Chondroplasty for isolated medial patellar facet cartilage lesions demonstrates no difference in clinical outcomes compared to a matched cohort of patients without patellofemoral chondral pathology in the setting of medial patellofemoral ligament reconstruction.

Abstract

To determine whether chondroplasty for isolated medial patellar facet lesions produces similar clinical outcomes compared to patients without patellofemoral cartilage lesions in the setting of medial patellofemoral ligament (MPFL) reconstruction for patellar instability. We retrospectively identified patients who underwent MPFL reconstruction with or without tibial tubercle osteotomy (TTO) from 2015 to 2020 with minimum 2-year follow-up. Operative reports detailed patellofemoral articular surfaces and Outerbridge grade. Exclusion criteria were: prior knee surgery, multiple lesions, concomitant cartilage repair, trochleoplasty, or meniscus repair. Patients with isolated medial facet lesions (case) were propensity matched to patients without patellofemoral cartilage injury (control) by age, sex, BMI, and concomitant TTO. Clinical outcomes were evaluated using the Kujala score, Tegner activity scale, and the Visual Analog Score (VAS) for pain. Of 79 eligible patients, 59 (74.7%) completed all surveys, and 40 patients (8 M and 32 F) were matched 1:1 with mean 4.1-year (range: 2.1-8.5) follow-up, including 20 patients with medial facet lesions (5 grade II, 6 grade III, and 9 grade IV). There were no significant differences between groups with respect to Kujala score (85.2 vs 84.6, p = 0.906), Tegner (5.7 ± 2.6 vs 4.9 ± 3.0, p = 0.924), or VAS pain score (12.4 ± 20.1 vs 16.5 ± 23.9, p = 0.718). Chondral lesion size at the index procedure was not significantly correlated with pain (R = - 0.06, p = 0.816) or Kujala score (R = - 0.67, p = 0.779). Chondroplasty for isolated medial patellar facet lesions led to similar clinical outcomes to patients with intact patellofemoral articular cartilage at a minimum of 2 years following MPFL reconstruction. These findings support conservative management of isolated medial facet lesions without need for cartilage restoration procedures. Retrospective comparative cohort study.