Cartilage Restoration of Patellofemoral Lesions: A Systematic Review

Abstract

Purpose This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery. Methods This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality. Results Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes. Conclusion Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics. Level of evidence Level IV, systematic review of level II to IV studies.

Osteochondral Allograft Transplant of the Patella Using Femoral Condylar Allografts: Magnetic Resonance Imaging and Clinical Outcomes at Minimum 2-Year Follow-up

“…One possible explanation is that the majority of patients included in the Mirzayan et al study were primarily treated for patellar instability, whereas the patients in the present study were treated primarily for degenerative change; this could lead to differences in both the type of chondral injury and biological healing response. In a recent systematic review, Andrade et al 1 showed that when compared with osteochondral autograft transfer, autologous chondrocyte implantation, particulated juvenile allograft cartilage, and autologous matrix-induced chondrogenesis, OCA of the patella led to similar improvements in clinical scores above the MCID, with no definitive differences between groups.…”

“…4,27 Although most of the existing outcomes literature has focused on condylar OCA, treatment of patellar lesions with OCA has been reported as well. Patellar OCA has been shown to have good outcomes, comparable with other forms of cartilage restoration in the patella, 1 with graft survivorship of 78.1% at both 5 and 10 years, maintained improvement in pain and function, and 89% patient satisfaction. 9 The unique shape of the patella presents a challenge for osteochondral allograft implantation.…”

Recent advances and future trends in knee arthroscopy

“…Hence, it is suggested that OCA be reserved for salvage and revision situations. [82] The medial and lateral trochlea which are the usual donors for OATS can be used in these cases for only small patellar defects. Scaffolds for patellar cartilage regeneration have given disappointing results with a 90% failure and 70% re-operation rate.…”

“…Going forward scaffolds with better stress resistance need to be developed. [82] Algorithmic approach to recurrent lateral patellar instability…”

Diz çevresi osteotomilerinde kıkırdak rejenerasyonunu artırıcı uygulamalar

“…Patellar eklem kaybı patella baja ve patellar eklem kontraktüründe daha yaygın görülmektedir (Şekil 1). [6]…”