Articular Cartilage Restoration in the Patella: Greater Precision With Arthroscope-Assisted Grafts

Osteochondral allografting is a well-established, durable treatment option for focal patellar cartilage defects, particularly in young, active patients with symptomatic grade 3 and 4 lesions. Clinical outcomes show success rates of 77% to 87% when grafts are accurately placed and properly integrated. Precise cartilage-to-graft congruity is critical, as malalignment may lead to persistent pain, graft failure, or cartilage degeneration. Arthroscope-assisted techniques enhance visual accuracy, improving fit and load distribution while reducing the risk of prominent or unstable grafts.

The procedure was indicated in a young female patient with a symptomatic grade 4 osteochondral defect of the patella that had failed nonoperative management. No concomitant realignment or osteotomy was required.

Through a medial parapatellar approach, the patella was everted, and multiple full-thickness defects were identified on the medial and lateral facets. The degenerated cartilage was debrided, and the recipient sites were precisely measured and prepared (6-8 mm diameter, 8 mm depth). Using arthroscopic assistance, osteochondral plugs were harvested from the flattest portion of the donor condyle with careful axial alignment. Each graft was inserted under direct arthroscopic visualization, ensuring a flush, congruent surface with surrounding native cartilage. Multiple grafts were placed sequentially, guided by enhanced visualization to avoid prominence and optimize contour matching.

Intraoperative assessment confirmed stable fixation and optimal surface congruence of all grafts. Arthroscopic visualization enabled correction of subtle irregularities that may not be palpable through open techniques. Rehabilitation was initiated early to prevent arthrofibrosis, with partial weightbearing maintained for 4 weeks, followed by a progressive recovery program emphasizing mobility, strength, and endurance.

Arthroscope-assisted patellar osteochondral grafting provides enhanced accuracy in graft placement and alignment, potentially improving integration and long-term outcomes. This technique is particularly valuable for achieving flush, congruent reconstruction in patients with isolated patellar chondral lesions. Early mobilization and structured rehabilitation are essential for optimizing functional recovery and reducing the risk of complications, such as stiffness, pain, or poor graft incorporation.

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