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
