Cartilage Defects of the Patellofemoral Joint

2019 ◽  
pp. 81-87
Author(s):  
Yaser Ghani ◽  
James Donaldson
Keyword(s):  
Patellofemoral Joint ◽  
Cartilage Defects

scholarly journals New trochlea - old patella. Do both fit together?

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Peter Balcarek ◽  
Felix Zimmermann
Keyword(s):  
Patellofemoral Joint ◽  
Normal Values ◽  
Trochlear Dysplasia ◽  
Mpfl Reconstruction ◽  
Cartilage Defects ◽  
Control Group ◽  
Clear Correlation ◽  
Study Group ◽  
Contact Ratio ◽  
Patellar Tilt

Aims and Objectives: Trochlear dysplasia has been established as the most common and impactful predisposing factor of lateral patellar dislocation (LPD). In addition, a clear correlation between trochlear dysplasia and the development of cartilage defects and osteoarthritis in the patellofemoral joint has been established. Though current literature increasingly supports trochleoplasty procedures for the treatment of LPD only few data evaluated the actual improvements of the cartilaginous patella-trochlea congruence after deepening trochleoplasty procedure. The aim of this study was therefore to evaluate the patella-trochlea congruence before and after a deepening trochleaplasty and medial patellofemoral ligament (MPFL) reconstruction in severe trochlear dysplasia. The hypothesis was that the deepening trochleoplasty and MPFL reconstruction is able to correct patella-trochlea congruence to physiological parameters. Materials and Methods: The study group comprised 20 patients. All patients suffered recurrent LPD due to severe trochlear dysplasia and underwent a deepening ‘Bereiter’ trochleoplasty and MPFL reconstruction. Pre- and postoperative magnetic resonance imaging (MRI) investigations were used to assess the patella-trochlea contact ratio, the posterior patellar edge - trochlea groove ratio, and the lateral patellar inclination angle (patellar tilt). Measurements were obtained using open-source PACS workstation software (OsiriX v. 5.8.5, Pixmeo SARL, CH1233 Bernex, Switzerland). All parameters were compared to a control group of 20 at random selected patients without any medical history related to the patellofemoral joint. A paired two-tailed t-test was used to test for differences between the pre- and postoperative measurements within the study group. A one-way analysis of variance (ANOVA) with Bonferoni post-test adjustment was used to test for differences between all measurement series. The level of significance was set at 0.05. Results: Preoperatively, all parameters of the study group were significantly different when compared to the control group. This meant a reduced patella-trochlea contact ratio (0.38 ± 0.13 vs. 0.67 ± 0.09; p<0.001), an increased patellar lateralization (0.81 ± 0.10 vs. 0.98 ± 0.03; p<0.001), and increased patellar tilt (27.1° ± 7.7° vs. 9.4° ± 5.7°; p<0.001). Postoperatively, all parameters showed a significant improvement. The patella-trochlea contact ratio increased to a mean of 0.65 ± 0.11 (p<0.0001), patellar lateralization improved to a mean posterior patellar edge - trochlea groove ratio of 0.94 ± 0.06 (<0.0001), and patellar tilt reduced to a mean of 15.05° ± 4.2° (p< 0.0001). All parameters reached normal values when compared to the control group (all p >0.05). Conclusion: Findings of this study indicate that in severe trochlear dysplasia deepening trochleoplasty and MPFL reconstruction is able to correct patellar alignment und patellar-trochlear congruence to normal values.

scholarly journals PATELLOFEMORAL JOINT CARTILAGE RESTORATION WITH PARTICULATED JUVENILE ALLOGRAFT IN PATIENTS UNDER 21 YEARS OLD: POSTOPERATIVE MRI ANALYSIS AND RETURN TO SPORT RATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Brody J. Dawkins ◽  
Beth E. Shubin Stein ◽  
Douglas N. Mintz ◽  
Peter D. Fabricant ◽  
Andreas H. Gomoll ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Tertiary Care ◽  
Sport Activity ◽  
Return To Sport ◽  
Cartilage Defects ◽  
Joint Cartilage ◽  
Postoperative Mri ◽  
Chondral Defects ◽  
Cartilage Restoration

Background: Patellofemoral joint cartilage defects are difficult to treat due to their unique thickness and topography. Numerous cartilage restoration techniques are available to surgeons treating articular cartilage defects. However, patellofemoral joint restoration historically produces worse outcomes than tibiofemoral joint restoration. One cell-based option is particulated juvenile allograft cartilage (PJAC), though literature regarding the efficacy of this treatment is sparse, especially in patients under the age of 21 years. Hypothesis/ Purpose: The aim of this study is to investigate postoperative outcomes of PJAC for patellofemoral chondral defects using MRI and return to sport rates in this active, high-demand patient population. Methods: Patients at an urban tertiary care musculoskeletal institution who underwent PJAC for patellofemoral joint cartilage restoration were identified through records review. Patients 21 years old or younger with minimum clinical follow-up of 1 year and postoperative MRI at a minimum of 6 months after surgery were included. Cartilage restoration was assessed by MRI using the International Cartilage Repair Society’s standardized system. Sport activity was collected from medical records. Results: Thirty-six knees in 34 patients with a mean age of 16.1 ± 3.1 years old (range 10—21 years old) were analyzed. Mean follow-up was 32.1 months. Defects were located on the patella in 25 knees, and trochlea in 11 knees (Figure 1). There were no bipolar lesions in the cohort. Mean defect size was 2.47 cm2. Twenty-four knees (66.7%) were graded either ‘normal’ or ‘nearly normal’, and 28 knees (77.8%) had greater than 50% of the defect filled on follow-up imaging. Return to sport rates among patients who participated in a sport preoperatively was 100%. Conclusion: Restoration of patellofemoral chondral defects in young patients with particulated juvenile allograft can be performed with satisfactory short-term efficacy, excellent postoperative MRI appearance, and very high rates of return to sport. Tables/Figures: [Figure: see text]

scholarly journals Are Patellofemoral Joint Alignment and Shape Associated With Structural Magnetic Resonance Imaging Abnormalities and Symptoms Among People With Patellofemoral Pain?

2018 ◽  
Vol 46 (13) ◽  
pp. 3217-3226 ◽  
Author(s):  
Marienke van Middelkoop ◽  
Erin M. Macri ◽  
Joost F. Eijkenboom ◽  
Rianne A. van der Heijden ◽  
Kay M. Crossley ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Patellofemoral Joint ◽  
Cartilage Defects ◽  
Resonance Imaging ◽  
Fat Pad ◽  
Patellar Tilt ◽  
Morphological Abnormalities ◽  
Patellofemoral Alignment ◽  
And Function

Background: Patellofemoral malalignment has been observed among people with patellofemoral pain (PFP) and may be associated with the presence of imaging features of osteoarthritis, symptoms, and function. Purpose: To determine whether patellofemoral joint alignment and bony shape are associated with (1) cartilage, bone, and soft tissue morphological abnormalities defined on magnetic resonance imaging (MRI) and (2) reported symptoms and function among people with PFP. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants (mean ± SD age, 30.2 ± 9.5 years; range, 14-50 years; 78 females, 58.6%) completed questionnaires regarding demographics, pain, symptoms, and function and underwent a 3-T MRI scan of their more symptomatic eligible knee. Structural MRI abnormalities were scored with the MOAKS (Magnetic Resonance Imaging Osteoarthritis Knee Score), and MRI alignment and shape were measured with standardized methods. Associations among MOAKS features, PFP symptoms, and alignment and shape measures were evaluated with regression analyses (α = .05). Results: Minor cartilage defects were present in 22 (16.5%) participants, patellar osteophytes in 83 (62.4%), anterior femur osteophytes in 29 (21.8%), Hoffa synovitis in 81 (60.9%), and prefemoral fat pad synovitis in 49 (36.8%). A larger Insall-Salvati ratio was significantly associated with the presence of patellar osteophytes (odds ratio [OR], 51.82; 95% CI, 4.20-640.01), Hoffa synovitis (OR, 60.37; 95% CI, 4.66-782.61), and prefemoral fat pad synovitis (OR, 43.31; 95% CI, 4.28-438.72) in the patellofemoral joint. A larger patellar tilt angle was significantly associated with the presence of minor cartilage defects (OR, 1.10; 95% CI, 1.00-1.20), the presence of patellar osteophytes (OR 1.12; 95%CI 1.02-1.22), and prefemoral fat pad synovitis (OR, 1.11; 95% CI, 1.03-1.20) in the patellofemoral joint. Finally, a larger bisect offset was significantly associated with the presence of minor cartilage defects (OR, 1.05; 95% CI, 1.00-1.11) and patellar osteophytes (OR, 1.07; 95% CI, 1.01-1.14) in the patellofemoral joint. The majority of patellofemoral alignment measures were not associated with symptoms or function. Conclusion: For people with PFP, the presence of morphological abnormalities defined on MRI appears to be related to particular patellofemoral alignment measures, including higher Insall-Salvati ratio (indicating patella alta), larger patellar tilt angle (indicating greater lateral tilt), and larger bisect offset (indicating greater lateral displacement). Hardly any associations were found with symptoms or function. So there might be a distinct subgroup of PFP that is more prone to developing patellofemoral osteoarthritis later in life, as particular alignment measures seem to be associated with the presence of patellar osteophytes. Prospective studies are required to investigate the longitudinal relationship between alignment or bony shape and morphological abnormalities defined on MRI in this patient population.

scholarly journals Distribution of MR-detected cartilage defects of the patellofemoral joint in chronic knee pain

2003 ◽  
Vol 11 (7) ◽  
pp. 494-498 ◽  
Author(s):  
T.L Boegård ◽  
O Rudling ◽  
I.F Petersson ◽  
K Jonsson
Keyword(s):  
Knee Pain ◽  
Patellofemoral Joint ◽  
Cartilage Defects ◽  
Chronic Knee Pain
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