Assessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach: Analysis Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

Abstract

Patellofemoral cartilage restoration procedures, including osteochondral allograft, particulated juvenile cartilage, and matrix-induced autologous chondrocyte implantation, have been shown to be effective treatments for patellofemoral cartilage lesions. However, concerns exist regarding disruption of the patellar vascular supply and secondary stabilizers of the patellofemoral joint during medial parapatellar approaches, especially when combined with a lateral release. A lateral parapatellar approach affords the possibility of avoiding disruption of the medial blood supply to the patella, while also allowing laterally-based soft tissue stabilization procedures. The purpose of this study was to investigate in vivo changes in patellar vascularity following patellofemoral cartilage restoration procedures performed via a lateral parapatellar approach via use of dynamic contrast-enhanced magnetic resonance (MR) imaging. This study is a prospective case series of 5 adult patients undergoing patellofemoral cartilage restoration procedures via a lateral parapatellar approach with pre-operative and post-operative dynamic contrast-enhanced MR imaging to assess changes in patellar vascularity. Secondary outcomes included knee range of motion, need for revision surgery, and complications. There was no significant post-operative difference in patellar vascularity in patients undergoing patellofemoral cartilage restoration procedures via a lateral parapatellar approach, as evaluated by qualitative MR imaging. Our results suggest that a lateral parapatellar approach for cartilage restoration procedures may preserve patellar vascularity, while also allowing for lateral release to be performed through the same incision.