37. Dr. Cassandra Lee: Patellofemoral Cartilage Injuries Part II

On each episode, we chat about the most recent developments in sports medicine with experts from around the country. In this episode, we’re going to continue our discussion with Dr. Cassandra Lee and chat more about osteochondral allograft transplantation and tibial tubercle osteotomy.

From the October 2020 issue of Cartilage, we start with the publication titled “Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea.” David DeWitt and colleagues at Kaiser Permanente Southern California prospectively followed 18 patients who underwent fresh osteochondral allograft transplantation of the patella and trochlea with an average follow up of 33 months. 

All patients had graft survival at final follow up with no revisions and no conversion to arthroplasty. All clinical outcome scores – including KOOS, IKDC, SANE and VAS – significantly improved from pre-op. We finish up our conversation with a focus on realignment osteotomies to augment cartilage restoration procedures for the patellofemoral joint, referencing an infographic from the 2019 issue of Arthroscopy titled “Optimizing Patellofemoral Cartilage Restoration and Instability With Tibial Tubercle Osteotomy.” The authors explain that the specific type of TTO depends on the pathology being treated, with four subgroups identified. In the absence of patellar instability, distal lateral patellar lesions are treated well with an isolated anteromedializing TTO while medial, central and/or panpatellar cartilage lesions are best treated with combined anteromedializing TTO and cartilage restoration as well.
 
Patients with patellar instability require soft tissue stabilization, i.e. an MPFL reconstruction, and either a medializing TTO for those with lateralized tubercle position or a distalizing TTO for those with patella alta. Did you get all of that? Well, if you didn’t don’t worry. We have a nice graphic from this article on our Instagram – the sportsdocspod.