Brophy Robert H, Wojahn Robert D, Lamplot Joseph D
From Washington University Orthopedics, Chesterfield, MO (Dr. Brophy) and Washington University Orthopedics, Washington University in St. Louis, St. Louis, MO (Dr. Wojahn and Dr. Lamplot).
J Am Acad Orthop Surg. 2017 May;25(5):321-329. doi: 10.5435/JAAOS-D-15-00447.
Symptomatic osteochondral lesions of the patellofemoral joint are clinically challenging to manage because of the limited healing potential of articular cartilage; the complex morphology of the patellofemoral joint; the heterogeneity of the articular surface between patients; and high stresses across the joint, which can be altered by malalignment, tilt, or maltracking. Indications for surgery include traumatic lesions, osteochondritis dissecans, and high-grade chondromalacia in association with persistent pain despite a course of nonsurgical management. Various techniques have been described for managing symptomatic osteochondral lesions of the patellofemoral joint, including microfracture, osteochondral autograft transplantation, and biologic cell transplantation, including autologous chondrocyte implantation. Salvage techniques (eg, fresh allograft) may provide satisfactory outcomes after a failed attempt at surgical management. Irrespective of the surgical technique used, outcomes are generally worse in the patellofemoral compartment than in the tibiofemoral joint. The concomitant management of associated pathology, including patellar malalignment, is recommended because it has been shown to improve the success of cartilage restoration procedures.
髌股关节有症状的骨软骨损伤在临床上处理起来具有挑战性，这是因为关节软骨的愈合潜力有限；髌股关节形态复杂；患者之间关节表面存在异质性；以及关节上的高应力，而这种应力会因对线不良、倾斜或轨迹异常而改变。手术指征包括创伤性损伤、剥脱性骨软骨炎以及尽管经过非手术治疗仍伴有持续疼痛的高级别软骨软化症。已经描述了多种用于处理髌股关节有症状的骨软骨损伤的技术，包括微骨折、骨软骨自体移植以及生物细胞移植，其中包括自体软骨细胞植入。补救技术（如新鲜同种异体移植）在手术治疗尝试失败后可能会提供令人满意的结果。无论使用何种手术技术，髌股关节间隙的治疗结果通常都比胫股关节差。建议同时处理相关病变，包括髌骨对线不良，因为已证明这可以提高软骨修复手术的成功率。
