Patellofemoral Joint Preservation: Cartilage Restoration, Unloading, and Avoiding Complications

Patellofemoral (PF) chondral lesions are a common source of knee pain and disability, typically arising from traumatic (instability/fracture) or degenerative (overload) etiologies. This review synthesizes contemporary evidence on PF joint preservation with an emphasis on avoiding complications. We highlight the importance of defining lesion characteristics and identifying the primary mechanical driver(s) of chondral injury. We then summarize current and emerging cartilage restoration options. Finally, we emphasize that durable outcomes often require concomitant biomechanical optimization through mechanical unloading and soft tissue balancing. Collectively, this review aims to support informed surgical decision-making and maximize long-term survival of the PF joint.