Chondral Lesions of the Patella
Journal of Clinical Orthopaedics | Vol 5 | Issue 1 | Jan-Jul 2021 | page: 65-73 | Deepak Goyal
Author: Deepak Goyal [1]
[1] Saumya Arthroscopy & Sports Knee Clinic, 201, Viva Atelier, Opp B D Patel House, Naranpura, Ahmedabad, India: 380014
[2] Visiting Professor of Orthopaedics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Address of Correspondence
Dr. Deepak Goyal,
Saumya Arthroscopy & Sports Knee Clinic, 201, Viva Atelier, Opp B D Patel House, Naranpura, Ahmedabad, India: 380014
E-mail: deepak@knee.in
Abstract
Background: The articular cartilage injuries of the patella are increasingly being reported, being more common in young population and are mostly associated with abnormal biomechanics. The abnormal biomechanics could be an instability, a maltracking or a patellofemoral overload. It is not uncommon to have a mixture of abnormal alignment and abnormal loading, making understanding of the patellofemoral biomechanics more difficult. Abnormal biomechanics put different types of biomechanical forces on the patella leading to the chondral damage. The patellar cartilage lesions usually show different patterns based on these different biomechanics. It is very important to understand the biomechanics of patella before treating the patellar cartilage lesion. A consideration to correct the abnormally aligned or loaded patella is an important step while treating a patellar chondral defect. The purpose of this article is to review the concepts behind occurrence of patellar chondral lesions and the biomechanics behind it, decision making with a brief overview of the treatment strategies.
Keywords: Chondral Lesion, Patella, Maltracking, biomechanics
References
1. Arøen, A. et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am. J. Sports Med. 32, 211–215 (2004).
2. Curl, W. W. et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 13, 456–460.
3. Flanigan, D. C., Harris, J. D., Trinh, T. Q., Siston, R. A. & Brophy, R. H. Prevalence of chondral defects in athletes’ knees: a systematic review. Med. Sci. Sports Exerc. 42, 1795–1801 (2010).
4. Pareek, A. et al. Long-Term Outcomes after Autologous Chondrocyte Implantation: A Systematic Review at Mean Follow-Up of 11.4 Years. Cartilage 7, 298–308 (2016).
5. von Keudell, A., Han, R., Bryant, T. & Minas, T. Autologous Chondrocyte Implantation to Isolated Patella Cartilage Defects. Cartilage 8, 146–154 (2017).
6. Goyal, D. R. The Illustrative Biomechanics of a Chondral Injury. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 33–41 (Springer International Publishing, 2021). doi:10.1007/978-3-030-47154-5_5.
7. Goyal, D. R. The Classifications of the Chondral Lesions. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 43–56. (Springer International Publishing, 2021). doi:10.1007/978-3- 030-47154-5_6.
8. Outerbridge, R. E. The etiology of chondromalacia patellae. 1961. Clin. Orthop. 5–8 (2001) doi:10.1097/00003086- 200108000-00002.
9. Brittberg, M. & Winalski, C. S. Evaluation of cartilage injuries and repair. J. Bone Joint Surg. Am. 85-ASuppl 2, 58–69 (2003).
10. Sallay, P. I., Poggi, J., Speer, K. P. & Garrett, W. E. Acute dislocation of the patella. A correlative pathoanatomic study. Am. J. Sports Med. 24, 52–60 (1996).
11. Post, W. R. Anterior knee pain: diagnosis and treatment. J. Am. Acad. Orthop. Surg. 13, 534–543 (2005).
12. DeJour D, Reynaud P, & Lecoultre B. Douleurs et instabilité rotulienne. Essai de classification. Med Hyg Geneve 56, 1466–1471 (1998).
13. Dejour, H., Walch, G., Nove-Josserand, L. & Guier, C. Factors of patellar instability: an anatomic radiographic study. Knee Surg. Sports Traumatol. Arthrosc. Off. J. ESSKA 2, 19–26 (1994).
14. Gillogly, S. D. & Arnold, R. M. Autologous chondrocyte implantation and anteromedialization for isolated patellar articular cartilage lesions: 5- to 11-year follow-up. Am. J. Sports Med. 42, 912–920 (2014).
15. Mehl, J. et al. Clinical mid- to long-term outcome after autologous chondrocyte implantation for patellar cartilage lesions and its correlation with the geometry of the femoral trochlea. The Knee 26, 364–373 (2019).
16. Herman, K., Irlandini, E., Dallo, I., Coloma, E. S. & Gobbi, A. The Illustrative Marrow Stimulation Techniques for Cartilage Repair: The Microfracture Technique. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 97–103 (Springer International Publishing, 2021). doi:10.1007/978-3-030- 47154-5_10.
17. Gobbi, A., Dallo, I., Herman, K. & Irlandini, E. The Illustrative Bone Marrow Aspirate Concentrate and Hyaluronan-Based Scaffold Technique for Single-Stage Cartilage Repair. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 191–202 (Springer International Publishing, 2021). doi:10.1007/978-3- 030-47154-5_18.
18. Hangody, L. The Illustrative Osteochondral Cylinder Transfer Techniques for Cartilage Repair: The Mosaicplasty Technique. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 105–122 (Springer International Publishing, 2021). doi:10.1007/978-3-030-47154-5_11.
19. Ramos, N., Mandelbaum, B. & Banffy, M. The Illustrative Membrane Based Autologous Chondrocyte Implantation for Cartilage Repair. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 147–156 (Springer International Publishing, 2021). doi:10.1007/978-3-030-47154-5_14.
20. Brittberg, M. The Illustrative First and Second Generation Autologous Chondrocyte Implantation (ACI) for Cartilage Repair. in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 137–146 (Springer International Publishing, 2021). doi:10.1007/978-3-030-47154-5_13.
21. Goyal, D. The Illustrative Third Generation Autologous Chondrocyte Implantation for the Cartilage Repair- The Gel Based ACI Technique. in The Illustrative Book of Cartilage Repair (ed. Goyal, D.) (Springer International Publishing, 2020).
22. Wong, I. & Ravipati, A. P. T. The Illustrative Single-Stage Cartilage Repair Technique with Chitosan-Based Bioscaffold (BST-CarGel). in The Illustrative Book of Cartilage Repair (ed. Goyal, D. R.) 167–180 (Springer International Publishing, 2021). doi:10.1007/978-3-030-47154-5_16.
23. Nho, S. J. et al. Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am. J. Sports Med. 36, 1101–1109 (2008).
24. Astur, D. C. et al. Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study. J. Bone Joint Surg. Am. 96, 816–823 (2014).
25. Goyal, Deepak & Modi, Vishwas. Gel Based Autologous Chondrocyte Implantation: The Surgical Technique. Asian J. Arthrosc. 4(1), 10–16.
26. Ebert, J. R., Schneider, A., Fallon, M., Wood, D. J. & Janes, G. C. A Comparison of 2-Year Outcomes in Patients Undergoing Tibiofemoral or Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation. Am. J. Sports Med. 45, 3243–3253 (2017).
27. Goyal, D. Recent advances and future trends in articular cartilage repair. J. Arthrosc. Surg. Sports Med. 1, 159–173 (2020).
28. Cotter, E. J., Wang, K. C., Yanke, A. B. & Chubinskaya, S. Bone Marrow Aspirate Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence. Cartilage 9, 161–170 (2018).
How to Cite this article: Goyal D. Chondral Lesions of the Patella. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):65-73. |
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