Management of chondral ‘kissing’ lesion of patella and trochlea

• 34 y.o. man, orthopaedic surgeon, strong pain when standing and sitting for a long period of time
• ext : 0°/ flex: 120° , Lachman +, Steinman negative med and lat, Varus and valgus stress test + in 30 °, patellar grind test positive (VAS 8/10), J sign negative
• No infection signs
• No skin suffering 
• Normal muscle strength

How would you classify this lesion according to the ICRS classification?

• ✔️Grade IV

^{Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002 Sep;18(7):730-4. doi: 10.1053/jars.2002.32839. PMID: 12209430.}

How would you manage this condition?

• ✔️Cartillage reconstruction with TTO

Final strategy decision

• Arthroscopy - taking healthy cartilage from the notch and preparing it for the defects using Autocart method (Arthrex ®)
• Lateral approach to the knee joint and TT<
• Debridement of the defects and filling with prepared cartilage
• Pure anteriorization of the TT to remove pressure of the PF joint and allow cartilage to heal

Clinical presentation 8 months post op

• No pain when standing, little pain when sitting for a long period of time (VAS 1/10)
• ext : 0°/ flex: 120° , Lachman +, Steinman negative med and lat, Varus and valgus stress test + in 30°, patellar grind test negative, J sign negative
• No infection signs
• No skin suffering 
• Weaker vastus medialis strength