Cartilage Restoration in the Patellofemoral Joint

  • Jack Farr
  • Brian J. Cole
  • Michael J. Salata
  • Marco Collarile
  • Sarvottam Bajaj


The treatment of patellofemoral (PF) articular cartilage pathology is difficult because the pathology is multifactorial and symptoms related to the cartilage portion of the problem are expressed through noncartilaginous tissue. Since cartilage is aneural, the symptoms from the cartilage defects are mediated through the mechanical effects on bone and by cartilage debris that causes noxious stimulation of soft tissues. A systematic history, thorough physical examination, and appropriate imaging studies are essential to assign a portion of the patient’s symptoms to the cartilage pathology. A successful outcome for patellofemoral articular cartilage restoration requires treatment of each individual component of the multifactorial pathology, and with careful patient selection and comprehensive patient and knee specific surgical management, it is possible for cartilage restoration in the patellofemoral compartment to have a success rate similar to the tibiofemoral compartment.


Complex Regional Pain Syndrome Anterior Knee Pain Autologous Chondrocyte Implantation Patellofemoral Joint Chondral Lesion 
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  1.  1.
    Aroen A, Loken S, Heir S, et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004;32:211-215.PubMedCrossRefGoogle Scholar
  2.  2.
    Beaconsfield T, Pintore E, Maffulli N, et al. Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res. 1994;308:18-28.PubMedGoogle Scholar
  3.  3.
    Bentley G, Biant LC, Carrington RW, et al. A prospective, randomised comparison of autologous chondrocyte implantation verses mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85:223-230.PubMedCrossRefGoogle Scholar
  4.  4.
    Biedert RM. Patellofemoral Disorders. Diagnosis and Treatment. West Sussex: Wiley; 2004.CrossRefGoogle Scholar
  5.  5.
    Blevins FT, Steadman JR, Rodrigo JJ, et al. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics. 1998;21:761-767.PubMedGoogle Scholar
  6.  6.
    Brittberg M, Lindahl A, Nilsson A, et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889-895.PubMedCrossRefGoogle Scholar
  7.  7.
    Brittberg M, Peterson L, Sjiogren-Jansson E, et al. Articular cartilage engineering with autologous chondrocyte transplantation. J Bone Joint Surg Am. 2003;85:109-115.PubMedGoogle Scholar
  8.  8.
    Brittberg M, Tallheden T, Sjogren-Sansson B, et al. Autologous chondrocyte used for articular cartilage repair: an update. Clin Orthop Relat Res. 2001;391:337-348.CrossRefGoogle Scholar
  9.  9.
    Chen H, Sun J, Hoemann CD, et al. Subchondral structure and repair responses following bone marrow stimulation by drilling versus microfracture in rabbit trochleas. ICRS; 2009; Miami.Google Scholar
  10. 10.
    Curl WW, Krome J, Gordon ES, et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13:456-460.PubMedCrossRefGoogle Scholar
  11. 11.
    Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2:19-26.PubMedCrossRefGoogle Scholar
  12. 12.
    Ficat P, Ficat C, Bailleux A. External hypertension syndrome of the patella. Its significance recognition arthrosis. Rev Chir Orthop Reparatrice Appar Mot. 1975;61:39-59.PubMedGoogle Scholar
  13. 13.
    Ficat P, Hungerford D. Disorder of the Patellofemoral Joint. Baltimore: Williams & Wilkins; 1977.Google Scholar
  14. 14.
    Fulkerson JP. The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop Relat Res. 1983;179:129-133.PubMedGoogle Scholar
  15. 15.
    Fulkerson JP. A clinical test for medial patella tracking. Tech Orthop. 1997;12:165-169.CrossRefGoogle Scholar
  16. 16.
    Gomoll AH, Probst C, Farr J, et al. Use of type I/III bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous chondrocyte implantation. Am J Sports Med. 2009;35:20S-23S.CrossRefGoogle Scholar
  17. 17.
    Grelsamer RP, McConnell J. The Patella. A Team Approach. Gaithersburg: Aspen Publication; 1998.Google Scholar
  18. 18.
    Hangody L, Rathonyi GK, Duska Z, et al. Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg Am. 2004;86:65-72.PubMedGoogle Scholar
  19. 19.
    Hejgaard N, Arnoldi CC. Osteotomy of the patella in the patellofemoral pain syndrome. The significance increased intraosseous pressure during sustained knee flexion. Int Orthop. 1987;8:89-94.Google Scholar
  20. 20.
    Hjelle K, Solheim E, Strand T, et al. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002;18:730-734.PubMedCrossRefGoogle Scholar
  21. 21.
    Jakob RP, Franz T, Gautier E, et al. Autologous osteochondral grafting in the knee: indication, results and reflections. Clin Orthop Relat Res. 2002;401:170-184.PubMedCrossRefGoogle Scholar
  22. 22.
    Jamali AA, Emmerson BC, Chung C, et al. Fresh osteochondral allografts. Clin Orthop Relat Res. 2005;437:176-185.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaplan LD, Schurhoff MR, Selesnick H, et al. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy. 2005;21:557-561.PubMedCrossRefGoogle Scholar
  24. 24.
    Knutsen G, Engerbretsen L, Ludvigsen TC, et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004; 86:455-464.PubMedGoogle Scholar
  25. 25.
    Kreuz PC, Steinwachs MR, Erggelet C, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006;14(11):1119-1125.PubMedCrossRefGoogle Scholar
  26. 26.
    Merchant AC. Radiography of the patellofemoral joint. Oper Tech Sports Med. 1999;7:59-64.CrossRefGoogle Scholar
  27. 27.
    Miller BS, Steadman JR, Briggs KK, et al. Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg. 2004;17:13-17.PubMedGoogle Scholar
  28. 28.
    Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res. 2005;436:30-39.PubMedCrossRefGoogle Scholar
  29. 29.
    Mithoefer K, Williams RJ III, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87:1911-1920.PubMedCrossRefGoogle Scholar
  30. 30.
    Moseley B, O’Malley K, Petersen N, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81-88.PubMedCrossRefGoogle Scholar
  31. 31.
    Post WR. History and physical examination. In: Fulkerson JP, ed. Disorders of the Patellofemoral Joint. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.Google Scholar
  32. 32.
    Potter HG, Foo LF. Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair. Am J Sports Med. 2006;34:661-667.PubMedCrossRefGoogle Scholar
  33. 33.
    Recht MP, Goodwin DW, Winalsky CS, White LM. MRI of articular cartilage: revisiting current status and future directions. A journal review. Am J Roentegenol. 2005;185:899-914.CrossRefGoogle Scholar
  34. 34.
    Schepsis AA, Fitzgerald M, Nicoletta R. Revision surgery for exertional compartment syndrome of the lower leg: technique, findings and results. Am J Sports Med. 2005;33:1040-1047.PubMedCrossRefGoogle Scholar
  35. 35.
    Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am. 1986;17:235-248.PubMedGoogle Scholar
  36. 36.
    Shasha N, Krywulak S, Backstein D, et al. Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fracture. J Bone Joint Surg Am. 2003;85:33-39.PubMedGoogle Scholar
  37. 37.
    Spencer JD, Hayes KC, Alexander IJ. Knee joint effusion and quadriceps inhibition in man. Arch Phys Med Rehabil. 1984;65:171-177.PubMedGoogle Scholar
  38. 38.
    Steadman JR, Briggs KK, Rodrigo JJ, et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19:477-484.PubMedCrossRefGoogle Scholar
  39. 39.
    Steinwachs M. New technique for cell-seeded collagen-matrix-supported autologous chondrocyte transplantation. Arthroscopy. 2009;25:208-211.PubMedCrossRefGoogle Scholar
  40. 40.
    Teitge RA. Plain patellofemoral radiographs. Oper Tech Sports Med. 2001;9:134-151.CrossRefGoogle Scholar
  41. 41.
    Torga Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res. 2006;444:193-200.PubMedCrossRefGoogle Scholar
  42. 42.
    Walczak BE, McCulloch PC, Kang RW, et al. Abnormal finding on magnetic resonance imaging in asymptomatic NBA players. J Knee Surg. 2008;21:27-33.PubMedGoogle Scholar
  43. 43.
    Walsh WM. Patellofemoral joint. In: DeLee JC, Drez D, eds. Orthopaedic Sports Medicine. Principles and Practice. Philadelphia: W.B. Saunders Company; 1994.Google Scholar
  44. 44.
    Winalski CS, Gupta KB. Magnetic resonance imaging of focal articular cartilage lesions. Top Magn Reson Imaging. 2003;14:131-144.PubMedCrossRefGoogle Scholar
  45. 45.
    Yates JW. The effectiveness of autologous chondrocyte implantation for treatment of full-thickness articular cartilage lesions in workers’ compensation patients. Orthopedics. 2003;26:295-301.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Jack Farr
    • 1
  • Brian J. Cole
  • Michael J. Salata
  • Marco Collarile
  • Sarvottam Bajaj
  1. 1.Voluntary Clinical, Orthopaedic Surgery, IU School of MedicineOrthoIndy Knee Care Institute, Cartilage Restoration Center of IndianaIndianapolisUSA

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