Pinkowsky Gregory J, Farr Jack
*Department of Orthopaedic Surgery, Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA †Cartilage Restoration Center of Indiana, OrthoIndy Hospital, Greenwood ‡Indiana University Medical Center, Indianapolis, IN.
Sports Med Arthrosc Rev. 2016 Jun;24(2):92-7. doi: 10.1097/JSA.0000000000000104.
Patellofemoral (PF) pain, a subset of anterior knee pain, presents a particularly challenging diagnosis due to the multifactorial etiology. Within this group, assigning the patient's symptoms to a patellofemoral cartilage lesion is indirect; that is, a diagnosis by exclusion as hyaline cartilage is aneural. In addition, these PF compartment lesions are often in conjunction with various comorbidities, for example, malalignment and/or instability. In light of these factors and the high shear and compression stresses at the PF compartment, patellar and trochlear chondral lesions require unique treatment considerations from the tibiofemoral compartments. A thorough understanding of the various cartilage restoration techniques available is necessary to select the best option for the individual patient/knee/lesion noting that there is overlap of techniques' applications. In addition, failure to address and correct associated comorbidities may jeopardize the outcome of any cartilage restoration procedure. That is, the key to achieving optimal outcomes with PF cartilage restoration is to select the best cartilage treatment for the particular setting and to concomitantly optimize the PF biomechanical environment and stability.
髌股关节（PF）疼痛是膝前疼痛的一种类型，由于其病因多因素，诊断颇具挑战性。在这一群体中，将患者症状归因于髌股关节软骨损伤是间接的；也就是说，由于透明软骨无神经支配，只能通过排除法进行诊断。此外，这些髌股关节区域的损伤常伴有多种合并症，例如，对线不良和/或不稳定。鉴于这些因素以及髌股关节区域的高剪切力和压缩应力，髌骨和滑车软骨损伤需要与胫股关节区域不同的治疗考量。要为个体患者/膝关节/损伤选择最佳方案，就必须全面了解现有的各种软骨修复技术，要注意技术应用存在重叠。此外，未能处理和纠正相关合并症可能会危及任何软骨修复手术的结果。也就是说，实现髌股关节软骨修复最佳效果的关键在于为特定情况选择最佳的软骨治疗方法，并同时优化髌股关节的生物力学环境和稳定性。
