Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report

Cavalheiro, Camila Maftoum; Gobbi, Riccardo Gomes; Hinckel, Betina B.; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luís

doi:10.1016/j.rboe.2017.04.008

Cited by 3 publications

(6 citation statements)

References 19 publications

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“…There are different techniques described in the literature for the repair of osteochondral fractures and to avoid future chondral damage and subsequent osteoarthrosis. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 The more classic techniques use metallic devices, such as screws and pins, and more recently, there is new available materials and biomaterials with new mechanisms of fixation. Some of these materials are resorbable, which are thought to be less harmful to the cartilage and the surrounding soft tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Classically, the treatment of OCFs include osteosynthesis of the fragment with different devices described in the literature, such as standard compression screws, headless compression screws, Herbert screws, bioabsorbable screws and pins, meniscus arrows, or sutures passed through complete bone tunnels. [6][7][8][9][10][11][12][13][14][15][16][17][18] Occasionally, when the subchondral bone or the fragment is too small for fixation or chronic, it has to be removed and managed with cartilage restorative techniques, such as debridement and/or micro/nanofractures, autologous chondrocyte implantation/ matrix-induced chondrocyte implantation, mosaicplasty, bone grafts and scaffolds, biomaterials or fresh osteochondral allograft, depending on the size and depth of injury. [19][20][21][22][23] The purpose of this Technical Note is to describe the one-stage osteochondral fracture repair technique with knotless anchors and interconnected crossing suture sliding loops, with no complete bone tunnels, no need for a second-stage surgery hardware removal, and suitable in certain cases (Table 1) and for different anatomic locations, such as patella, condyle, or trochlea defects.…”

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One-Stage Osteochondral Fracture Repair Technique With Knotless Anchors and Interconnected Crossing Suture Sliding Loops for the Knee

Samitier

Vinagre

Cugat

et al. 2020

Arthroscopy Techniques

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Osteochondral fractures of the knee represent a challenging entity to manage since there are many different surgical techniques for cartilage repair or other salvage procedures. In terms of cartilage repair, several hardware devices can be used, and many of them could imply a second-stage surgery for hardware removal. The purpose of this article is to describe in detail a one-stage osteochondral fracture repair technique with knotless anchors and interconnected crossing suture sliding loops for the knee. This technique is a one-stage open or arthroscopic procedure with an unlimited number of loops configurations with no particular need for a second surgery for hardware removal, no knot damage, and without the use of bone tunnels. It can be used in different cartilage anatomic locations, such as femoral condyles, trochlea, patella, or other joints.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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One-Stage Osteochondral Fracture Repair Technique With Knotless Anchors and Interconnected Crossing Suture Sliding Loops for the Knee

Samitier

Vinagre

Cugat

et al. 2020

Arthroscopy Techniques

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“…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%

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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Chondral and Soft Tissue Injuries Associated to Acute Patellar Dislocation: A Systematic Review

Migliorini

Marsilio

Cuozzo

et al. 2021

Life

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Introduction: Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A systematic review of the literature was performed to investigate the frequency, location, and extent of chondral and medial patellofemoral ligament (MPFL) injuries in patients following first time patellar dislocation. Methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2021. All the published clinical studies reporting the frequency, location, and extent of soft tissue lesions following first time patellar dislocation were accessed. Studies reporting data on habitual, congenital, or recurrent patellofemoral instability were excluded. Results: Data from 42 articles (2254 patients, mean age 21.6 ± 7.3 years) were retrieved. Ninety-eight percent of patients who experienced first time patellar dislocation demonstrated MPFL rupture at MRI. Forty-eight percent of MPFL ruptures were located at the patellar side, 34% at the femoral insertion site, and 18% in the midportion. Eighty-five percent of patients showed signs of patellar chondral damage at MRI, and trochlear chondral injuries were evidenced in 47% of patients. Intra-articular loose bodies were observed in 11.5% of patients. At arthroscopy, the medial facet and the crest of the patella more commonly exhibited chondral lesions than the lateral facet and femoral trochlea. Conclusions: Most patients suffer chondral damage and MPFL tears following after a first time patellar dislocation.

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Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report

Cited by 3 publications

References 19 publications

One-Stage Osteochondral Fracture Repair Technique With Knotless Anchors and Interconnected Crossing Suture Sliding Loops for the Knee

One-Stage Osteochondral Fracture Repair Technique With Knotless Anchors and Interconnected Crossing Suture Sliding Loops for the Knee

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

Chondral and Soft Tissue Injuries Associated to Acute Patellar Dislocation: A Systematic Review

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