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K.F. Almqvist, A.A.M. Dhollander, P. Verdonk, J. Victor
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Treatment ofa
cartilage defect in the
patellofemoral joint
The question is now: does the treatment of
cartilage lesions in the patellofemoral joint
prevent or slow down the appearance of
osteoarthritis in this joint?
Treatment of cartilage defects (conservative or
surgical) in the PFJ is performed when there
are symptoms such as pain and locking.
The cause of the lesion has to be diagnosed:
is it:
1/
duetoanunderlyingstructural(morphologic)
deformity or soft tissue insufficiency
causing recurrent dislocation of the patella
or mechanical overload of the joint, or
2/
induced by a blunt trauma or a traumatic
dislocation of the patella without any
underlying structural deformities.
In the first case the underlying deformity or
insufficiency must be addressed to optimize the
cartilage repair procedure. This is complex
surgery that could be performed in a one or
two-stage procedure. Rotational abnormality,
patella alta, excessive patella tilt, high grade
trochlea dysplasia and/or ligamentous
insufficiency must be addressed when one
believes they are producing increased or
abnormal load on the repaired cartilage. After
these correcting procedures the cartilage defect
in the PFJ could be addressed by different types
of cartilage restoring procedures that will be
discussed below.
In the second case eg. a blunt trauma, different
cartilage procedures have been described. Due
to disappointing results after microfracturing
patellofemoral chondral lesions, alternative
treatment methods in this compartment are
preferred. For patella chondral lesions > 2cm
2
,
different techniques of ACI can be used [13].
For the trochlea, ACI as well or autologous
osteochondral transplantation could be done.
In long-term follow-up studies with ACI in the
PFJ a promising clinical outcome has been
noted with improved symptoms [16] and a
disappearance of the initially present BME.
Conclusion
We need a classification system that includes
advanced imaging which is already a part of
our current clinical practice. This would allow
for a category of early osteaoarthritis.
Resurfacing techniques may have success only
if patellofemoral joint kinematics are optimized.
There are no studies today showing that these
resurfacing techniqueswill reduce the incidence
of PF OA, although the reduction of pain and
symptoms keeps us optimistic.