Management of Patellar Chondral Defects

Kelsey L. Wise, Jeffrey A. Macalena

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 30-35

Author: Kelsey L Wise [1], Jeffrey A Macalena [1]

[1] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.

Address of Correspondence
Dr. Jeffrey A. Macalena,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454.
E-mail: maca0049@umn.edu

Abstract

Patellar cartilage has a poor capacity for healing because of the avascular and hypocellular nature of articular cartilage. Surgical options for cartilage defects are varied and include repair, regeneration, and reconstruction. Open reduction internal fixation of chondral defects should be attempted when a large chondral fragment with bone is present. This is frequently seen following patellar dislocation, patellar fracture, or in the setting of osteochondritis dissecans lesions. Cartilage regeneration options include microfracture and a bone marrow-stimulating technique that involves penetration of the subchondral bone. This technique is best for small, isolated defects. Augmentation to microfracture with biologically active adjuncts is becoming more widely available and is thought to enhance stem cell production and tissue regeneration. Cartilage reconstruction options such as autologous chondrocyte implantation area cell-based therapy that develops hyaline-like cartilage, as opposed to the fibrocartilage of microfracture, and has the added advantage of ease in contouring to patellar anatomy. Short-term data suggest improvement of clinical outcomes for most patellar cartilage techniques; however, long-term studies are needed to assess the durability and clinical outcomes of these evolving procedures.
Keywords: Patellar, Chondral, Cartilage.

References

1. Brattstroem H. Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and x-ray-anatomical investigation. Acta Orthop ScandSuppl 1964;68Suppl 68:1-148.
2. Goldthwait JE. V. Permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 1899;29:62-8.
3. Hauser ED. Total tendon transplant for slipping patella: A new operation for recurrent dislocation of the patella 1938. ClinOrthopRelat Res 2006;452:7-16.
4. Roux C. Luxation habituelle de la rotule. Traitementopératoire/[Recurrent dislocation of the patella. Operative treatment]. Rev Chir 1888;8:682-9.
5. Dejour D, Byn P, Ntagiopoulos PG. The lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. IntOrthop 2013;37:433-9.
6. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports TraumatolArthrosc 1994;2:19-26.
7. Trillat A, Dejour H, Couette A. Diagnostic et traitement des subluxation récidivantes de la rotule/[Diagnosis and treatment of recurrent dislocations of the patella]. Rev ChirOrthopReparatriceAppar Mot 1964;50:813-24.
8. Campbell WC, Edmonson AS, Crenshaw AH. Campbell’s Operative Orthopaedics. 6th ed. St. Louis: Mosby; 1980.
9. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986;14:117-20.
10. Macnab I. Recurrent dislocation of the patella. J Bone Joint Surg [Am] 1952;34:957-67.
11. Arendt EA, Donell ST, Sillanpää PJ, Feller JA. The management of lateral patellar dislocation: State of the art. J ISAKOS 2017;2:205-12.
12. Tensho K, Akaoka Y, Shimodaira H, Takanashi S, Ikegami S, Kato H, et al. What components comprise the measurement of the tibial tuberosity-trochlear groove distance in a patellar dislocation population? J Bone Joint Surg Am 2015;97:1441-8.
13. Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S, et al. Tibial tubercle-posterior cruciate ligament distance: A new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012;40:1119-25.
14. Heidenreich MJ, Camp CL, Dahm DL, Stuart MJ, Levy BA, Krych AJ, et al. The contribution of the tibial tubercle to patellar instability: Analysis of tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances. Knee Surg Sports TraumatolArthrosc 2017;25:2347-51.
15. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports TraumatolArthrosc 2017;25:3099-107.
16. Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: A Prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017;45:50-8.
17. Matsushita T, Kuroda R, Oka S, Matsumoto T, Takayama K, Kurosaka M, et al. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports TraumatolArthrosc 2014;22:2438-44.
18. Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. ClinOrthopRelat Res 1983;177:176-81.
19. Blumensaat C. Die lageabweichungen und verrenkungen der kniescheibe/[The positional deviation and dislocation of the kneecap]. In: Payr E, Kirschner M, editors. Ergebnisse der Chirurgie und Orthopädie. Einunddreissigster Band. Berlin: Springer-Verlag; 1938. p. 149-223.
20. Brattström H. Patella alta in non-dislocating knee joints. ActaOrthopScand 1970;41:578-88.
21. Geenen E, Molenaers G, Martens M. Patella alta in patellofemoral instability. ActaOrthopBelg 1989;55:387-93.
22. Lancourt JE, Cristini JA. Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 1975;57:1112-5.
23. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101-4.
24. Grelsamer RP, Meadows S. The modified insall-salvati ratio for assessment of patellar height. ClinOrthopRelat Res 1992;282:170-6.
25. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases. Rev ChirOrthopReparatriceAppar Mot 1982;68:317-25.
26. Caton J. Method of measuring the height of the patella. ActaOrthopBelg 1989;55:385-6.
27. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977;59:241-2.
28. Biedert RM, Albrecht S. The patellotrochlear index: A new index for assessing patellar height. Knee Surg Sports TraumatolArthrosc 2006;14:707-12.
29. Bernageau J, Goutallier D, Debeyre J, Ferrané J. Nouvelle technique d’exploration de l’articulationfémoro-patellaire: Incidences axiales quadriceps décontractés et quadriceps contractés. [New exploration technique of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps]. Rev ChirOrthopReparatriceAppar Mot 1975;61Suppl 2:286-90.
30. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R, et al. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013;41:374-84.
31. Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. IntOrthop 2010;34:305-9.
32. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003;10:215-20.
33. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report. Arthroscopy 1992;8:335-40.

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