Operative treatment of deep chondral defects of the patella: results after abrasive arthroplasty and periosteal arthroplasty.
This prospective, non-randomized study was aimed to evaluate the effects of abrasive arthroplasty and periosteal arthroplasty in the treatment of deep chondral defects of the patella. A total of 30 patients in group A (13 male, 17 female, age: 28.7+/-6.9 years) underwent arthroscopic abrasive arthroplasty. The other patients in group B (n=17, 11 male, 8 female, age 26.8+/-7.0 years) underwent periosteal arthroplasty by an autologous periosteal flap. The maximal diameter of the defects was 31.1+/-6.7 (range 20-45 mm). The Lysholm score and the intensity of pain were evaluated preoperatively and at the time of follow-up (3.1+/-1.1, range 2-5 years). The Tegner activity score was evaluated before onset of the symptoms and at the time of follow-up. The Lysholm score increased significantly in both groups (in group a from 36.1+/-7.1 to 42.5+/-6.6 points and in group B from 42.7+/-2.4 to 67.6+/-7.8 points). The result in group B was significantly better than in group A. In group A the intensity of pain was unchanged, whereas patients from group B reported a significant reduction of pain. The level of physical activity (Tegner score) was 5.5+/-2.1 in group A and 5.5+/-2.1 in group B before onset of the complaints. In follow-up, patients from group B (4.9+/-1.2) had a reduced Tegner score in tendency. The patients in group A had a significantly reduced level of physical activity (2.7+/-0.6). A total of 12 patients from group B had a range of motion lesser than 80 degrees in flexion. These patients underwent joint mobilization and control arthroscopy. During control arthroscopy there was always found a stable periosteal flap. Short-term clinical results with periosteal arthroplasty produced a significant reduction in pain and improved Lysholm score in comparison to abrasive arthroplasty.
Spahn
Gunter
G
Clinic of Traumatology and Orthopaedic Surgery, Sophienstrasse 16, 99817 Eisenach, Germany. Spahn@pk-eisenach.de
Kirschbaum
Stefan
S
D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D046789:Chondromalacia Patellae / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010521:Periosteum / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome
Clin Orthop Relat Res. 1985 Sep;(198):43-9
4028566
Knee Surg Sports Traumatol Arthrosc. 1998;6(4):202-8
9826800
Knee Surg Sports Traumatol Arthrosc. 1997;5(3):168-75
9335029
Arthroscopy. 1986;2(1):51-3
3954839
Clin Orthop Relat Res. 2000 May;(374):212-34
10818982
Arthroscopy. 2002 Feb;18(2):151-5
11830808
N Engl J Med. 2002 Jul 11;347(2):81-8
12110735
Arthroscopy. 2001 Mar;17(3):307-310
11239353
J Bone Joint Surg Br. 1961 Nov;43-B:752-7
14038135
Knee Surg Sports Traumatol Arthrosc. 1999;7(4):232-8
10462213
Clin Orthop Relat Res. 1990 Apr;(253):197-202
2317974
Clin Sports Med. 1997 Jan;16(1):17-28
9012559
Arch Orthop Trauma Surg. 2001 May;121(5):248-53
11409552
Arthroscopy. 1999 Mar;15(2):142-6
10210070
J Bone Joint Surg Br. 1978 Feb;60(1):74-81
627583
Arthroscopy. 2002 Feb;18(2):190-3
11830814
Pain. 1983 Sep;17(1):45-56
6226917
Am J Sports Med. 1982 May-Jun;10 (3):150-4
6896798
Unfallchirurg. 2000 Nov;103(11):999-1002
11142891