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Cartilage resurfacing, anteromedialization, or both for patella cartilage lesions?
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Determining the best surgical option can be difficult when dealing with symptomatic focal patella cartilage lesions. Distal realignment, or anteromedialization, can be used to unload patella cartilage lesions with or without cartilage resurfacing. Anteromedialization has been shown to decrease distal and lateral patellofemoral contact pressure. The key to surgical planning is to know the location of the lesion and the tibial tubercle–trochlear groove distance.
We recommend an isolated anteromedialization tubercle osteotomy for lateral patella lesions. If the tibial tubercle–trochlear groove (TT-TG) is greater than 15 mm, then a standard anteromedialization is performed. If the TT-TG is less than 15 mm, the osteotomy should be made steeper to shift the tubercle more anterior than medial. For central and medial patella lesions, we recommend both cartilage resurfacing and an unloading anteromedialization tubercle osteotomy.
To read the full Patellofemoral Update blog from Matthew Bollier, MD, click here.