PDF herunterladen
J Knee Surg 2023; 36(08): 894-899
DOI: 10.1055/s-0042-1744222
Original Article

Chronic Osteochondral Fractures of the Patella Managed with Open Reduction and Internal Fixation Yields Excellent Knee Function

Ravi Mittal
1   Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
,
Vijay K. Digge 
1   Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
,
Tushar Nayak 
1   Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Currently, the management of acute osteochondral fractures (OCFs) of the patella is well established. However, the management of chronic OCFs remains debatable, as it is not clear whether such lesions can be accurately reduced or whether they will reliably heal. With well proven results of open reduction and internal fixation (ORIF) with headless compression screws (HCS) for acute OCFs, the application of this technique in late presenting cases is inconclusive. Thus, we present the clinicoradiological outcome of patients with chronic osteochondral injuries managed with ORIF. Fifteen patients who underwent surgical fixation by ORIF with HCS for chronic OCFs of the patella, between February 2013 and June 2018, were retrospectively analyzed after a mean follow-up of 3.8 years (range: 2–7 years). The mode of injury, size of the osteochondral fragment, and knee range of motion along with Kujala's scoring were examined clinically and radiological assessment was done by X-rays and magnetic resonance imaging (MRI) scans. Fifteen patients (11 males and 4 females), with a mean age of 17 years with chronic OCF of patella were enrolled. Noncontact twisting injuries were the most common mode of injury seen in 86.66% of patients and postcontact injuries in two patients (13.33%). The mean time from trauma to presentation was 7 weeks (range: 6–14 weeks). The mean preoperative Kujala's score improved from 44 to 84.8 at 6 months and 92.6 at 2 years, postoperatively. Intraoperatively, the lesion was found in medial patellar facet in 12 patients and 3 had lesions in the central facet. The mean size of the lesion was 20 mm × 18 mm. Radiological union was observed in all patients, at a mean duration of 16 weeks (range: 12–20 weeks). One patient underwent implant removal 1 year after initial surgery for mechanical symptoms. ORIF of OCFs of the patella using headless cannulated screws is simple, reliable, reproducible, and provides satisfactory outcomes. This technique can be considered for fixation of fragments with adequate subchondral bone.

Keywords

chronic patellar OCF - osteochondral fracture - knee - patella - ORIF - HCS


Publikationsverlauf

Eingereicht: 15. Oktober 2020

Angenommen: 25. Januar 2022

Artikel online veröffentlicht:
18. April 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Li Z-X, Song H-H, Wang Q, Guo D-M. Clinical outcomes after absorbable suture fixation of patellar osteochondral fracture following patellar dislocation. Ann Transl Med 2019; 7 (08) 173
    CrossrefPubMedGoogle Scholar
  • 2 Song SY, Kim T-S, Seo Y-J. Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation. BMC Musculoskelet Disord 2020; 21 (01) 617
    CrossrefPubMedGoogle Scholar
  • 3 Lee BJ, Christino MA, Daniels AH, Hulstyn MJ, Eberson CP. Adolescent patellar osteochondral fracture following patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2013; 21 (08) 1856-1861
    CrossrefPubMedGoogle Scholar
  • 4 Kühle J, Angele P, Balcarek P. et al. Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. Int Orthop 2013; 37 (12) 2385-2394
    CrossrefPubMedGoogle Scholar
  • 5 Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986; 14 (02) 117-120
    CrossrefPubMedGoogle Scholar
  • 6 Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy 2003; 19 (07) 717-721
    CrossrefPubMedGoogle Scholar
  • 7 Hsu TL, Lin SM, Chang CH, Lan TY. Neglected pediatric osteochondral fracture dislocation of the patella. Case Rep Orthoped 2019; 2019: 2904782
    PubMedGoogle Scholar
  • 8 McMahon S, Rajkumar SS. Surgical management of delayed presentation of osteochondral knee injuries in adolescents-case series and literature review. 2016; DOI: 10.19080/OROAJ.2016.03.555607.
    CrossrefPubMedGoogle Scholar
  • 9 Unal M, Tatari H. The largest osteochondral fracture of patella, case report. Austin J Orthopade Rheumatol 2014; 1 (01) 2
    PubMedGoogle Scholar
  • 10 Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 11 Seeley MA, Knesek M, Vanderhave KL. Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop 2013; 33 (05) 511-518
    CrossrefPubMedGoogle Scholar
  • 12 Chotel F, Knorr G, Simian E, Dubrana F, Versier G. French Arthroscopy Society. Knee osteochondral fractures in skeletally immature patients: French multicenter study. Orthop Traumatol Surg Res 2011; 97 (Suppl 8): S154-S159
    CrossrefPubMedGoogle Scholar
  • 13 Callewier A, Monsaert A, Lamraski G. Lateral femoral condyle osteochondral fracture combined to patellar dislocation: a case report. Orthop Traumatol Surg Res 2009; 95 (01) 85-88
    CrossrefPubMedGoogle Scholar
  • 14 Mashoof AA, Scholl MD, Lahav A, Greis PE, Burks RT. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy 2005; 21 (02) 228-232
    CrossrefPubMedGoogle Scholar
  • 15 Hiemstra LA, Kerslake S, Lafave M, Mohtadi NG. Concurrent validation of the Banff patella instability instrument to the Norwich patellar instability score and the kujala score in patients with patellofemoral instability. Orthop J Sports Med 2016; 4 (05) 2325967116646085
    CrossrefPubMedGoogle Scholar
  • 16 Buckwalter JA, Brown TD. Joint injury, repair, and remodeling: roles in post-traumatic osteoarthritis. Clin Orthop Relat Res 2004; (423) 7-16
    CrossrefPubMedGoogle Scholar
  • 17 Rae PS, Khasawneh ZM. Herbert screw fixation of osteochondral fractures of the patella. Injury 1988; 19 (02) 116-119
    CrossrefPubMedGoogle Scholar
  • 18 Vogel LA, Fitzsimmons KP, Lee Pace J. Osteochondral fracture fixation with fragment preserving suture technique. Arthrosc Tech 2020; 9 (06) e761-e767
    CrossrefPubMedGoogle Scholar
  • 19 Nuelle CW, Nuelle JAV, Balldin BC. Open reduction internal fixation of a traumatic osteochondral lesion of the patella with bioabsorbable screw fixation. Arthrosc Tech 2019; 8 (11) e1361-e1365
    CrossrefPubMedGoogle Scholar
  • 20 Gesslein M, Merkl C, Bail HJ, Krutsch V, Biber R, Schuster P. Refixation of large osteochondral fractures after patella dislocation shows better mid-to long-term outcome compared with debridement. Cartilage 2019; 13 (Suppl 1): 966S-973S
    CrossrefPubMedGoogle Scholar
  • 21 Aydoğmuş S, Duymuş TM, Keçeci T. An unexpected complication after headless compression screw fixation of an osteochondral fracture of patella. Case Rep Orthoped 2016; 2016: 7290104
    PubMedGoogle Scholar