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.
The decision rule here is simple: when patellar chondral pathology is confined to one facet and the rest of the knee is normal, facetectomy of that facet gives over 90% excellent results. The author's broader argument is diagnostic. Identify correctable malalignment early using the Q angle, patella alta on Blumensaat's line, a shallow groove, and a positive apprehension test.
Realign the extensor mechanism (lateral release, medial imbrication, tibial tubercle transfer) before the patella is damaged, because degenerative cases do far worse than malacic or traumatic ones. Remember the treatment ladder and match the procedure to the pathology, not the reverse: laissez faire, shaving, trephining and drilling, facetectomy, patellectomy, replacement.
One durable pearl for patellectomy: approximate quadriceps to patellar tendon to avoid extension lag, which is worse tolerated than an equivalent extension contracture. This is an old opinion-driven review with no arthroscopic follow-up to confirm cartilage fill, so weight the outcome numbers accordingly.
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.
The decision rule here is simple: when patellar chondral pathology is confined to one facet and the rest of the knee is normal, facetectomy of that facet gives over 90% excellent results. The author's broader argument is diagnostic. Identify correctable malalignment early using the Q angle, patella alta on Blumensaat's line, a shallow groove, and a positive apprehension test.
Realign the extensor mechanism (lateral release, medial imbrication, tibial tubercle transfer) before the patella is damaged, because degenerative cases do far worse than malacic or traumatic ones. Remember the treatment ladder and match the procedure to the pathology, not the reverse: laissez faire, shaving, trephining and drilling, facetectomy, patellectomy, replacement.
One durable pearl for patellectomy: approximate quadriceps to patellar tendon to avoid extension lag, which is worse tolerated than an equivalent extension contracture. This is an old opinion-driven review with no arthroscopic follow-up to confirm cartilage fill, so weight the outcome numbers accordingly.