Introduction
Materials and methods
Search details
Inclusion and exclusion criteria
Search strategy
Study quality
Data extraction and analysis
Statistical analysis
Results
Search results and study design
Authors (year)/journal | Study design/LOE/MINORS | Cases (N) | Age (years) mean | FU (months) mean | Study groups | Patellar cartilage defect size mean (cm2) | Technique |
---|---|---|---|---|---|---|---|
Akgün, Akpolat [2] J Orthop Surg | Retrospective cohort LOE 4/MINORS 13/16 | 14 | 29.7 | 44.4 | No | 1.32 | AOT |
Astur et al. [5] J Bone Joint Surg Am | Prospective cohort LOE 4/MINORS 16/16 | 33 | 37.6 | 30.2 (median) | No | n.i | AOT |
Astur et al. [6] Knee Surg Sports Traumatol Arthrosc | Prospective cohort LOE 4/MINORS 14/16 | 20 | 26–45 (range) | 24 | No | 1.16 | AOT |
Biant et al. [8] Am J Sports Med | Prospective cohort LOE 4/MINORS 16/16 | 36 | 29.7 | > 120 | Subgroup patella | 4.49 | ACI-C (85x) |
ACI-P (19x) | |||||||
Bouwmester et al. [9] J Orthop Res | Prospective comparative LOE 2/MINORS 16/24 | 10 | 28.9 (SD 7.8) | 132.2 (SD 57.4) | Perichondrium Tx | 2.8 | Perichondrium Tx |
Debridement + drilling | Debridement + drilling | ||||||
Chadli et al. [11] Int Orthop | Retrospective cohort LOE 4/MINORS 11/16 | 8 | 15.0 | 28.6 | No | 0.97 | Autologous osteochondral mosaicplasty |
Cohen et al. [13] Rev Bras Ortop | Prospective cohort LOE 4/MINORS 12/16 | 17 | 38.1 (SD 13.4) | 19.8 | No | n.i | AOT |
Figueroa et al. [19] Knee | Prospective cohort LOE 4/MINORS 15/16 | 10 | 20.2 | 37.3 | No | 1.2 | AOT |
Filardo et al. [20] Am J Sports Med | Prospective comparative LOE 2/MINORS 23/24 | 28 | 29.3 (SD 8.9) | 60 | Patella (28) | All: 3.0 | MACI |
Trochlea (17) | Patella: 2.8 | ||||||
Both (4) | |||||||
Gaweda et al. [22] Int Orthop | Retrospective comparative LOE 3/MINORS 18/24 | Group 1: 19 | Group 1: 25.5 | 24 | Group 1: realignment | All: > 1 | AOT |
Group 2: 30 | Group 2: 21.7 | Group 2: realignment + AOT | |||||
Gigante et al. [23] Knee Surg Sports Traumatol Arthrosc | Prospective cohort LOE 4/MINORS 15/16 | 14 | 31 (median) | 36 | No | 4 (median) | MACI |
Gillogly et al. [24] Am J Sports Med | Retrospective cohort LOE 4/MINORS 12/16 | 25 | 31.0 (SD 7.0) | 90.7 (SD 27.6) | No | 6.4 | ACI-P |
Gobbi et al. [26] Am J Sports Med | Prospective cohort LOE 4/MINORS 15/16 | 22 | 30.5 | 24 | No | 4.7 | MACI |
Gomoll et al. [27] Am J Sports Med | Prospective cohort LOE 4/MINORS 13/16 | 110 | 33.0 (SD 10.1) | 90 (SD 31.7) | No | 5.4 | ACI-P |
Gracitelli et al. [28] Am J Sports Med | Retrospective cohort LOE 4/MINORS 12/16 | 28 | 33.7 | 116.4 (SD 7.5) | No | 10.1 | OCA |
Hangody et al. [29] Am J Sports Med | Prospective cohort LOE 4/MINORS 11/16 | 18 | 24.0 | 115.2 | No | 2.4 | Mosaicplasty |
Henderson, Lavigne [31] Knee | Retrospective comparative LOE 3/MINORS 23/24 | Group A: 22 | Group A: 32.1 | Group A: 26.2 | Group A: with realignment | Group A: 2.92 | ACI-P |
Group B: 22 | Group B: 25.1 | Group B: 28.9 | Group B: no realignment | Group B: 3.22 | |||
Joshi et al. [35] Am J Sports Med | Prospective cohort LOE 4/MINORS 14/16 | 10 | 33.3 | 24 | No | 2.64 | TruFit (synthetic osteochondral scaffold plug) |
Kreuz et al. [38] Osteoarthritis Cartilage | Retrospective cohort LOE 4/MINORS 13/16 | 18 | 28.4 (SD 8.8) | 36 | No | 5.7 | ACI-P |
Kreuz et al. [37] Am J Sports Med | Prospective cohort LOE 4/MINORS 15/16 | 13 | 35.2 (SD 10.7) | 48 | No | 4.69 | ACI (BioSeed-C) |
Kusano et al. [39] Knee Surg Sports Traumatol Arthrosc | Retrospective cohort LOE 4/MINORS 14/16 | 20 | 39.2 (SD 2.8) | 29.3 (SD 2.3) | No | 4.4 | AMIC |
Macmull et al. [42] Int Orthop | Retrospectve comparative LOE 4/MINORS 19/24 | 48 | 34.8 | 40.3 | Group 1: ACI-C (25) | Group 1: 4.73 | MACI |
Group 2: MACI (23) | Group 2: 4.76 | ACI-C | |||||
Minas and Bryant [45] Clin Orthop Relat Res | Prospective cohort LOE 4/MINORS 14/16 | 8 | 35.0 | 47.5 | No | 4.34 | ACI-P |
Nho et al. [47] Am J Sports Med | Retrospective cohort LOE 4/MINORS 15/16 | 22 | 30.0 (SD 12.0) | 28.7 | No | 1.6 | AOT |
Niemeyer et al.[ 49] Arch Orthop Trauma Surg | Restrospective cohort LOE 4/MINORS 12/16 | 70 | 34.3 (SD 10.1) | 38.4 (SD 15.6) | ACI-P | 4.41 | ACI-P |
ACI-C | ACI-C | ||||||
MACI | MACI | ||||||
Niemeyer et al. [48] Arch Orthop Trauma Surg | Retrospective comparative LOE 3/MINORS 22/24 | 45 | 33.5 (SD 8.88) | 60 | 45 Patella | 5.4 | MACI |
28 Fem. condyle | |||||||
Perdisa et al. [52] Am J Sports Med | Prospective cohort LOE 4/MINORS 14/16 | 34 | 30.0 (SD 10.0) | 24 | No | 2.1 | Cell-free biphasic collagen-hydroxy apatite osteo-chondral scaffold |
Peterson et al. [55] Am J Sports Med | Retrospective cohort LOE 4/MINORS 10/16 | 34 | 34.0 | 153.6 | No | 6.1 | ACI-P |
Sadlik et al. [57] J Knee Surg | Prosepective cohort LOE 4/MINORS 13/16 | 12 | 36.0 | 38 | No | 2.5 | AMIC |
Spahn, Kirschbaum [65] Knee Surg Sports Traumatol Arthrosc | Retrospective comparative LOE 4/MINORS 20/24 | 42 | Group A: | Group A: | Group A: | Group A: 31.4 (diameter mean, mm) | Abrasive arthroplasty |
27.3 | 38.4 | Abrasive | Periostal arthroplasty | ||||
(SD 6.6) | (SD 1.0) | arthroplasty (25) | |||||
Group B: | Group B: | Group B: | Group B: 30.6 (diameter mean, mm) | ||||
25.7 | 37.3 | Periostal | |||||
(SD 6.5) | (SD 1.1) | arthroplasty (17) | |||||
Teo et al. [69] Clin Orthop Relat Res | Retrospective cohort LOE 4/MINORS 12/16 | 23 | 16.8 | 72 | No | n.i | ACI-P (20x) BMSCs implantation with periost patch (3x) |
Visona et al. [73] Orthop Traumatol Surg Res | Retrospective cohort LOE 4/MINORS 12/16 | 6 | 20.5 (SD 9.2) | 26 | No | 0.88 | Mosaicplasty |
von Keudell et al. [74] Cartilage | Prospective cohort LOE 4/MINORS 14/16 | 30 | 32.0 (SD 10.0) | 88 | No | 4.7 | ACI-P, ACI-C |
Yonetani et al. [76] J Orthop Case Rep | Retrospective cohort LOE 4/MINORS 14/16 | 6 | 38.0 (SD 8.0) | 51 | No | 1.24 | AOT |
Isolated cartilage repair
Authors (year)/journal | Inclusion criteria | Exclusion criteria | PROMS | p value | ||
---|---|---|---|---|---|---|
Score | preop (mean) | postop (mean) | ||||
Akgün, Akpolat [2] J Orthop Surg | Age 18–55 years, defect size > 0.8 cm2, osteochondral lesion patella, symptoms > 6 months | Alignment problems (patellar height, varus-valgus), chondral lesion < 0.8 cm2 | VPS | 75.5 | 17.57 | p < 0.01 |
Lysholm | 44.57 | 80 | p < 0.01 | |||
Kujala | 48.21 | 78.42 | p < 0.01 | |||
Astur et al. [5] J Bone Joint Surg Am | Age < 60 years, anterior knee pain, patellar chondral lesion, grade 3 or 4, diameter 1–2.5 cm | Diameter < 1 and > 2.5 cm, patella tilt, patella alta or baja, TTTG > 15 mm, ACL injury, meniscal tear, infection, systemic inflammatory disease | Lysholm | 57.27 | 80.76 | p < 0.05 |
Fulkerson | 54.24 | 80.42 | p < 0.05 | |||
Kujala | 54.76 | 75.18 | p < 0.05 | |||
SF-36 | see study details | |||||
Astur et al. [6] Knee Surg Sports Traumatol Arthrosc | Age < 45 years, traumatic injury, patellar chondral lesion, grade 3 or 4, diameter 1–2.5 cm | Diameter < 1 and > 2.5 cm, patella tilt, patella alta or baja, TTTG > 15 mm, ACL injury, meniscal tear | VAS | 7.1 | 2.4 | p < 0.05 |
Tegner | n.i | |||||
Kujala | 44.9 | 76.9 | p < 0.001 | |||
Biant et al. [8] Am J Sports Med | Symptomatic isolated cartilage defect | Limb malalignment, ligament deficiency, osteoarthritis, inflammatory arthritis, defect depth > 5 mm | Mod. Cincinnati knee score | 40 | 79 | n.i |
Stanmore/Bentley score | 3 | 1.3 | ||||
VAS | 6.4 | 2 | ||||
Bouwmester et al. [9] J Orthop Res | Age < 40 years, no previous drilling, isolated defect | Osteoarthritis > grade 2 | HSSS | 80.8 | 92.2 | n.i |
VAS walk | 1.8 | |||||
VAS rest | 0.9 | |||||
Chadli et al. [11] Int Orthop | Clinical symptoms: pain, crepitus, hydarthrosis, locking, MRI: OCD grade 3 or 4 | n.i | IKDC | 49.9 | 86.1 | p < 0.001 |
Lysholm | 53.8 | 88.5 | p < 0.001 | |||
Tegner | 4.5 | 6.2 | p = 0.02 | |||
Figueroa et al. [19] Knee | Age < 45 years, patellar chondral lesion grade 4, defect size < 2.5 cm2 | Multiligamentous lesions, concomitant ACL-reconstruction, other cartilage lesions than patella, defect size > 2.5 cm2 | Lysholm | 73.8 | 95 | p < 0.05 |
IKDC | na | 95 | ||||
Joshi et al. [35] Am J Sports Med | Patellofemoral pain, full-thickness patellar cartilage defect | Age < 15 years and > 50 years, patellofemoral malalignment (> 10° tilt), tibiofemoral malalignment (> 10°), chondral lesions other location than patella | KOOS | 64.7 | 69.9 | n.i |
VAS | 7.9 | 6.9 | ||||
SF-36 | n.i | 61.3 | ||||
Kreuz et al. [38] Osteoarthritis Cartilage | ACI-P for outerbridge grade 3 or 4 defects | Acute trauma, varus or valgus malalignment > 5°, limits in knee extension, limits in knee flexion < 130°, patellofemoral malalignment with med. or lat.l shift > 5 mm, ACL- or MCL instability, Meniscal pathologies, I.a. corticosteorid injections < 1 month | Cincinnati score patella | 3.67 | 2.22 | p < 0.05 |
ICRS score patella | 3.72 | 2.5 | p < 0.05 | |||
Macmull et al.[42] Int Orthop | Chondral or osteochondral defect secondary to chondro-malacia patellae | n.i | VAS all | 6.42 | 4.5 | p < 0.001 |
VAS Group 1 | 6.32 | 5 | p = 0.017 | |||
VAS Group 2 | 6.52 | 3.96 | p < 0.001 | |||
Mod. Cinc. score all | 45.13 | 54.81 | p = 0.01 | |||
Mod. Cinc. score Group 1 | 42.12 | 48.76 | n.s | |||
Mod. Cinc. score Group 2 | 48.39 | 61.39 | p < 0.001 | |||
Bentley all | 2.92 | 2.27 | p < 0.001 | |||
Bentley Group 1 | 3.04 | 2.44 | p = 0.013 | |||
Bentley Group 2 | 2.78 | 2.09 | p < 0.001 | |||
Niemeyer et al. [49] Arch Orthop Trauma Surg | Retropatellar cartilaginous damage | Trochlea dysplasia, varus or valgus deformity > 5° | Cincinnati sports activity | 34.44 | 61.5 | p < 0.001 |
Lysholm | n.i | 73 | ||||
IKDC | n.i | 62 | ||||
Niemeyer et al. [48] Arch Orthop Trauma Surg | Age 18–50 years, isolated, chondral or osteo-chondral defects ICRS 3 or 4, defects size 4–10 cm2 after debridement, OCD with max depth 6 mm | Radiological signs of osteoarthritis, valgus or varus malalignment > 5°, previous treatment with ACI, and many more | KOOS overall patella | 54.6 | 82.6 | p = 0.0099 |
KOOS Pain Patella | 61.2 | 88.3 | p < 0.001 | |||
KOOS Symptoms patella | 69.9 | 87.6 | p < 0.001 | |||
KOOS ADL patella | 71.4 | 91.4 | p < 0.001 | |||
KOOS Sport patella | 43.1 | 76 | p < 0.001 | |||
KOOS QOL patella | 28.1 | 70.6 | p < 0.001 | |||
Peterson et al. [53] Am J Sports Med | Chondral lesion outerbridge grade 3 or 4, severe symptoms, poor results according to clinical grading system of Brittberg et al | n.i | Cincinnati patella | 1.6 | 6.6 | p < 0.001 |
Brittberg VAS patella | 68.1 | 27.8 | p < 0.001 | |||
Tegner–Wallgren patella | 5.5 | 8.8 | p < 0.001 | |||
Spahn, Kirschbaum [65] Knee Surg Sports Traumatol Arthrosc | Cartilage defect patella Outer-bridge grade 3 or 4 | Patellar malalignment, residual complaints after patella fracture or patella dislocation | Lysholm Group A | 36.1 | 42.5 | p < 0.05 |
Lysholm Group B | 42.7 | 67.6 | p < 0.05 | |||
Tegner Group A | 5.5 | 2.7 | p < 0.05 | |||
Tegner Group B | 5.5 | 4.9 | n.s | |||
VAS Group A | 80.4 | 84.4 | n.s | |||
VAS Group B | 73.4 | 25.9 | p < 0.05 | |||
Yonetani et al. [76] J Orthop Case Rep | Focal patellar cartilage defect, normal patellofemoral alignment, failure of conservative treatment > 6 months | n.i | Lysholm | 67 | 90 | n.i |
Concomitant surgeries
Authors (year)/journal | Concomitant surgeries | Indications for concomitant surgery | PROMS | p value | ||
---|---|---|---|---|---|---|
Score | preop (mean) | postop (mean) | ||||
Cohen et al. [13] Rev Bras Ortop | MPFL reconstruction (1x), Lat. release (6x) | Traumatic patellar dislocation, excessive lat. patellar tilt | Lysholm | 54.59 | 75.76 | p < 0.05 |
Fulkerson | 52.53 | 78.41 | p < 0.05 | |||
Kujala | 49.82 | 73.47 | p < 0.05 | |||
SF-36 | see study details | see study details | ||||
Filardo et al. [20] Am J Sports Med | Lat. release (13x) HTO (6x) | n.i | IKDC | 36.2 | 69.7 | IKDC with sig. improvement |
Kujala | na | 81.5 | ||||
EQ-VAS | na | 81.9 | ||||
Tegner | Improvement: 3.9 | |||||
Gaweda et al. [22] Int Orthop | Combination of proximal (lat release, VMO transfer) and distal (TTO) extensor realignment | Recurrent patellar dislocation or subluxation | Marchall score | 36.3 | 46.2 | Mean score improved faster than in the control group |
Gigante et al. [23] Knee Surg Sports Traumatol Arthrosc | TTO | Type 2 patellofemoral malalignment according to Fulkerson, TTTG > 20 mm | Kujala | 52 | 88.5 | p = 0.001 |
Lysholm | 55 | 92.5 | p = 0.001 | |||
Tegner | 1 | 4 | p = 0.001 | |||
Mod. Cincinnati rating scale | 2 | 8 | p = 0.001 | |||
Gillogly et al. [24] Am J Sports Med | TTO (25x), trochleoplasty (4x), Lat. release (25x), Med. imbrication or reefing | Failure to centralise patella in the trochlea by > 45°, increased Q-angle, arthroscop. lat. patellar maltracking, Recurr. dislocations, flat or convex trochlear entrance, increased patellar tilt, patients with excessive laxity | Mod. Cincinnati rating scale | 3 | 7 | p < 0.0001 |
Lysholm | 40.2 | 79.3 | p < 0.0001 | |||
IKDC | 42.5 | 75.7 | p < 0.0001 | |||
SF-12 PCS | 41.2 | 47.6 | p = 0.002 | |||
SF-12 MCS | 48.1 | 60.7 | p = 0.0001 | |||
Gobbi et al. [25] Am J Sports Med | Patellofemoral realignment (2x), Lat. release (3x), meniscectomy (3x), | n.i | IKDC | 43.2 | 73.6 | p < 0.0001 |
Gomoll et al. [27] Am J Sports Med | TTO (75x), Lat. release (45x), trochleaplasty (5x), Vastus med. advancement (22x), MPFL-reconstruction (1x) | History of patellar instability, Patellar maltracking, TTTG > 15 mm, large, uncontained or bipolar defects, decreased patellar mobility, trochleadysplasia | SF-12 PCS | 38.6 | 44.1 | p = 0.001 |
SF-12 MCS | 49.7 | 53.5 | n.s | |||
IKDC | 40.2 | 69.4 | p < 0.0001 | |||
Mod. Cincinnati knee score | 3.2 | 6.2 | p < 0.0001 | |||
WOMAC | 50.4 | 29.6 | p < 0.0001 | |||
KSS Knee | 61.8 | 85.2 | p < 0.0001 | |||
KSS Function | 58.5 | 72.7 | p < 0.0001 | |||
Gracitelli et al. [28] Am J Sports Med | Lat. release (7x), Vastus med. imbrication (1x), TTO + MPFL-reconstruction (3x), TTO only (3x) | Sign. malalignment or instability of PFJ in physical examination | Merle d’Aubigne-Postel score | 12 | 15.2 | p = 0.003 |
IKDC | 36.5 | 66.5 | p = 0.003 | |||
KS-F | 64.6 | 80.5 | p = 0.003 | |||
Hangody et al. [29] Am J Sports Med | Lat. release (11x), TTO (3x), meniscus resection (2x) | n.i | HSSS | 57 | 71 | n.s |
Henderson et al. [31] Knee | Group A: Lat. release + TTO + MPFL tensioning (22x) | Lateralisation of the patella during first 45° of flexion | IKDC all | 42.3 | 68.1 | p < 0.006 |
Mod Cincinnati score all | 3.4 | 6.5 | p < 0.05 | |||
Cincinnati Group A | Improvement.: 4.46 | Group A better (p < 0.001) | ||||
Group B: ACI-P only | Cincinnati Group B | Improvement.: 1.73 | ||||
IKDC Group A | Improvement.: 36.2 | Group A better (p < 0.05) | ||||
IKDC Group B | Improvement.: 22.3 | |||||
Kreuz et al. [37] Am J Sports Med | Patella balancing (2x), HTO (10x), microfracturing of secondary lesions (5x), subchondral bone grafting (2x), ACL-reconstruction (6x) | Med. or lat. shift > 5 mm, varus/valgus malalignment > 5° | ICRS patella | 4 | 2.1 | n.i |
IKDC patella | 44.1 | 68.2 | ||||
KOOS pain patella | 62.4 | 75.2 | ||||
KOOS symptoms patella | 70.8 | 73.3 | ||||
KOOS ADL patella | 67.8 | 81.5 | ||||
KOOS sport patella | 11.2 | 52.7 | ||||
KOOS QOL patella | 29.5 | 54.4 | ||||
Lysholm | 51.2 | 78.2 | ||||
Kusano et al. [39] Knee Surg Sports Traumatol Arthrosc | TTO + lat. release (18x) | Patellar maltracking | IKDC patella | 51 | 74 | p = 0.0025 |
Lysholm patella | 58 | 85 | p < 0.0001 | |||
Tegner patella | 3 | 4 | n.s | |||
VAS patella | 6 | 2 | p = 0.0004 | |||
Minas et al. [45] Clin Orthop Relat Res | TTO + lat. release (5x) | Patellofemoral malalignment (patellar subluxation or tilt) | SF-36 PCS patella | 32.84 | 40.06 | p = 0.02 |
SF-36 MCS patella | 45.1 | 43.99 | n.s | |||
KSS patella | 47.13 | 71.88 | p = 0.01 | |||
KSS function patella | 49.38 | 70.63 | p = 0.01 | |||
WOMAC patella | 56.75 | 34.88 | p = 0.02 | |||
Mod. Cincinnati score patella | 3.63 | 5.13 | p = 0.03 | |||
Nho et al. [47] Am J Sports Med | Lat. release (13x), TTO (9x), proximal realignment (3x) | Patellofemoral malalignment, surgeons preference | IKDC all | 47.2 | 74.4 | p = 0.028 |
ADL all | 60.1 | 84.7 | p = 0.022 | |||
SF-36 all | 64 | 79.4 | n.s | |||
IKDC (AOT + TTO) | 54.3 | 64.9 | n.s | |||
ADL (AOT + TTO) | 66 | 81.6 | n.s | |||
SF-36 (AOT + TTO) | 64.7 | 70.7 | n.s | |||
Perdisa et al. [52] Am J Sports Med | TTO (9x), Lat. release (1x), MPFL-reconstruction (1x), removal of calcifications (3x), MAT (1x), patellar tendon repair (1x) | n.i | IKDC | 39.5 | 67.6 | p < 0.001 |
Tegner | 1.8 | 3.3 | p < 0.001 | |||
Peterson et al. [55] Am J Sports Med | TTO, med. soft-tissue plication, lat release + trochleaplasty (21x), TO, med. soft-tissue plication, lat. release (7x) Med. soft-tissue plication + trochleaplasty (1x) Lat. release + trochleaplasty (1x) HTO (2x) | Patellofemoral malalignment | Lysholm patella | 69 | 66 | n.s |
Tegner–Wallgren patella | 7.4 | 8.1 | n.s | |||
KOOS pain patella | n.i | 69.7 | ||||
KOOS symptoms patella | n.i | 67.5 | ||||
KOOS ADL patella | n.i | 81.3 | ||||
KOOS sports patella | n.i | 41.1 | ||||
KOSS QOL patella | n.i | 48.2 | ||||
Mod. Cincinnati patella | n.i | 5.1 | ||||
Brittberg–Peterson patella | 50.1 | 49.2 | n.s | |||
Sadlik et al. [57] J Knee Surg | TTO (2x), MPFL (2x), HTO (1x) | n.i | KOOS | 50.3 | 90.1 | p < 0.01 |
IKDC | 37.4 | 79.4 | p < 0.01 | |||
VAS | 7.8 | 2.3 | p < 0.01 | |||
Teo et al. [69] Clin Orthop Relat Res | TTO (Elmslie–Trillat) (4x), Roux–Goldthwaite (2x) | Increased TTTG > 15 mm and/or increased patellar tilt > 20° | IKDC | 45 | 75 | p < 0.001 |
Lysholm | 50 | 70 | p < 0.001 | |||
Tegner | 2.5 | 4 | p < 0.001 | |||
Visona et al. [73] Orthop Traumatol Surg Res | Sectioning of the patellar retinaculum (2x), TTO + MPFL-reconstruction (1x) | n.i | IKDC | 37.2 | 66.3 | n.i |
Lysholm | 58.3 | 85 | ||||
Tegner | 3.5 | 5.7 | ||||
von Keudell et al. [74] Cartilage | TTO + soft-tissue balancing (19x), Lat. subvastus release (28x), VMO advancement (23x), TTO + trochleaplasty + proximal soft-tissue balancing (5x) | Lat. maltracking, patellar instability, TTTG > 15 mm, hypoplastic trochlea | SF-36 PCS | 40 | 47 | p = 0.01 |
SF-36 MCS | 47 | 53 | p = 0.02 | |||
KSS function | 55.7 | 73 | p < 0.01 | |||
KSS pain | 63.9 | 81.8 | p < 0.01 | |||
WOMAC | 52.2 | 27.9 | p < 0.01 | |||
Mod. Cincinnati rating scale | 3.1 | 5.7 | p < 0.01 |