Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jun;11(2):188-200.
doi: 10.1007/s12178-018-9474-3.

Patellofemoral Cartilage Repair

Alexandre Barbieri Mestriner  1   2 , Jakob Ackermann  3 , Andreas H Gomoll  3
Affiliations
Review

Patellofemoral Cartilage Repair

Alexandre Barbieri Mestriner et al. Curr Rev Musculoskelet Med. 2018 Jun.

Abstract

Purpose of review: This review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces.

Recent findings: Recent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients. While autologous chondrocyte implantation shows good and excellent outcomes for chondral lesions, osteochondral defects are adequately addressed with osteochondral allograft transplantation. In case of patellar malalignment, concomitant tibial tubercle osteotomy can significantly improve outcomes. Particulated cartilage and bone marrow aspirate concentrate are potential new alternative treatments for cartilage repair, currently in early clinical studies. Due to the frequency of concomitant anatomic abnormalities in the PFJ, a thorough clinical examination combined with careful indication for each procedure in each individual patient combined with meticulous surgical technique is central to achieve satisfying outcomes. Additional comparative studies of cartilage repair procedures, as well as investigation of newer techniques, are needed.

Keywords: Autologous chondrocyte implantation; Cartilage repair; Chondral lesion; Osteochondral allograft; Particulated allograft; Patellofemoral joint.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

Andreas H. Gomoll reports grants from JRF during the conduct of study and personal fees from NUTECH outside of the submitted work.

Alexandre Barbieri Mestriner and Jakob Ackermann declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Arthroscopic image of a small, well-contained chondral lesion treated with microfracturing. Note that the holes are 3–4 mm apart from each other to prevent tunnel collapse
Fig. 2
Fig. 2
Intraoperative image of an autologous chondrocyte implantation (ACI) to the central trochlear. The collagen membrane is secured with 6-0 absorbable sutures and watertight sealed with fibrin glue
Fig. 3
Fig. 3
Intraoperative image of two osteochondral autograft plugs transferred to both the patella and trochlea. Note that the lateral margin of the trochlea served as donor site to harvest both osteochondral cylinders
Fig. 4
Fig. 4
Intraoperative image of a flush seated osteochondral allograft to the trochlea. Marking of the 12 o’clock ensures correct insertion and thus perfect fitting of the osteochondral allograft plug
Fig. 5
Fig. 5
BMAC augmentation of an osteochondral allograft. Bone marrow is extracted from the lateral femoral condyle or tibial plateau
Fig. 6
Fig. 6
Intraoperative image of particulated juvenile osteochondral allograft to a chondral lesion on the patella
Fig. 7
Fig. 7
Treatment algorithm for patellofemoral chondral lesions
See this image and copyright information in PMC

References

    1. Bedi A, Feeley BT, Williams RJ., 3rd Management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92(4):994–1009. doi: 10.2106/JBJS.I.00895. - DOI - PubMed
    1. Bitton R. The economic burden of osteoarthritis. Am J Manag Care. 2009;15(8 Suppl):S230–S235. - PubMed
    1. Duncan RC, Hay EM, Saklatvala J, Croft PR. Prevalence of radiographic osteoarthritis—it all depends on your point of view. Rheumatology (Oxford) 2006;45(6):757–760. doi: 10.1093/rheumatology/kei270. - DOI - PubMed
    1. Hart HF, Stefanik JJ, Wyndow N, Machotka Z, Crossley KM. The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology: a systematic review and meta-analysis. Br J Sports Med. 2017;51(16):1195–1208. doi: 10.1136/bjsports-2017-097515. - DOI - PubMed
    1. Duncan R, Peat G, Thomas E, Wood L, Hay E, Croft P. Does isolated patellofemoral osteoarthritis matter? Osteoarthr Cartil. 2009;17(9):1151–1155. doi: 10.1016/j.joca.2009.03.016. - DOI - PubMed

LinkOut - more resources