Redondo Michael L, Beer Adam J, Yanke Adam B
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Knee Surg. 2018 Mar;31(3):231-238. doi: 10.1055/s-0037-1618592. Epub 2018 Feb 2.
The treatment of patellofemoral cartilage defects presents several distinct challenges when compared with cartilage restoration techniques used for other compartments of the knee due to the unique anatomy and distribution of forces. The etiologies of patellofemoral articular cartilage lesions include acute traumatic instability injuries, such as dislocation and subluxation, osteochondritis dissecans, and chronic degenerative changes. Regardless of the etiology, untreated patellofemoral cartilage lesions can contribute to activity-limiting anterior knee pain. The goal of patellofemoral cartilage restoration procedures is to impart symptomatic relief and improve quality of life by repairing the articular cartilage surface and any comorbid malalignment or maltracking.Microfracture and osteochondral autograft transplantation (OAT) are two cartilage restoration procedures to consider when treating full-thickness patellofemoral chondral defects. Considered by some experts to be the gold standard therapy, microfracture is one of the most common procedures used for cartilage restoration. The technique involves the perforation of the subchondral bone plate for the release of marrow elements, filling the defect with a fibrocartilage clot repair. Though less commonly used, OAT allows defect replacement with native hyaline cartilage via autologous transplantation from a non-weight bearing area. The purpose of this article is to discuss the indication, technical considerations, and outcomes of microfracture and OAT when used for treating chondral lesions of the patellofemoral joint.
与用于膝关节其他部位的软骨修复技术相比，由于独特的解剖结构和力的分布，髌股关节软骨缺损的治疗存在几个明显的挑战。髌股关节软骨损伤的病因包括急性创伤性不稳定损伤，如脱位和半脱位、剥脱性骨软骨炎以及慢性退行性改变。无论病因如何，未经治疗的髌股关节软骨损伤都会导致限制活动的膝前疼痛。髌股关节软骨修复手术的目标是通过修复关节软骨表面以及任何合并的排列不齐或轨迹不良来缓解症状并提高生活质量。微骨折和自体骨软骨移植（OAT）是治疗全层髌股关节软骨缺损时可考虑的两种软骨修复手术。微骨折被一些专家视为金标准疗法，是最常用于软骨修复的手术之一。该技术包括穿透软骨下骨板以释放骨髓成分，用纤维软骨凝块修复填充缺损。虽然OAT使用较少，但它可以通过从非负重区域进行自体移植，用天然透明软骨替代缺损。本文的目的是讨论微骨折和OAT用于治疗髌股关节软骨损伤时的适应症、技术要点和结果。
