Operative treatment of deep chondral defects of the patella: results after abrasive arthroplasty and periosteal arthroplasty

Abstract

This prospective, non-randomized study was aimed to evaluate the effects of abrasive arthroplasty and periosteal arthroplasty in the treatment of deep chondral defects of the patella. A total of 30 patients in group A (13 male, 17 female, age: 28.7+/-6.9 years) underwent arthroscopic abrasive arthroplasty. The other patients in group B (n=17, 11 male, 8 female, age 26.8+/-7.0 years) underwent periosteal arthroplasty by an autologous periosteal flap. The maximal diameter of the defects was 31.1+/-6.7 (range 20-45 mm). The Lysholm score and the intensity of pain were evaluated preoperatively and at the time of follow-up (3.1+/-1.1, range 2-5 years). The Tegner activity score was evaluated before onset of the symptoms and at the time of follow-up. The Lysholm score increased significantly in both groups (in group a from 36.1+/-7.1 to 42.5+/-6.6 points and in group B from 42.7+/-2.4 to 67.6+/-7.8 points). The result in group B was significantly better than in group A. In group A the intensity of pain was unchanged, whereas patients from group B reported a significant reduction of pain. The level of physical activity (Tegner score) was 5.5+/-2.1 in group A and 5.5+/-2.1 in group B before onset of the complaints. In follow-up, patients from group B (4.9+/-1.2) had a reduced Tegner score in tendency. The patients in group A had a significantly reduced level of physical activity (2.7+/-0.6). A total of 12 patients from group B had a range of motion lesser than 80 degrees in flexion. These patients underwent joint mobilization and control arthroscopy. During control arthroscopy there was always found a stable periosteal flap. Short-term clinical results with periosteal arthroplasty produced a significant reduction in pain and improved Lysholm score in comparison to abrasive arthroplasty.