Treatment outcome after patellar re-alignment by one-stage correction of the axis of the knee extensor and mosaicplasty of the patellofemoral joint.

Background. Patellar misalignment is often accompanied by damage to the chondral surface of the patello-femoral joint. The goal of surgical treatment is to address the primary cause by correcting the axis of knee flexion. In the Orthopedics and Traumatology Clinic in Lublin, Poland, we repair damaged cartilage and align the knee extensor in a one-stage operation. The goal of the present study is to compare the course of recovery and outcome in patients operated for recurrent patellar dislocation, in whom chondral damage in the patello-femoral joint is discovered intraoperatively. Material and methods. In a prospective experiment, 14 patients treated in our clinic from 2001 to 2003 were evaluated. The axis of the knee extensor was corrected both proximally and peripherally. Third- or fourth-degree chondral damage according to the ICRS scale was repaired by mosaicplasty. Outcome was evaluated by systematic assessment using the Marshall scale. The control group consisted of patients in whom only realignment was performed due to the absence of chondral damage. Results. Recovery was slower after combined treatment than in the control group. Two years post-operatively the functional outcomes in both groups were comparable, with no statistically significant differences. Conclusions. The treatment method described here gives reason to hope for long-term remediation of patellar misalignment, and removes the effects of earlier abnormalities. After 2 years, the functional outcome after repair to patello-femoral articular cartilage combined with patellar realignment are comparable to those achieved in patients not requiring repair of articular cartilage during patellar realignment.