Knee Cartilage Patellofemoral Injuries

Cartilage injuries of the patellofemoral joint present a difficult challenge owing to the unique anatomy and high shear forces. Active duty military personnel commonly present with cartilage injuries of the patella and trochlea owing to acute trauma or chronic repetitive injury. The initial treatment for patellofemoral chondral injury is nonoperative modalities to include: rest, activity modification, anti-inflammatory medication, and physical therapy. Physical therapy predominantly focuses on strengthening the vastus medialis obliquus to improve patellofemoral alignment. Reconstructive cartilage procedures like fresh osteochondral allograft transplant and autologous chondrocyte implantation are used to restore articular congruity and minimize symptoms when nonoperative modalities and common first-line reparative techniques fail. Although there is currently no evidencebased algorithm for the management of cartilage lesions of the patellofemoral joint, there are trends in treatment that help guide the surgeon. The successful outcome of treatment for cartilage lesions depends on recognizing and addressing concomitant pathology with proximal or distal realignment and patellar unloading procedures. Outcomes also depend on appropriate patient selection with his/her commitment to an extended period of rehabilitation and the ability to modify their activities. The active duty patient does not always have the ability to participate in an extended period of rehabilitation and must be treated with the best treatment option that allows an effective return to duty. Therefore, the purpose of this article is to review the standard treatment options for chondral lesions of the patellofemoral joint and our preferred treatment options in the active duty patient.