Abstract
High-grade chondral injuries in the setting of patellar instability are a challenging
problem for patients and surgeons. In patients undergoing autologous chondrocyte implantation
(ACI) to address cartilage defects, medial patellofemoral ligament (MPFL) reconstruction
with or without tibial tubercle osteotomy (TTO) is one option to both treat patellar
instability and repair and offload defects. The primary aim of this case series was
to describe return to activity, reoperation rates, and instances of recurrent patellar
instability after medial patellofemoral ligament reconstruction with ACI with or without
TTO. We also discuss reoperation rates among patients with multiple cartilage defects
in comparison to those with single cartilage defects. A retrospective chart review
from 2010 to 2022 identified patients with patellar instability who underwent concurrent
MPFL reconstruction and cartilage restoration at a single academic institution. Data
regarding patient demographics, cartilage defect location and size, concomitant procedures,
return to activity data, and repeat surgery risk were collected. Review identified
14 patients who underwent cartilage restoration and MPFL reconstruction, including
11 who underwent a concomitant TTO. Clinical follow-up was 2.68 years. All patients
returned to activity with a mean time of 13.7 months. There were no instances of graft
delamination or persistent symptoms necessitating arthroplasty. One patient underwent
a second surgery on the index knee for tibial tubercle hardware removal. Cartilage
restoration with patellar stabilization surgery may be effective for addressing high-grade
cartilage defects associated with patellar instability.
Keywords
knee - articular cartilage - knee - patella - knee - osteotomy - growth factors -
healing enhancement
