Combined Cartilage Restoration and Distal Realignment for Patellar and Trochlear Chondral Lesions

Abstract

Chondral lesions of the patellofemoral joint are relatively common and pose a treatment challenge to the orthopaedic surgeon because of the complex three-dimensional topography and high contact stresses. Anterior knee pain, either at or surrounding the patella, is the most common symptom in patients with patellofemoral cartilage defects; however, posterior knee pain may also suggest a trochlear defect. Given the wide differential diagnosis for anterior knee pain, the patient history and physical examination should focus on osseous, cartilaginous, and tendinous structures from the hip to the ankle. MRI and CT should be considered to better visualize the state of the underlying cartilage and to quantify the patellar alignment and tilt. Treatment options for patellofemoral cartilage defects include realignment procedures such as anteromedialization of the tibial tubercle, or cartilage restoration procedures such as autologous chondrocyte implantation, microfracture, and osteochondral allograft transplantation. Although reasonable results have been reported with distal realignment and cartilage restoration used in isolation, better outcomes are seen when these types of procedures are combined.

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