Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

Filippo Migliorini; Alice Baroncini; Andreas Bell; Christian Weber; Frank Hildebrand; Nicola Maffulli

doi:10.1186/s13018-022-03419-4

Surgical strategies for chondral defects of the patellofemoral joint: a systematic review

J Orthop Surg Res. 2022 Dec 5;17(1):524. doi: 10.1186/s13018-022-03419-4.

Authors

Filippo Migliorini^{1

2}, Alice Baroncini³, Andreas Bell⁴, Christian Weber³, Frank Hildebrand³, Nicola Maffulli^{5

6

7}

Affiliations

¹ Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.
² Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany. migliorini.md@gmail.com.
³ Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
⁴ Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
⁵ Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
⁶ School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England.
⁷ Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, E1 4DG, England.

Abstract

Background: The management of chondral defects of the patellofemoral joint is debated, and definitive evidence is lacking. This study systematically updated and summarised the current literature on the surgical management of isolated chondral defects of the patellofemoral joint, discussing techniques, outcome, pitfalls, and new frontiers.

Methods: This systematic review was conducted according to the 2020 PRISMA statement. In August 2022, PubMed, Web of Science, Google Scholar, and Embase databases were accessed with no time constrain. All the clinical studies investigating the surgical management of chondral defects of the patellofemoral joint were retrieved. Articles which reported data on patients with advanced to severe osteoarthritis were not eligible. Only studies with a minimum 24 months follow-up were considered. Studies which mixed results of patellofemoral and tibiofemoral joints were not considered.

Results: Data from 10 studies (692 procedures) were retrieved. The mean follow-up was 46.9 ± 18.2 months. The mean age of the patients was 34.0 ± 6.1 years, and the mean BMI was 25.9 ± 0.8 kg/m². The mean duration of symptoms before the index surgery was 81.0 ± 24.0 months. The mean defect size was 3.8 ± 0.8 cm². All the PROMs improved from baseline to last follow-up: VAS 0-10 (P = 0.04), Tegner (P = 0.02), Lysholm (P = 0.03), and International Knee Documentation Committee (P = 0.03). The rate of hypertrophy was 5.6% (14 of 251), the rate of progression to total knee arthroplasty was 2.4% (2 of 83), the rate of revision was 16.9% (29 of 136), and the rate of failure was 13.0% (16 of 123).

Conclusion: Current surgical strategies may be effective to improve symptoms deriving from chondral defects of the patellofemoral joint. The limited and heterogeneous data included for analysis impact negatively the results of the present study. Further clinical studies are strongly required to define surgical indications and outcomes, and the most suitable technique.

Keywords: AMIC; Chondral defects; Knee; Patellofemoral; mACI.

Publication types

Systematic Review
Review

MeSH terms

Adult
Arthroplasty, Replacement, Knee*
Cartilage Diseases* / surgery
Cartilage, Articular* / surgery
Humans
Knee Joint / surgery
Patellofemoral Joint* / surgery
Patient Satisfaction
Transplantation, Autologous