Abstract

Cartilage lesions are frequent in routine knee arthroscopy (63%). Among these injuries, 11–23% are located in patella and 6–15% in the trochlea. Treatment of cartilage lesions in patellofemoral joint (PFJ) represents a challenge because of its complex access, high axial loading, and shearing forces. These factors explain the 7% of good results in the PFJ versus 90% in femoral condyles for autologous chondrocyte implantation (ACI). Microfracture (MF) as the first line of treatment has revealed limited hyaline-like cartilage formation in comparison to ACI. This fibrocartilage deteriorates with the time resulting in inferior biomechanical properties. Important issues that enhance the results of cartilage repair procedures in PFJ are associated with the restoration of the joint balance as unloading/realigning techniques. In the literature, there is no description of any convenient arthroscopic technique for ACI. The reported techniques usually require to set up the patient in prone position to perform the arthroscopy making it difficult to treat associated knee malalignment or instability. Others are open techniques with more risk of morbidities, pain, and complications and longer recovery time. In this chapter, we will describe a novel all-arthroscopic technique to treat cartilage lesions in the patella that permits the correction and treatment of associated lesions in the same patient position.

Highlights

  • The patella is covered by a thick hyaline cartilage which decreases friction in the patellofemoral joint (PFJ) and allows a correct and smooth flexion of the knee

  • The accurate detection and treatment of articular cartilage lesions (ACL) are essential for the proper function of the knee

  • Arthroscopic autologous chondrocyte implantation in the PFJ is a reproducible and safety technique that permits the early recovery of the patient and the treatment of concomitant lesions as patellar realignment and/or ligament reconstruction

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Summary

Introduction

The patella is the biggest sesamoid bone in the body. The main functions of the patella are to direct forces of the quadriceps and to protect the deeper knee joint and the quadriceps tendon. Basic nonsurgical management is recommended as an initial treatment modality to treat chondral lesion of patellofemoral joint for at least 6 months [7] This option is recommended for patients without significant pain and without mechanical symptoms. Microfractures have shown great short-term results for well-contained lesions less than 2 cm; 47–80% of patients have shown functional deterioration between 18 and 36 months after microfracture technique Some authors attribute this decline to incomplete defect filling and poor integration with the surrounding normal cartilage as well as an inferior capacity of the fibrocartilage to resist articular stress [10–14]. The aim of the present chapter is to describe a surgical procedure for the arthroscopic ACI in the patellofemoral joint

Arthroscopic chondrocyte implantation in the PFJ
Arthroscopic chondrocyte implantation in the trochlea
Take-home points
Findings
24–48 Cartilage hardens

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