PATELLOFEMORAL INSTABILITY PART 3 (PATELLOFEMORAL CARTILAGE TREATMENT): STATE OF THE ART.

Cartilage lesions around the knee are common injuries in the orthopedic practice. The spontaneous healing capacity of the articular cartilage is limited, and therefore surgical intervention may be necessary. The goal is to improve patients' symptoms, articular functionality, and potentially delay the progression of knee osteoarthritis. Extensive knowledge is available regarding the efficacy of cartilage restoration procedures for tibiofemoral chondral and osteochondral lesions; however, evidence on patellofemoral surgery remains more limited and controversial. The complex biomechanics and morphology of the patellofemoral joint represents a challenge in the setting of knee cartilage surgery and, as a result, inferior outcomes have been reported when compared to treatment of condylar lesions. Furthermore, patellofemoral cartilage restoration can be combined with procedures such as a tibial tuberosity osteotomy and/or other realigning osteotomies when pathological deformities are present. Finally, when the aforementioned strategies fail or when severe osteoarthritis develops, and preservation procedures are contra-indicated, arthroplasty and other options can be considered. This state-of-the-art review aims to critically examine the current concepts of conservative and surgical treatment of patellofemoral cartilage lesions, reporting the latest clinical evidence and describing potential future perspectives in this field.