Fixation of an osteochondral fragment after acute patellar dislocation in an immature skeleton

Albuquerque, Rodrigo Pires e; Neto, José Félix dos Santos; Albuquerque, Maria Isabel Pires e; Giordano, Vincenzo; Amaral, Ney Pecegueiro do

doi:10.1016/j.rboe.2014.03.014

Cited by 2 publications

(5 citation statements)

References 9 publications

(15 reference statements)

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“…A priori power analysis was performed with G*Power (v3.1.2) to determine the number of patients needed for tests of two independent proportions (redislocation rate). Based on previous literatures, [9,10,14,15] the value of two proportions were defined as 0.55 for group 1 and 0.20 for group 2 and allocation ratio was defined as 2.2. A sample size analysis with a power of 80% and an alpha of 0.05 showed that 17 subjects for group 1 and 36 for group 2 were required.…”

Section: Discussionmentioning

confidence: 99%

“…There were various reports about treatment for APD with OCF, including conservative treatment, loose body removal and microfracturing, osteochondral fragment fixation, and medial patellofemoral ligament (MPFL) repair [12][13][14][15][16]. However, consensus for treatment has not been established yet due to limited research on surgical and non-surgical management for APD [3].…”

Section: Introductionmentioning

confidence: 99%

“…However, consensus for treatment has not been established yet due to limited research on surgical and non-surgical management for APD [3]. There has been no gold standard of the initial treatment strategy for APD with OCF [12][13][14][15]17].…”

Section: Introductionmentioning

confidence: 99%

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Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation

Song

Kim

Seo

2020

BMC Musculoskelet Disord

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Background There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment. Methods Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed. Results Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication. Conclusions First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation

Song

Kim

Seo

2020

BMC Musculoskelet Disord

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“…e average score was 96 according to the Lysholm scale and the average follow-up was 26 months [8]. A successful case of patellar OCF screw fixation was also described by Albuquerque et al [7].…”

Section: Discussionmentioning

confidence: 99%

“…Although fast and accurate diagnosis increases the possibility of restoring the articular surface by fixing the fractured fragment, no studies have so far reported the long-time clinical results including a MRI scan of the knee. Available articles are primarily based on case reports and low-number case series [2,[5][6][7][8][9][10][11]. Only a few articles are based on large case series with clinical and MRI follow-up [3,12].…”

Section: Introductionmentioning

confidence: 99%

Clinical Results and MRI Evaluation of Patellar Osteochondral Fracture Fixation following Patellar Dislocation

Małecki

Pruchnik–Witosławska

Gwizdała

et al. 2019

BioMed Research International

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Aim. The aim of the study was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation following patellar dislocation. Methods. Our study group comprised 17 patients with patellar dislocation followed by osteochondral fracture of the articular surface of the patella. All patients underwent surgery where the fractured osteochondral fragments of the patella were attached using the transpatellar suture technique. The mean age at the time of surgery was 14.1 years, and the mean follow-up period was 7.5 years. Results. The results of the patellar compression test and the apprehension test were negative in all patients. The mean Lysholm and Kujala scores were 89.2 and 89.6, respectively. The MRI scan revealed healing of the fixed fragment and restoration of the articular surface in all patients. In 16 cases, subchondral bone of the fixed fragment area was described as irregular: its articular cartilage was narrowed and not homogenous. Progressive degenerative changes were observed in the patellofemoral joint at follow-up in three patients. Conclusions. By fixing osteochondral fragments, the patellar articular surface can be restored. The MRI scans show that the cartilage in the reconstructed surface is narrowed after a mean 7.5-year follow-up.

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Fixation of an osteochondral fragment after acute patellar dislocation in an immature skeleton

Cited by 2 publications

References 9 publications

Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation

Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation

Clinical Results and MRI Evaluation of Patellar Osteochondral Fracture Fixation following Patellar Dislocation

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