O'Donoghue, Am J Sports Med 1981 - Treatment of Chondral Damage to the Patella

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Treatment of Chondral Damage to the Patella

O'Donoghue·Am J Sports Med·1981·16 citations·Review article

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This is a narrative treatment review and opinion piece on managing chondral damage to the patella. O'Donoghue lays out a treatment ladder from observation through shaving, drilling, facetectomy, patellectomy, and replacement. The central message is diagnostic: find correctable malalignment and operate before cartilage damage becomes unsalvageable.

Key Findings

Facetectomy confined to a single medial or lateral facet gives over 90% excellent results when the rest of the knee is normal. This is the paper's core claim across 289 cases since 1970, with 125 having pathology confined to the patella.
In the earlier 60-case series, cases of malacia or trauma confined to one facet had 85% excellent and 15% good results with no poor outcomes. Degenerative arthritic cases fared worse because the underlying arthritis persists even after pain relief.
Up to one-third of the patella (a full medial or lateral facet) can be removed while preserving normal function, provided normal cartilage remains on the rest of the patella. The central facet is never resected.
Facetectomy allows rehabilitation on par with meniscectomy, with weightbearing on the first postoperative day. This is its main advantage over patellectomy, which requires prolonged immobilization.
Trephining and drilling uses vertical-walled excision down to subchondral bone, then drilling roughly 12 holes per square centimeter. The rationale is that cartilage refills from the base of the defect upward.
After patellectomy, the quadriceps tendon is approximated directly to the patellar tendon to prevent extension lag, which causes the knee to give way with every step.
Prosthetic patellar replacement was abandoned because rigid metal or polyethylene wears out the trochlear groove, and later revision leaves denuded bone that tracks tendons poorly.

Board PearlFor patellar chondromalacia confined to one facet in an otherwise normal knee, facetectomy gives over 90% excellent results — operate before the whole patella is lost.

Treatment of Chondral Damage to the Patella.

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Treatment of Chondral Damage to the Patella

O'Donoghue·Am J Sports Med·1981·16 citations·Review article

|

This is a narrative treatment review and opinion piece on managing chondral damage to the patella. O'Donoghue lays out a treatment ladder from observation through shaving, drilling, facetectomy, patellectomy, and replacement. The central message is diagnostic: find correctable malalignment and operate before cartilage damage becomes unsalvageable.

Key Findings

Facetectomy confined to a single medial or lateral facet gives over 90% excellent results when the rest of the knee is normal. This is the paper's core claim across 289 cases since 1970, with 125 having pathology confined to the patella.
In the earlier 60-case series, cases of malacia or trauma confined to one facet had 85% excellent and 15% good results with no poor outcomes. Degenerative arthritic cases fared worse because the underlying arthritis persists even after pain relief.
Up to one-third of the patella (a full medial or lateral facet) can be removed while preserving normal function, provided normal cartilage remains on the rest of the patella. The central facet is never resected.
Facetectomy allows rehabilitation on par with meniscectomy, with weightbearing on the first postoperative day. This is its main advantage over patellectomy, which requires prolonged immobilization.
Trephining and drilling uses vertical-walled excision down to subchondral bone, then drilling roughly 12 holes per square centimeter. The rationale is that cartilage refills from the base of the defect upward.
After patellectomy, the quadriceps tendon is approximated directly to the patellar tendon to prevent extension lag, which causes the knee to give way with every step.
Prosthetic patellar replacement was abandoned because rigid metal or polyethylene wears out the trochlear groove, and later revision leaves denuded bone that tracks tendons poorly.

Board PearlFor patellar chondromalacia confined to one facet in an otherwise normal knee, facetectomy gives over 90% excellent results — operate before the whole patella is lost.

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