Objectives

For a long time lateral release (LR) was performed as a standard procedure both, for patellofemoral pain syndrome (PFPS) and patellofemoral instability (PFI). However, recent biomechanical studies have shown that LR is not useful for decreasing the lateral force onto the patella, but is increasing not only medial but also lateral PFI. Furthermore, pain on palpation over the lateral patellofemoral joint space can result in patients treated with extensive LR. We postulate that in case of persistent PFI or PFPS after failed LR the reconstruction of the lateral retinaculum as an addition of the reconstruction of the medial patellofemoral ligament (MPFL) is necessary in terms of decreasing medial PFI as well as lateral pain.

Introduction Osteochondral autologous transplantation (OATS) is a technique to treat hyaline cartilage injuries in different joints. It delivers high quality hyaline cartilage to the defect.

Methods In a prospective study we used the OATS technique in 201 patients (125 male, 76 female). The mean defect size was 3.3 sq cm. The medial femoral condyle was treated in 96 cases, the lateral femoral condyle in 16, the patella in 22, the trochlea in seven, the tibial plateau in one, the talus in 48, the tibial plafond in two and the capitellum in four. There were 17 other locations. The procedure was performed either open or arthroscopically. A mean of 2.2 cylinders were implanted. Mal-alignment was corrected in 20 cases with an osteotomy and instability of the knee by anterior (ACL) or posterior (PCL) reconstruction. Five patients required reconstruction of both the ACL and PCL.

Results The Lysholm score increased from 58.3 (20 to 77) to a mean of 90.2 (70 to 100) in the lower extremity. Treatment by OATS alone increased the score from 65.2 to 91.6. With additional ACL/PCL reconstruction, the score increased from 49.9 to 82.6. The combination of OATS, HTO and ACL/PCL reconstruction increased the Lysholm score from 55.5 to 85.5. Post-operative MR imaging with intravenous contrast showed incorporation of all but one cylinder. Complications included one case of arthrofibrosis and sinking of one cylinder. One patient developed regional pain syndrome and three had pain at the malleolar osteotomy site resolved by screw removal. Ten percent of the patients developed pain at the donor site.

Conclusions The results are encouraging. It is a cost effective and safe treatment.