Acute chondral injuries of the patellofemoral joint

Patients with acute chondral injuries of the patellofemoral joint often complain of pain and catching in the knee.Physical exam may reproduce this pain with patellofemoral compression. Further history and physical examination should elicit the cause and location of these lesions. The peripatellar soft tissue, which may contribute to patellofemoral joint injury, should be assessed with measurement of the Q-angle, medial and lateral patellar glide, and patellar tilt. Radiographic analysis, including plain films, computed tomography scan, and magnetic resonance imaging may help in the diagnosis of these injuries. Arthroscopic evaluation precisely defines chondral lesions of the patellofemoral joint. When visualization is difficult, alternate portals should be created. Treatment of these lesions includes microfracture technique or debridement depending on their location, size, and character. If patellar instability or malalignment contributes to the pathology, a patellar stability repair or realignment procedure should be performed in conjunction with treatment of the articular lesion. An algorithm is presented to assist in planning the treatment for injuries to the patellofemoral joint. A detailed history and physical examination, logical use of imaging techniques, and a thorough arthroscopic evaluation enhances accurate decision making about the treatment of these disorders.