PURPOSE: The purpose of this review was to determine if there is an ideal operation for large symptomatic articular cartilage lesions on the undersurface of the patella in young patients. METHODS: A systematic search of PubMed was conducted to determine the outcome of operations performed for large patellar lesions in young patients. Inclusionary criteria were English language, original clinical trials published from 1992 to 2012, patellar lesions 4 cm(2) or larger, mean patient age 50 years or younger, and all evidence levels. RESULTS: Of 991 articles identified, 18 met the inclusionary criteria, encompassing 840 knees in 828 patients. These included 613 knees that underwent autologous chondrocyte implantation (ACI) (11 studies), 193 knees that had patellofemoral arthroplasty (PFA) (5 studies), and 34 knees that underwent osteochondral allografting (OA) (2 studies). The mean patient age was 37.2 years and the mean follow-up was 6.2 years. Long-term follow-up (>10 years) was available in only 4 studies (2 PFA, 1 ACI, 1 OA). All studies except one were Level IV and none were randomized or had a control group. Twenty-one outcome instruments were used to determine knee function. When taking into account knees that either failed or had fair/poor function, the percentage of patients who failed to achieve a benefit averaged 22% after PFA and 53% after OA and ranged from 8% to 60% after ACI. In addition, all 3 procedures had unacceptable complication and reoperation rates. CONCLUSIONS: The combination of failure rates and fair/poor results indicated that all 3 procedures had unpredictable results. We concluded that a long-term beneficial effect might not occur in one of 3 ACI and PFA procedures and in 2 of 3 OA procedures. We were unable to determine an ideal surgical procedure to treat large symptomatic patellar lesions in patients 50 years or younger. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.
PURPOSE: The purpose of this review was to determine if there is an ideal operation for large symptomatic articular cartilage lesions on the undersurface of the patella in young patients. METHODS: A systematic search of PubMed was conducted to determine the outcome of operations performed for large patellar lesions in young patients. Inclusionary criteria were English language, original clinical trials published from 1992 to 2012, patellar lesions 4 cm(2) or larger, mean patient age 50 years or younger, and all evidence levels. RESULTS: Of 991 articles identified, 18 met the inclusionary criteria, encompassing 840 knees in 828 patients. These included 613 knees that underwent autologous chondrocyte implantation (ACI) (11 studies), 193 knees that had patellofemoral arthroplasty (PFA) (5 studies), and 34 knees that underwent osteochondral allografting (OA) (2 studies). The mean patient age was 37.2 years and the mean follow-up was 6.2 years. Long-term follow-up (>10 years) was available in only 4 studies (2 PFA, 1 ACI, 1 OA). All studies except one were Level IV and none were randomized or had a control group. Twenty-one outcome instruments were used to determine knee function. When taking into account knees that either failed or had fair/poor function, the percentage of patients who failed to achieve a benefit averaged 22% after PFA and 53% after OA and ranged from 8% to 60% after ACI. In addition, all 3 procedures had unacceptable complication and reoperation rates. CONCLUSIONS: The combination of failure rates and fair/poor results indicated that all 3 procedures had unpredictable results. We concluded that a long-term beneficial effect might not occur in one of 3 ACI and PFA procedures and in 2 of 3 OA procedures. We were unable to determine an ideal surgical procedure to treat large symptomatic patellar lesions in patients 50 years or younger. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.
Authors: Ryan M Degen; Nathan W Coleman; Danielle Tetreault; Brenda Chang; Greg T Mahony; Christopher L Camp; Shawn G Anthony; Riley J Williams Journal: Cartilage Date: 2016-08-24 Impact factor: 4.634
Authors: Renato Andrade; Joni Nunes; Betina B Hinckel; Jordan Gruskay; Sebastiano Vasta; Ricardo Bastos; J Miguel Oliveira; Rui L Reis; Andreas H Gomoll; João Espregueira-Mendes Journal: Cartilage Date: 2019-12-17 Impact factor: 3.117
Authors: Eric J Cotter; David R Christian; Rachel M Frank; Eildar Abyar; Dillen Wischmeier; Adam B Yanke; Jack Farr; Brian J Cole Journal: Arthrosc Sports Med Rehabil Date: 2019-09-26