Chondral Defects of the Patella: Diagnosis and Management

  • Andreas H. Gomoll
  • Brian J. ChilelliEmail author


Articular cartilage injuries of the patella are common and associated with acute trauma, patellar instability, chronic maltracking, and repetitive overuse. However, chondral defects of the patella are often multifactorial and, at times, a specific etiology can be difficult to ascertain. Studies have reported patella cartilage lesions to be the second most common site within the knee behind the medial femoral condyle and have been seen in up to 36% of patients undergoing routine knee arthroscopy. Chondral lesions commonly occur following patellar dislocation and often involve the inferior aspect of the medial patellar facet. This chapter will focus on the work-up and management of patients with chondral defects of the patella. Although patellar instability is frequently seen in conjunction with cartilage injuries, it will not be discussed here in detail.


  1. 1.
    Mihalko WM, Boachie-Adjei Y, Spang JT, et al. Controversies and techniques in the surgical management of patellofemoral arthritis. Instr Course Lect. 2008;57:365–80.PubMedGoogle Scholar
  2. 2.
    Gomoll AH, Yoshioka H, Watanabe A, et al. Preoperative measurement of cartilage defects by MRI underestimates lesion size. Cartilage. 2011;2(4):389–93.CrossRefGoogle Scholar
  3. 3.
    Mehl J, Feucht MJ, Bode G, et al. Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects. Knee Surg Sports Traumatol Arthrosc. 2016;24:838–46.CrossRefGoogle Scholar
  4. 4.
    Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S. Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med. 2012;40(5):1119–25.CrossRefGoogle Scholar
  5. 5.
    Chevidikunnan MF, Saif AA, Gaowgzeh RA, et al. Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome. J Phys Ther Sci. 2016;28:1518–23.CrossRefGoogle Scholar
  6. 6.
    Santos TR, Oliveira BA, Ocarino JM, et al. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Phys Ther. 2015;19:167–76.Google Scholar
  7. 7.
    Alba-Martín P, Gallego-Izquierdo T, Plaza-Manzano G, et al. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review. J Phys Ther Sci. 2015;27:2387–90.CrossRefGoogle Scholar
  8. 8.
    Peng HT, Song CY. Predictors of treatment response to strengthening and stretching exercises for patellofemoral pain: an examination of patellar alignment. Knee. 2015;22:494–8.CrossRefGoogle Scholar
  9. 9.
    Goyal D, Keyhani S, Lee EH, Hui JH. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy. 2013;29(9):1579–88.CrossRefGoogle Scholar
  10. 10.
    Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Traumatol Arthrosc. 2014;22:1986–96.CrossRefGoogle Scholar
  11. 11.
    Mithoefer K, McAdams T, Williams RJ, et al. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: An evidence-based systematic analysis. Am J Sports Med. 2009;37:2053–63.CrossRefGoogle Scholar
  12. 12.
    Kreuz PC, Steinwachs MR, Erggelet C, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil. 2006;14:1119–25.CrossRefGoogle Scholar
  13. 13.
    Gomoll AH, Minas T, Farr J, et al. Treatment of chondral defects in the patellofemoral joint. J Knee Surg. 2006;19(4):285–95.CrossRefGoogle Scholar
  14. 14.
    Bentley G, Biant LC, Carrington RW, et al. A prospective, randomized comparison of autologous chondrocyte implantation versus mosaic- plasty for osteochondral defects in the knee. J Bone Joint Surg (Br). 2003;85(2):223–30.CrossRefGoogle Scholar
  15. 15.
    Emre TY, Atbasi Z, Demircioglu DT, et al. Autologous osteochondral transplantation (mosaicplasty) in articular cartilage defects of the patellofemoral joint: retrospective analysis of 33 cases. Musculoskelet Surg. 2016.Google Scholar
  16. 16.
    Nho SJ, Foo LF, Green DM, Shindle MK, Warren RF, Wickiewicz TL, Potter HG, Williams RJ. Evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med. 2008;36(6):1101–9.CrossRefGoogle Scholar
  17. 17.
    Astur DC, Arliani GG, Binz M, et al. Autologous osteochondral transplantation for treating patellar chondral injuries. J Bone Joint Surg. 2014;96:816–23.CrossRefGoogle Scholar
  18. 18.
    Gracitelli GC, Meric G, Pulido PA, Gorz S, De Young AJ, Bugbee WD. Fresh osteochondral allograft transplantation for isolated patellar cartilage injury. Am J Sports Med. 2015;43(4):879–84.CrossRefGoogle Scholar
  19. 19.
    Chahal J, Gross AE, Gross C, et al. Outcomes of osteochondral allograft transplantation in the knee: systematic review. Arthroscopy. 2013;29(3):575–88.CrossRefGoogle Scholar
  20. 20.
    Torga Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res. 2006;444:193–200.CrossRefGoogle Scholar
  21. 21.
    Gillogly SD, Arnold RM. Autologous chondrocyte implantation and anteromedialization for isolated patellar articular cartilage lesions: 5-to11-year follow-up. Am J Sports Med. 2014;42(4):912–20.CrossRefGoogle Scholar
  22. 22.
    Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res. 2007;463:187–94.PubMedGoogle Scholar
  23. 23.
    Kon E, Filardo G, Gobbi A, et al. Long-term results after hyaluronan-based MACT for the treatment of cartilage lesions of the patellofemoral joint. Am J Sports Med. 2016;44(3):602–8.CrossRefGoogle Scholar
  24. 24.
    Gobbi A, Kon E, Berruto M, et al. Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med. 2009;37(6):1083–92.CrossRefGoogle Scholar
  25. 25.
    Gomoll AH, Gillogly SD, Cole BJ, et al. Autologous chondrocyte implantation in the patella: a multicenter experience. Am J Sports Med. 2014;42(5):1074–81.CrossRefGoogle Scholar
  26. 26.
    Von Keudell A, Han R, Bryant T, et al. Autologous chondrocyte implantation to isolated patella cartilage defects: two- to 15-year follow-up. Cartilage. 2016;8(2):146–54.CrossRefGoogle Scholar
  27. 27.
    Tompkins M, Hamann JC, Diduch DR, Bonner KF, Hart JM, Gwathmey FW, Milewski MD, Gaskin CM. Preliminary results of a novel single-stage cartilage restoration technique: particulated juvenile articular cartilage allograft for chondral defects of the patella. Arthroscopy. 2013;29(10):1661–70.CrossRefGoogle Scholar
  28. 28.
    Fulkerson J, Becker G, Meaney J, Miranda M, Folcik M. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med. 1990;18(5):490–7.CrossRefGoogle Scholar
  29. 29.
    Beck PR, Thomas AL, Farr J, Lewis PB, Cole BJ. Trochlear contact pressures after anteromedialization of the tibial tubercle. Am J Sports Med. 2005;33:1710–5.CrossRefGoogle Scholar
  30. 30.
    Stephen JM, Lumpaopong P, Dodds AL, Williams A, Amis AA. The effect of tibial tuberosity medialization and lateralization on patellofemoral joint kinematics, contact mechanics, and stability. Am J Sports Med. 2015;43(1):186–94.CrossRefGoogle Scholar
  31. 31.
    Trinh TQ, Harris JD, Siston RA, et al. Improved outcomes with combined autologous chondrocyte implantation and patellofe- moral osteotomy versus isolated autologous chondrocyte implanta- tion. Arthroscopy. 2013;29(3):566–74.CrossRefGoogle Scholar
  32. 32.
    Pascual-Garrido C, Slabaugh MA, L’Heureux DR, et al. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: pro- spective evaluation at average 4-year follow-up. Am J Sports Med. 2009;37(Suppl 1):33S–41S.CrossRefGoogle Scholar
  33. 33.
    Siebold R, Karidakis G, Fernandez F. Clinical outcome after medial ptellofemoral ligament reonstruction and autologous chondrocyte implantation following recurrent patella dislocation. Knee Surg Traumatol Arthrosc. 2014;22:2477–83.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Northwestern Medicine, Regional Medical Group OrthopaedicsWarrenvilleUSA

Personalised recommendations