The treatment of patellofemoral cartilage defects presents several distinct challenges when compared with cartilage restoration techniques used for other compartments of the knee due to the unique anatomy and distribution of forces. The etiologies of patellofemoral articular cartilage lesions include acute traumatic instability injuries, such as dislocation and subluxation, osteochondritis dissecans, and chronic degenerative changes. Regardless of the etiology, untreated patellofemoral cartilage lesions can contribute to activity-limiting anterior knee pain. The goal of patellofemoral cartilage restoration procedures is to impart symptomatic relief and improve quality of life by repairing the articular cartilage surface and any comorbid malalignment or maltracking.Microfracture and osteochondral autograft transplantation (OAT) are two cartilage restoration procedures to consider when treating full-thickness patellofemoral chondral defects. Considered by some experts to be the gold standard therapy, microfracture is one of the most common procedures used for cartilage restoration. The technique involves the perforation of the subchondral bone plate for the release of marrow elements, filling the defect with a fibrocartilage clot repair. Though less commonly used, OAT allows defect replacement with native hyaline cartilage via autologous transplantation from a non-weight bearing area. The purpose of this article is to discuss the indication, technical considerations, and outcomes of microfracture and OAT when used for treating chondral lesions of the patellofemoral joint.

Purpose: To define the minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient‐acceptable symptomatic state (PASS) for patient‐reported outcome measures (PROMs) after medial patellofemoral ligament reconstruction (MPFLR) and to investigate the role of preoperative, demographic, and intraoperative variables for predicting achievement of these thresholds. Methods: This retrospective cohort study used a prospectively maintained database of patients undergoing primary MPFLR between August 2015 and December 2019. PROMs included the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS joint replacement (JR), and Kujala. Anchor‐based and distribution‐based methods were used to calculate the MCID, SCB, and PASS. Regression analyses were performed to identify prognosticators for achievement of clinically significant thresholds. Results: 139 patients met inclusion criteria (mean age: 21.7± 8.2 years). At 6 months, the MCID values were 8.3 (KOOS‐Pain) and 8.5/13.5 (Kujala); SCB values were 1.4 (KOOS‐Pain) and 43.7 (KOOS‐QOL); and PASS values were 64.9 (IKDC), 83.3 (KOOS‐Symptom), 76.8 (KOOS‐Pain), 91.2 (KOOS‐ADL), 47.5 (KOOS‐Sport), 40.6 (KOOS‐QOL), and 78.1 (KOOS‐JR). At 1 year, the MCID values were 4.2 (KOOS‐Pain), 7.2 (KOOS‐ADL), 12.4 (KOOS‐QOL) and 25.2 (KOOS‐JR); SCB were 23.6 (IKDC), 4.2 (KOOS‐Symptom), 19.7 (KOOS‐Pain), 6.5 (KOOS‐ADL), 55.0 (KOOS‐Sport), 6.3 (KOOS‐QOL), and 19.6/25.2 (KOOS‐JR); and PASS were 65.5 (IKDC), 80.4 (KOOS‐Symptom), 84.7 (KOOS‐Pain), 99.3 (KOOS‐ADL), 57.5 (KOOS‐Sport), 53.1 (KOOS‐QOL), and 76.3 (KOOS‐JR). In regression analysis, greater age, body mass index, and preoperative PROMs were negative prognosticators for achieving clinically significant thresholds. Conversely, male gender increased the likelihood of achieving PASS for Kujala at 6 months and KOOS‐ADL at 1 year. Conclusions: This study established thresholds for the MCID, SCB, and PASS at 6 months and 1 year after MPFLR, providing physicians an evidence‐based method to advise patients and assess outcomes with this surgery. Older patients and those with higher preoperative outcome scores are less likely to report improvement and satisfaction with MPFLR, while male patients are more likely to report some satisfaction. Level of Evidence: Level III, retrospective cohort study (diagnosis).