Systematic review on conservative and surgical treatment in patellar chondromalacia

Abstract

Patellar chondromalacea, also called patellofemoral pain, is a chronic disorder common to adults, affecting the knee, presenting as pain around or behind the patella during exertion activities in this joint. Conservative treatment consists of the use of medications such as common analgesics, opioids, non-steroidal anti-inflammatories and corticosteroids, as well as chondroprotectors (chondroitin sulfate and glycosamamine sulfate), physiotherapy (which include several techniques) and body weight loss. In the surgical treatment, the most used techniques are microfracture, mosaicoplasty, chondroplasty, transference (autologous and allograft) of chondrocytes. The objective of this work is to verify the most used and most effective techniques in the treatment of patellar chondromalacia, after a systematic review of the literature. The searches were carried out in the bibliographic databases, Pubmed, Scielo, VHL. After applying inclusion and exclusion criteria, 28 articles were selected. The parameters such as score, lesion area, mean age, total number of patients, men and women and their respective treatments were highlighted. Then, the conservative and surgical treatments were separated in the number of publication by technique. It was observed that the autologous implant of chondrocytes was the technique most present in the articles, the general mean age of the patients was 41.67 years, the Lyshom scores and the International Knee Documentation Committee (IKDC) were the most used in studies with Significant improvement in all studies, the total number of patients was 2035, with 1046 men and 920 women undergoing treatment. Conservative treatment should be the first choice and, in the case of failure, the surgical techniques are chosen. The autologous implant of chondrocytes (IAC) is the technique currently most cited and most used. The patient should be analyzed in an individualized way regarding the parameters of age, area of injury, site of injury and depth, and can be benefited both from conservative and surgical treatments; Therefore, further studies are needed to determine a better technique.