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Major anatomic risk factors for recurrent patellar instability include trochlear dysplasia, patella alta, a lateralized tibial tuberosity, and medial patellofemoral ligament insufficiency. Acute first-time patellar dislocation may be treated nonoperatively in the absence of osteochondral injury. Recurrent patellar instability often requires medial patellofemoral ligament reconstruction, with osseous procedures reserved for patients with substantial underlying anatomic abnormalities. Surgical treatment of patellar instability is complex and should be individualized to address the needs of each patient.

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Objectives:To determine the short-term outcomes, effectiveness and perception of the subchondroplasty (SCP) procedure in patients with radiographic evidence of bone marrow edema (BME) in the setting of knee osteoarthritis (OA).Methods:A retrospective chart review in conjunction with a follow-up questionnaire was conducted on fifty patients with radiographic evidence of BME lesions who underwent the SCP procedure performed at a single academic medical institution. All patients failed prior conservative measures, including medications, injections, physical therapy, and bracing. The questionnaire focused on symptoms before and after the procedure, the perception of the procedure, any other interventions performed after the procedure, and willingness to undergo SCP again.Results:The average patient age was 55 years (range 36-82 years) and 53.2% of patients were male. The average follow-up period was 14.6 months (range 12.9-25.1 months). Preliminary data from 50 patients demonstrated an average 4.7 point improvement in pain on a 10 point visual analog scale (pre-SCP 8.3, post-SCP 3.6). Eighty-eight percent (44 of 50) of patients experienced improvement in their pain and 72% (36 of 50) experienced improvement in pain-free walking distance. Forty-eight percent (24 of 50) of patients required additional interventions: eighteen received cortisone or hyaluronic acid injections, two required serial aspirations, and four went on to total knee arthroplasty. The average satisfaction level was 7.8 on a 10 point scale. Seventy-eight percent (39 of 50) of patients stated they would undergo SCP again and 86% (43 of 50) would recommend the procedure to a friend or family member.Conclusion:SCP is an effective treatment modality in the management of patients with knee OA and BME lesions. The goal of the procedure is to provide enduring pain relief caused by BME, hopefully delaying the need for TKA in this select patient population. Future studies are necessary to evaluate the long-term outcomes of SCP.

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Objectives:Bone marrow edema (BME) is a negative prognostic factor for patients with knee osteoarthritis (KOA). BME is strongly associated with pain, decreased function, structural deterioration and rapid progression to total knee arthroplasty (TKA). Subchondroplasty (SCP) (Knee Creations, Zimmer, Warsaw, IN) directly addresses BME in the setting of KOA by injecting calcium phosphate cement into the area of BME. The objective of this research was to show clinical results of the SCP procedure.Methods:A retrospective chart review with follow-up questionnaire was conducted on SCP patients in short-term and midterm (>2 years). All patients failed conservative measures and were candidates for TKA. The questionnaire addressed symptoms before and after SCP, further interventions, the perception of and willingness to undergo SCP again.Results:133 of 143 subchondroplasty patients responded. The average patient was 57 years old (38-84 years) and 47% male. The average follow-up for short-term patients was 14.6 (4-22) months and for mid-term patients was 32.1 (24-43) months. Pain score decreased from 8.3 pre-op to 3.4 post-op in both groups. 35% in the short-term group required injections, increasing to 41% in the mid-term. The short-term group demonstrated satisfaction of 8.3 out of 10, with 82% willing to undergo SCP again and 89% recommending SCP. In the mid-term group, satisfaction increased to 8.5 with 95% willing to undergo SCP again and 96% recommending the procedure. In all, 32 patients (25%) progressed to TKA (Figure 1) at an average of 17.8 months, with 22 (69%) of these occurring before 2 years.Conclusion:SCP is an effective and well received treatment for patients with KOA and BME. In patients who failed conservative measures and were considering TKA, excellent results are seen at 2.5 years follow-up with only 25% of patients requiring TKA. Of all patients not requiring TKA, 93% would undergo SCP again and 98% would recommend it.Table l.Short and Mid-term Results of the Snhcliondroplasty Procedure

Results: 26 patients (28 knees), mean age 33.7 (21-49) years were identified. 34 Outerbridge grade IV lesions on MFC, LFC, patella and trochlea were treated. Average cross-sectional area was 3.075 cm2; associated procedures included patellar realignment (TTO in 12, VMO advancement in 4), MPFL reconstruction (6/28), lateral release (10/28), ACL reconstruction (7/28) and partial meniscectomy (9/28). There were 11 re-operations, including 5 debridements of hypertrophic repair tissue and 2 microfractures of prior or new lesion. The mean MOCART score was 54.7 (range 20-85). 12/17 had complete fill, 10/17 had full border integration, 5/17 were isointense on T2. Sequential MRIs showed a progressive improvement in MOCART score with increasing time from surgery. Average pre-op Lysholm was 48.73 (29.17-68.76) and post-op 84.73 (70.84-100) at an average of 4.4 years postoperatively. This improvement in Lysholm scores was statistically significant, p< 0.001. Conclusion: This is the first study that confirms good ingrowth and integration on MRI and excellent clinical outcomes following DeNovo NT cartilage transplantation in the knee. These results are maintained at a mid-term follow up of nearly 5 years.