Cartilage restoration procedures in patellofemoral stabilization

Patellar instability and dislocation events are often associated with chondral injury to the patellofemoral joint. Patients may present with swelling, anterior knee pain, and mechanical symptoms. Clinical evaluation should include a detailed history, assessment of standing and rotational alignment, and radiographic and advanced imaging. Operative intervention for treating instability includes soft tissue reconstruction, trochleoplasty, and osteotomies, as both soft tissue and bony pathoanatomic factors contribute to patellar maltracking. Cartilage injury in the setting of patellofemoral instability offers a unique challenge for orthopedic surgeons given the biocomplexity of the patellofemoral joint. We seek to provide a review of various treatments and therapies that can be used in the management of patellofemoral chondral injuries. A comprehensive literature review was conducted, exploring interventions such as cell-based therapies, orthobiologics, and osteochondral-based approaches. Defect size, location, and patient age, and activity level contribute to surgical decision-making. Smaller defects in lower demand patients can be addressed with more cost-effective, minimally invasive procedures like chondroplasty and microfracture. Larger, full-thickness cartilage defects not affecting the subchondral bone can be addressed with cell-based therapies, which, despite being costly, are the most common procedures used to treat patellofemoral chondral injury. Full-thickness cartilage defects with osteochondral involvement are best treated with osteochondral-based approaches. In this article, we highlight a variety of techniques, their indications, and potential risks and benefits.