Cartilage defects of the femoral trochlea.

Despite improvements in the ability to detect articular cartilage defects of the trochlea, determining the significance of these lesions remains difficult. Physical examination and history taking remain the best way to estimate the clinical impact of these lesions. Debridement and/or microfracture are often initial surgical interventions; these procedures can be expected to provide functional improvement in over 50%, but studies suggest that the amount of improvement deteriorates within 3 years. While initial reports on ACI and osteochondral allografts in the treatment of trochlear defects appear to be more promising solutions, long-term follow-up studies are lacking. Similarly, the effect of tibial tubercle osteotomy combined with cartilage restoration techniques remains unresolved. Nonetheless, based on the limited available evidence, ACI or osteochondral allografts combined with a tibial tubercle osteotomy when appropriate have provided the most durable treatment for these difficult-to-treat lesions.