Biologic resurfacing of the patella: current status

The desire to relieve pain by restoring the articular surface of the patella altered by trauma, mechanical disorders, or disease, has remote origins. Like cartilage of all the diarthroses, the only intrinsic rudimentary potential that it has to repair itself lies in the disruption and exposition of the vascular subchondral bone. This event leads to the formation of fibrous connective tissue or fibrocartilage, whose organization is mechanically insufficient to withstand compression and shearing forces. The recent demonstration that articular chondrocytes dedifferentiate in tissue cultures suggests, however, that the cells retain the capacity to multiply and produce collagen and proteoglycans similar to those of the hyaline cartilage. This discovery has created new therapeutic possibilities. The purpose of this article is to analyze past and present methods, that have been studied in the surgical treatment of osteochondral defects of the patellofemoral joint to achieve clinical benefit, to slow arthritic changes, and to regain the integrity and function of the patella (ie, avoid patellectomy and prosthetic resurfacing).