreiro EW, Dominguez-Oronoz R (2012) Synthetic resorbable scaffolds for the treatment of isolated patellofemoral cartilage defects in young patients: magnetic resonance imaging and clinical evaluation. Am J Sports Med 40:1289–1295

    Article  PubMed  Google Scholar 

  20. Kon E, Filardo G, Di Martino A, Busacca M, Moio A, Perdisa F, Marcacci M (2014) Clinical results and MRI evolution of a nano-composite multilayered biomaterial for osteochondral regeneration at 5 years. Am J Sports Med 42:158–165

    Article  PubMed  Google Scholar 

  21. Kon E, Filardo G, Gobbi A et al (2015) Long-term results after hyaluronan-based MACT for the treatment of cartilage lesions of the patello-femoral joint (submitted)

  22. Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14:1119–1125

    Article  CAS  PubMed  Google Scholar 

  23. Krishnan SP, Skinner JA, Bartlett W, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2006) Who is the ideal candidate for autologous chondrocyte implantation? J Bone Joint Surg Br 88:61–64

    Article  CAS  PubMed  Google Scholar 

  24. Kuroda R, Kambic H, Valdevit A, Andrish J (2001) Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study. Am J Sports Med 29:403–409

    CAS  PubMed  Google Scholar 

  25. Lording T, Lustig S, Servien E, Neyret P (2014) Chondral injury in patellofemoral instability. Cartilage 5:136–144

    Article  PubMed  PubMed Central  Google Scholar 

  26. Maenpaa H, Lehto MU (1997) Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res 339:156–162

    Article  PubMed  Google Scholar 

  27. Mani S, Kirkpatrick MS, Saranathan A, Smith LG, Cosgarea AJ, Elias JJ (2011) Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 39:1024–1031

    Article  PubMed  PubMed Central  Google Scholar 

  28. Marcacci M, Zaffagnini S, Iacono F, Visani A, Petitto A, Neri NP (1995) Results in the treatment of recurrent dislocation of the patella after 30 years’ follow-up. Knee Surg Sports Traumatol Arthrosc 3:163–166

    Article  CAS  PubMed  Google Scholar 

  29. Marcacci M, Zaffagnini S, Lo Presti M, Vascellari A, Iacono F, Russo A (2004) Treatment of chronic patellar dislocation with a modified Elmslie–Trillat procedure. Arch Orthop Trauma Surg 124:250–257

    Article  CAS  PubMed  Google Scholar 

  30. Mehl J, Feucht MJ, Bode G, Dovi-Akue D, Sudkamp NP, Niemeyer P (2014) Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects. Knee Surg Sports Traumatol Arthrosc 24:838–846

    Article  PubMed  Google Scholar 

  31. Minas T, Bryant T (2005) The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res 436:30–39

    Article  PubMed  Google Scholar 

  32. Mouzopoulos G, Borbon C, Siebold R (2011) Patellar chondral defects: a review of a challenging entity. Knee Surg Sports Traumatol Arthrosc 19:1990–2001

    Article  PubMed  Google Scholar 

  33. Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long-term clinical results after the Elmslie–Trillat procedure for dislocation of the patella. J Bone Joint Surg (Am) 84-B:861–864

    Article  Google Scholar 

  34. Naveed MA, Ackroyd CE, Porteous AJ (2013) Long-term (ten- to 15-year) outcome of arthroscopically assisted Elmslie–Trillat tibial tubercle osteotomy. Bone Joint J 95-B:478–485

    Article  CAS  PubMed  Google Scholar 

  35. Nawaz SZ, Bentley G, Briggs TW, Carrington RW, Skinner JA, Gallagher KR, Dhinsa BS (2014) Autologous chondrocyte implantation in the knee: mid-term to long-term results. J Bone Joint Surg Am 96:824–830

    Article  PubMed  Google Scholar 

  36. Niemeyer P, Kreuz PC, Steinwachs M, Kostler W, Mehlhorn A, Kraft N, Sudkamp NP (2007) Technical note: the “double eye” technique as a modification of autologous chondrocyte implantation for the treatment of retropatellar cartilage defects. Knee Surg Sports Traumatol Arthrosc 15:1461–1468

    Article  PubMed  Google Scholar 

  37. Niemeyer P, Steinwachs M, Erggelet C, Kreuz PC, Kraft N, Kostler W, Mehlhorn A, Sudkamp NP (2008) Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg 128:1223–1231

    Article  PubMed  Google Scholar 

  38. Nomura E, Inoue M (2005) Second-look arthroscopy of cartilage changes of the patellofemoral joint, especially the patella, following acute and recurrent patellar dislocation. Osteoarthr Cartil 13:1029–1036

    Article  CAS  PubMed  Google Scholar 

  39. Nomura E, Inoue M, Kobayashi S (2007) Bilateral recurrent patellar dislocation in a patient with isolated patella aplasia-hypoplasia. Arthroscopy 23(1136):e1131–e1134

    Google Scholar 

  40. Nomura E, Inoue M, Kurimura M (2003) Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy 19:717–721

    Article  PubMed  Google Scholar 

  41. Ntagiopoulos PG, Byn P, Dejour D (2013) Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med 41:998–1004

    Article  PubMed  Google Scholar 

  42. Ntagiopoulos PG, Dejour D (2014) Current concepts on trochleoplasty procedures for the surgical treatment of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22:2531–2539

    Article  PubMed  Google Scholar 

  43. Pascual-Garrido C, Slabaugh MA, L’Heureux DR, Friel NA, Cole BJ (2009) Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med 37(Suppl 1):33S–41S

    Article  PubMed  Google Scholar 

  44. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP (1997) Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 25:533–537

    Article  CAS  PubMed  Google Scholar 

  45. Rouanet T, Gougeon F, Fayard JM, Remy F, Migaud H, Pasquier G (2015) Sulcus deepening trochleoplasty for patellofemoral instability: a series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res 101:443–447

    Article  CAS  PubMed  Google Scholar 

  46. Schuttler KF, Struewer J, Roessler PP, Gesslein M, Rominger MB, Ziring E, Efe T (2013) Patellofemoral osteoarthritis after insall’s proximal realignment for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 22:2623–2628

    Article  PubMed  Google Scholar 

  47. Siebold R, Karidakis G, Fernandez F (2014) Clinical outcome after medial patellofemoral ligament reconstruction and autologous chondrocyte implantation following recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 22:2477–2483

    Article  PubMed  Google Scholar 

  48. Sillanpaa P, Mattila VM, Visuri T, Maenpaa H, Pihlajamaki H (2008) Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res 466:1475–1484

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sillanpaa PJ, Mattila VM, Visuri T, Maenpaa H, Pihlajamaki H (2011) Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis. Knee Surg Sports Traumatol Arthrosc 19:230–235

    Article  PubMed  Google Scholar 

  50. Song GY, Hong L, Zhang H, Zhang J, Li X, Li Y, Feng H (2014) Trochleoplasty versus nontrochleoplasty procedures in treating patellar instability caused by severe trochlear dysplasia. Arthroscopy 30:523–532

    Article  PubMed  Google Scholar 

  51. Stanitski CL, Paletta GA Jr (1998) Articular cartilage injury with acute patellar dislocation in adolescents. Arthroscopic and radiographic correlation. Am J Sports Med 26:52–55

    CAS  PubMed  Google Scholar 

  52. Thakkar RS, Del Grande F, Wadhwa V, Chalian M, Andreisek G, Carrino JA, Eng J, Chhabra A (2015) Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3614-8

    PubMed  Google Scholar 

  53. Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P (2011) Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res 97:833–845

    Article  CAS  PubMed  Google Scholar 

  54. Thompson RC Jr, Oegema TR Jr, Lewis JL, Wallace L (1991) Osteoarthrotic changes after acute transarticular load. An animal model. J of Bone Joint Surg Ser A 73:990–1001

    Google Scholar 

  55. Tompkins MA, Arendt EA (2015) Patellar instability factors in isolated medial patellofemoral ligament reconstructions: what does the literature tell us? A systematic review. Am J Sports Med 43:2318–2327

    Article  PubMed  Google Scholar 

  56. Torzilli PA, Deng XH, Ramcharan M (2006) Effect of compressive strain on cell viability in statically loaded articular cartilage. Biomech Model Mechanobiol 5:123–132

    Article  CAS  PubMed  Google Scholar 

  57. Trinh TQ, Harris JD, Siston RA, Flanigan DC (2013) Improved outcomes with combined autologous chondrocyte implantation and patellofemoral osteotomy versus isolated autologous chondrocyte implantation. Arthroscopy 29:566–574

    Article  PubMed  Google Scholar 

  58. Tsavalas N, Katonis P, Karantanas AH (2012) Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study. Eur Radiol 22:418–428

    Article  PubMed  Google Scholar 

  59. Van Haver A, De Roo K, De Beule M, Labey L, De Baets P, Dejour D, Claessens T, Verdonk P (2015) The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 43:1354–1361

    Article  PubMed  Google Scholar 

  60. Vanlauwe JJ, Claes T, Van Assche D, Bellemans J, Luyten FP (2012) Characterized chondrocyte implantation in the patellofemoral joint: an up to 4-year follow-up of a prospective cohort of 38 patients. Am J Sports Med 40:1799–1807

    Article  PubMed  Google Scholar 

  61. Vasiliadis HS, Lindahl A, Georgoulis AD, Peterson L (2011) Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 19:452–457

    Article  PubMed  Google Scholar 

  62. Vollnberg B, Koehlitz T, Jung T, Scheffler S, Hoburg A, Khandker D, Hamm B, Wiener E, Diederichs G (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22:2347–2356

    Article  PubMed  Google Scholar 

  63. von Knoch F, Bohm T, Burgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 88:1331–1335

    Article  Google Scholar 

  64. Widuchowski W, Lukasik P, Kwiatkowski G, Faltus R, Szyluk K, Widuchowski J, Koczy B (2008) Isolated full thickness chondral injuries. Prevalence and outcome of treatment. A retrospective study of 5233 knee arthroscopies. Acta Chir Orthop Traumatol Cech 75:382–386

    CAS  PubMed  Google Scholar 

  65. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Luetzow WF, Vaccari V, Benzi A, Marcacci M (2014) Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surg Sports Traumatol Arthrosc 22:2491–2498

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av. So., Ste. R200, Minneapolis, MN, 55454, USA

    Elizabeth A. Arendt

  2. Department of Knee Surgery, Orthopaedic Hospital Gaetano Pini, Milan, Italy

    Massimo Berruto & Paolo Ferrua

  3. Biomechanics Lab – II Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy

    Giuseppe Filardo

  4. Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy

    Mario Ronga

  5. Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy

    Stefano Zaffagnini & Alberto Grassi

  6. Indiana School of Medicine, Greenwood, IN, USA

    Jack Farr

  7. Sacro Cuore Hospital, Negrar, Verona, Italy

    Vincenzo Condello

Authors
  1. Elizabeth A. Arendt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Massimo Berruto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Filardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Ronga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Zaffagnini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jack Farr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Ferrua
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alberto Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vincenzo Condello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth A. Arendt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arendt, E.A., Berruto, M., Filardo, G. et al. Early osteoarthritis of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 24, 1836–1844 (2016). https://doi.org/10.1007/s00167-016-4103-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4103-4

Keywords

Search

Navigation