Bipolar focal chondral defects of the patellofemoral joint with patellar instability

Abstract Background Patellar instability (PI) often increases the possibility of lateral patellar dislocation and early osteoarthritis. The molecular mechanism of early articular cartilage degeneration during patellofemoral osteoarthritis (PFOA) still requires further investigation. However, it is known that the NF-κB signaling pathway plays an important role in articular cartilage degeneration. The aim of this study was to investigate the relationship between the NF-κB signaling pathway and patellofemoral joint cartilage degeneration. Methods We established a rat model of PI-induced PFOA. Female 4-week-old Sprague-Dawley rats (n = 120) were randomly divided into two groups: the PI (n = 60) and control group (n = 60). The distal femurs of the PI and control group were isolated and compared 4, 8, and 12 weeks after surgery. The morphological structure of the trochlear cartilage and subchondral bone were evaluated by micro-computed tomography and histology. The expression of NF-κB, matrix metalloproteinase (MMP)-13, collagen X, and TNF-ɑ were evaluated by immunohistochemistry and quantitative polymerase chain reaction. Results In the PI group, subchondral bone loss and cartilage degeneration were found 4 weeks after surgery. Compared with the control group, the protein and mRNA expression of NF-κB and TNF-ɑ were significantly increased 4, 8, and 12 weeks after surgery in the PI group. In addition, the markers of cartilage degeneration MMP-13 and collagen X were more highly expressed in the PI group compared with the control group at different time points after surgery. Conclusions This study has demonstrated that early patellofemoral joint cartilage degeneration can be caused by PI in growing rats, accompanied by significant subchondral bone loss and cartilage degeneration. In addition, the degeneration of articular cartilage may be associated with the activation of the NF-κB signaling pathway and can deteriorate with time as a result of PI.

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Matrix-induced autologous chondrocyte implantation (MACI) for chondral defects in the patellofemoral joint

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3046-x ◽

2014 ◽

Vol 22 (10) ◽

pp. 2522-2530 ◽

Cited By ~ 32

Author(s):

Daniel Meyerkort ◽

Jay R. Ebert ◽

Timothy R. Ackland ◽

William B. Robertson ◽

Michael Fallon ◽

...

Keyword(s):

Patellofemoral Joint ◽

Autologous Chondrocyte Implantation ◽

Chondral Defects ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

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Physical examination of the patellofemoral joint

Sports & Exercise Medicine Switzerland ◽

10.34045/sems/2020/1 ◽

2020 ◽

Vol 68 (1) ◽

Keyword(s):

Physical Examination ◽

Knee Pain ◽

Anterior Knee Pain ◽

Patellofemoral Joint ◽

Patellar Instability ◽

Adequate Treatment ◽

Profound Knowledge ◽

Anterior Knee ◽

Patellofemoral Dislocation ◽

Underlying Pathology

Patients with a patellofemoral pain are either in an acute state after a patellofemoral dislocation or are suffering from a chronic anterior knee pain (AKP), whereas AKP might be accompanied by patellar instability without dislocation. Whereas the acute state after a dislocation is mostly clear and its examination limited, the examination of a AKP is much more complex. A profound knowledge of the anatomy, the painful structures and patellofemoral biomechanics is essential in order to find the underlying pathology within the heterogeneous and diverse etiologies. Furthermore, a meticulous and precise examination is key to find the adequate treatment for AKP.

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Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546518814236 ◽

2018 ◽

Vol 47 (12) ◽

pp. 3009-3018 ◽

Cited By ~ 5

Author(s):

Jorge Chahla ◽

Matthew C. Sweet ◽

Kelechi R. Okoroha ◽

Benedict U. Nwachukwu ◽

Betina Hinckel ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Patellofemoral Joint ◽

Osteochondral Allograft ◽

Cochrane Central Register ◽

Failure Rates ◽

Allograft Transplantation ◽

Chondral Defects ◽

Patient Reported

Background: The initial focus of cartilage restoration algorithms has been on the femur; however, the patellofemoral compartment accounts for 20% to 30% of significant symptomatic chondral pathologies. While patellofemoral compartment treatment involves a completely unique subset of comorbidities, with a comprehensive and thoughtful approach many patients may benefit from osteochondral allograft treatment. Purpose: To perform a systematic review of clinical outcomes and failure rates after osteochondral allograft transplantation (OCA) of the patellofemoral joint at a minimum 18-month follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA for patellofemoral joint chondral defects was performed with the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1990 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCA for the treatment of chondral defects in the patellofemoral joint, English language, minimum follow-up of 18 months, minimum study size of 5 patients, and human studies. The methodological quality of each study was assessed with a modified version of the Coleman methodology score. Results: The systematic search identified 8 studies with a total of 129 patients. The methods of graft procurement and storage time included fresh (121 patients, 93.8%), and cryopreserved (8 patients, 6.2%) grafts. The mean survival rate was 87.9% at 5 years and 77.2% at 10 years. The following outcome scores showed significant improvement from pre- to postoperative status: modified d’Aubigné-Postel, International Knee Documentation Committee, Knee Society Score–Function, and Lysholm Knee Score. Conclusion: OCA of the patellofemoral joint results in improved patient-reported outcome measures with high patient satisfaction rates. Five- and 10-year survival rates of 87.9% and 77.2%, respectively, can be expected after this procedure. These findings should be taken with caution, as a high percentage of patellofemoral osteochondral allografts were associated with concomitant procedures; therefore, further research is warranted to determine the effect of isolated osteochondral transplantations.

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Treatment of Chondral Defects in the Patellofemoral Joint

The Journal of Knee Surgery ◽

10.1055/s-0030-1248121 ◽

2010 ◽

Vol 19 (04) ◽

pp. 285-295 ◽

Cited By ~ 40

Author(s):

Andreas Gomoll ◽

Tom Minas ◽

Jack Farr ◽

Brian Cole

Keyword(s):

Patellofemoral Joint ◽

Chondral Defects

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Early Patellofemoral Articular Cartilage Degeneration in a Rat Model of Patellar Instability is Associated with Activation of the NF-κB Signaling Pathway

10.21203/rs.2.23233/v3 ◽

2020 ◽

Author(s):

Wei Lin ◽

Huijun Kang ◽

Yike Dai ◽

Yingzhen Niu ◽

Guangmin Yang ◽

...

Keyword(s):

Articular Cartilage ◽

Signaling Pathway ◽

Subchondral Bone ◽

Patellofemoral Joint ◽

Patellar Instability ◽

Cartilage Degeneration ◽

Control Group ◽

And Control ◽

Articular Cartilage Degeneration ◽

And Cartilage

Abstract Background: Patellar instability (PI) often increases the possibility of lateral patellar dislocation and early osteoarthritis. The molecular mechanism of early articular cartilage degeneration during patellofemoral osteoarthritis (PFOA) still requires further investigation. However, it is known that the NF-κB signaling pathway plays an important role in articular cartilage degeneration. The aim of this study was to investigate the relationship between the NF-κB signaling pathway and patellofemoral joint cartilage degeneration. Methods: We established a rat model of PI-induced PFOA. Female 4-week-old Sprague-Dawley rats (n=120) were randomly divided into two groups: the PI (n=60) and control group (n=60). The distal femurs of the PI and control group were isolated and compared 4, 8, and 12 weeks after surgery. The morphological structure of the trochlear cartilage and subchondral bone were evaluated by micro-computed tomography and histology. The expression of NF-κB, matrix metalloproteinase (MMP)-13, collagen X, and TNF-ɑ were evaluated by immunohistochemistry and quantitative polymerase chain reaction. Results: In the PI group, subchondral bone loss and cartilage degeneration were found 4 weeks after surgery. Compared with the control group, the protein and mRNA expression of NF-κB and TNF-ɑ were significantly increased 4, 8, and 12 weeks after surgery in the PI group. In addition, the markers of cartilage degeneration MMP-13 and collagen X were more highly expressed in the PI group compared with the control group at different time points after surgery.Conclusions: This study has demonstrated that early patellofemoral joint cartilage degeneration can be caused by PI in growing rats, accompanied by significant subchondral bone loss and cartilage degeneration. In addition, the degeneration of articular cartilage may be associated with the activation of the NF-κB signaling pathway and can deteriorate with time as a result of PI.

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Patellofemoral Joint Contact Pressures: Current Concepts and Use in Patellar Instability Studies

Orthopedics ◽

10.3928/01477447-20190118-05 ◽

2019 ◽

Vol 42 (2) ◽

pp. e172-e179 ◽

Cited By ~ 2

Author(s):

Jeffrey D. Osborne ◽

S. Brandon Luczak ◽

William B. Acker ◽

James Bicos

Keyword(s):

Patellofemoral Joint ◽

Patellar Instability ◽

Joint Contact ◽

Contact Pressures

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Comparison of Clinical Outcomes in the Treatment of Patellofemoral Chondral Defects: Autologous Chondrocyte Implantation versus Fresh Osteochondral Allografts

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00360 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0036

Author(s):

Nirav K. Patel ◽

Vahe Varzhapetyan ◽

Zaira Chaudhry ◽

Hytham S. Salem ◽

Bradford S. Tucker ◽

...

Keyword(s):

Clinical Outcomes ◽

Patellofemoral Joint ◽

Autologous Chondrocyte Implantation ◽

Complication Rates ◽

Type Iii ◽

Type Iv ◽

Chondral Defects ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Objectives: The complex environment and the extreme stresses of the patellofemoral joint make chondral defects a challenge to treat. Autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) have been reported as case series in the patellofemoral joint with mixed results. This study compared the clinical outcomes for ACI and OCA treatments for patellofemoral chondral defects at our institution. Methods: We reviewed all consecutive patients undergoing ACI and OCA at a single institution for the treatment of isolated patellofemoral cartilage defects. Treatment type was based on surgeon preference. Medical records were examined for patient demographic, lesion specific data, complications, re-operations and failures (graft delamination requiring surgery, revision cartilage repair or conversion to arthroplasty). Clinical outcomes included International Knee Documentation Committee (IKDC) and Short Form 12 health survey (SF-12) scores. Mean follow up was 5.2 years (range, 3.1-7.5 years). Results: There were 30 patients: 19 in the ACI group and 11 in the OCA group with a mean age of 33 (15-48) and 25.5 (16-55) respectively (p=0.12). Etiology in the ACI group was 63%(n=12) patellar instability, 21%(n=4) post-traumatic osteoarthritis, 10%(n=2) primary osteoarthritis and 5%(n=1) osteochondritis dissecans, whereas it was more evenly distributed in the OCA group (27%, 27%, 19% and 27% respectively). Lesions in the ACI group were either Fulkerson type III (84% (n=16), medial patellar facet) or type IV (16%(n=3), pan-patellar). In the OCA group, lesions varied between type 1 (9%(n=1)), type II (27%(n=3)), type III (9%(n=1)) and type IV (54%(n=6)). The mean lesion size was similar between the two groups (OCA 3.1 cm2 ±1.1 vs. ACI 3.4 cm2 ±2.4, p=0.7) with more bipolar lesions in the OCA group (45%(n=5) vs.11%(n=2), p=0.038). Failures (requiring revision or replacement surgery), were significantly more common in OCA at 36% (n=4) compared to 5.3% (n=1) in ACI patients (p=0.04), one of which was bipolar in the former group. Re-operation was performed in 27%(n=3) OCA patients (each for adhesiolysis) and in 21%(n=4) ACI patients (2 manipulation under anesthesia, 1 adhesiolysis and 1 graft debridement for overgrowth) (p=0.3). There were no significant differences between the OCA and ACI groups in IKDC (60.7 vs. 74, p=0.08) and SF-12 scores (43.5 vs 43.7, p=0.43). Conclusion: Compared to ACI, OCA had significantly more failures for patellofemoral chondral defects at short to mid-term follow-up. This may relate to differences in the etiology and lesion locations between the two groups. Despite these findings, both groups had similar complication rates and functional outcome scores.

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Trochlear Contact Pressures after Anteromedialization of the Tibial Tubercle

The American Journal of Sports Medicine ◽

10.1177/0363546505278300 ◽

2005 ◽

Vol 33 (11) ◽

pp. 1710-1715 ◽

Cited By ~ 92

Author(s):

Paul R. Beck ◽

Andre L. Thomas ◽

Jack Farr ◽

Paul B. Lewis ◽

Brian J. Cole

Keyword(s):

Contact Pressure ◽

Knee Flexion ◽

Patellofemoral Joint ◽

Tibial Tubercle ◽

Chondral Defects ◽

Cartilage Restoration ◽

Before And After ◽

The Mean ◽

Femoral Side ◽

Contact Pressures

Background Anteromedialization is recommended for cartilage restoration of patellofemoral defects, with the presumption that it decreases contact pressures across the trochlea. No study has evaluated pressures on the trochlear side of the patellofemoral joint after anteromedialization of the tibial tubercle. Hypothesis Anteromedialization of the tibial tubercle decreases contact pressure across the trochlea. Study Design Controlled laboratory study. Methods Ten cadaveric knees were tested by placing an electroresistive pressure sensor on the femoral side of the patellofemoral joint. A validated model of nonweightbearing resisted extension was simulated by loading the extensor mechanism at 89.1 N and 178.2 N. Knees were tested 3 times per load at 30°, 60°, 90°, and 105°. The center of force and pressure across the patellofemoral articulation were compared before and after a reproducible and consistent anteromedialization. Results The mean center of force shifted medially after anteromedialization at 89.1 N and 178.2 N. At 89.1 N, the mean total contact pressure decreased significantly (P <. 05) at all angles, and at 178.2 N, it decreased significantly at 30°, 60°, and 90° of knee flexion. The mean lateral trochlear contact pressure decreased significantly (P <. 05) at all flexion angles at both 89.1 N and 178.2 N. The mean central trochlear contact pressure decreased significantly (P <. 05) at 30° with the 89.1-N and 178.2-N loads but increased significantly (P <. 05) at 90° with the 89.1-N load. The mean medial trochlear contact pressure increased significantly (P <. 05) at all flexion angles at 89.1 N and 178.2 N. Conclusion Anteromedialization shifts the contact force to the medial trochlea and decreases the mean total contact pressure. Clinical Relevance Anteromedialization decreases the mean total contact pressure while shifting contact pressure toward the medial trochlea. This study suggests that anteromedialization is appropriate for unloading the lateral trochlea. However, this procedure appears to have minimal benefit on central chondral defects, and it may actually increase the load in patients with medial defects.

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Early Patellofemoral Articular Cartilage Degeneration in a Rat Model of Patellar Instability is Associated with Activation of the NF-κB Signaling Pathway

10.21203/rs.2.23233/v2 ◽

2020 ◽

Author(s):

Wei Lin ◽

Yike Dai ◽

Guangmin Yang ◽

Jinghui Niu ◽

Ming Li ◽

...

Keyword(s):

Articular Cartilage ◽

Signaling Pathway ◽

Subchondral Bone ◽

Patellofemoral Joint ◽

Patellar Instability ◽

Cartilage Degeneration ◽

Control Group ◽

And Control ◽

Articular Cartilage Degeneration ◽

And Cartilage

Abstract Background: Patellar instability (PI) often increases the possibility of lateral patellar dislocation and early osteoarthritis. The molecular mechanism of early articular cartilage degeneration during patellofemoral osteoarthritis (PFOA) still requires further investigation. However, it is known that the NF-κB signaling pathway plays an important role in articular cartilage degeneration. The aim of this study was to investigate the relationship between the NF-κB signaling pathway and patellofemoral joint cartilage degeneration. Methods: We established a rat model of PI-induced PFOA. Female 4-week-old Sprague-Dawley rats (n=120) were randomly divided into two groups: the PI (n=60) and control group (n=60). The distal femurs of the PI and control group were isolated and compared 4, 8, and 12 weeks after surgery. The morphological structure of the trochlear cartilage and subchondral bone were evaluated by micro-computed tomography and histology. The expression of NF-κB, matrix metalloproteinase (MMP)-13, collagen X, and TNF-ɑ were evaluated by immunohistochemistry and quantitative polymerase chain reaction. Results: In the PI group, subchondral bone loss and cartilage degeneration were found 4 weeks after surgery. Compared with the control group, the protein and mRNA expression of NF-κB and TNF-ɑ were significantly increased 4, 8, and 12 weeks after surgery in the PI group. In addition, the markers of cartilage degeneration MMP-13 and collagen X were more highly expressed in the PI group compared with the control group at different time points after surgery.Conclusions: This study has demonstrated that early patellofemoral joint cartilage degeneration can be caused by PI in growing rats, accompanied by significant subchondral bone loss and cartilage degeneration. In addition, the degeneration of articular cartilage may be associated with the activation of the NF-κB signaling pathway and can deteriorate with time as a result of PI.

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