Mestriner Alexandre Barbieri, Ackermann Jakob, Gomoll Andreas H
Cartilage Repair Center, Department of Orthopaedic Surgery, Harvard Medical School, Brigham and Women's Hospital, 850 Boylston Street, Suite 120, Chestnut Hill, MA, 02467, USA.
Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil.
Curr Rev Musculoskelet Med. 2018 Jun;11(2):188-200. doi: 10.1007/s12178-018-9474-3.
This review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces.
Recent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients. While autologous chondrocyte implantation shows good and excellent outcomes for chondral lesions, osteochondral defects are adequately addressed with osteochondral allograft transplantation. In case of patellar malalignment, concomitant tibial tubercle osteotomy can significantly improve outcomes. Particulated cartilage and bone marrow aspirate concentrate are potential new alternative treatments for cartilage repair, currently in early clinical studies. Due to the frequency of concomitant anatomic abnormalities in the PFJ, a thorough clinical examination combined with careful indication for each procedure in each individual patient combined with meticulous surgical technique is central to achieve satisfying outcomes. Additional comparative studies of cartilage repair procedures, as well as investigation of newer techniques, are needed.
本综述概述了用于髌股关节（PFJ）软骨缺损的成熟和新开发的软骨修复技术。将提出一种算法，用于考虑髌骨和滑车关节面的独特解剖结构来处理软骨缺损。
近期关于PFJ软骨修复的研究表明，在试图延迟或避免关节置换需求以及改善年轻患者症状方面取得了更好的结果。虽然自体软骨细胞植入对软骨损伤显示出良好和优异的效果，但骨软骨缺损可通过骨软骨异体移植得到充分处理。在髌骨排列不齐的情况下，同时进行胫骨结节截骨术可显著改善结果。颗粒状软骨和骨髓抽吸浓缩物是目前处于早期临床研究阶段的软骨修复潜在新替代疗法。由于PFJ中伴随解剖异常的频率，全面的临床检查、结合对每个患者每种手术的仔细适应症评估以及细致的手术技术是取得满意结果的关键。需要对软骨修复程序进行更多的比较研究以及对新技术进行研究。
