Patellar Cartilage Bossing Causing Patellofemoral Pain After Cartilage Repair With Hyalofast® Scaffold and Bone Marrow Aspirate Concentrate (BMAC)

Chondral lesions of the knee are common orthopedic issues encountered in daily practice. Hyalofast(®) (Anika Therapeutics, Bedford, Massachusetts) grafting with bone marrow aspirate concentrate (BMAC) has been shown, in numerous studies, to be clinically efficacious in the surgical treatment of these lesions. We describe a case of chondral lesions in the knee initially successfully treated with arthroscopic chondroplasty and Hyalofast(®) grafting with BMAC, but who subsequently developed patellar cartilage bossing, causing anterior patellofemoral joint pain eight months after surgery. A 48-year-old gentleman underwent arthroscopic chondroplasty and mini-open cartilage repair with Hyalofast(®) and BMAC after presenting with right knee pain and swelling affecting his ability to participate in sports. His initial recovery was unremarkable, but he subsequently developed anterior knee pain exacerbated by stair climbing and jogging eight months after the initial surgery. Magnetic resonance imaging revealed bossing of the Hyalofast(®) graft over the central patella, and intraoperative testing confirmed the impingement. The patient’s symptoms resolved immediately following arthroscopic debridement. While Hyalofast(®) grafting and BMAC remain viable options in the treatment of chondral lesions in the knee, the inability to predict the amount of cartilage repair and recovery may result in pain and impingement symptoms, and surgeons should be aware of such possible complications.