Fixation versus Excision of Osteochondral Fractures after Patellar Dislocations in Adolescent Patients

Abstract

Background:Patellar dislocation is one of the most common knee injuries in the adolescent population. It is often combined with osteochondral fracture. The purpose of this study was to compare the outcomes between fixation and excision of osteochondral fractures not involving the bearing surface in adolescent patients with patellar dislocations.Methods:Patients who underwent surgery for osteochondral fracture following patellar dislocation in our institution from 2007 to 2014 were retrospectively evaluated. Visual analog scale (VAS) of pain and the International Knee Documentation Committee (IKDC) form were used to assess knee pain and function at follow-up. Patient satisfaction was evaluated. Differences in the values of variables among groups were assessed using t-test if equal variance or Mann–Whitney U-test if not equal variance. The Pearson's Chi-square test was applied for dichotomous variables if expected frequency was >5 or Fisher's exact test was applied if not. A value of P < 0.05 was considered statistically significant.Results:Forty-three patients were included, with the average age of 14.1 ± 2.3 (range, 9.0–17.0) years. Nineteen underwent fixation of osteochondral fractures and 24 did not. The average follow-up time was 28 ± 10 months. There was no significant difference in age, gender, follow-up time, causes of injury, times of dislocation, and location of osteochondral fracture between fixation and excision groups. The fixation group had a significantly longer surgery time (82 ± 14 min) and larger size of osteochondral fracture (2.30 ± 0.70 cm2) than the excision group (43 ± 10 min, 1.88 ± 0.62 cm2, respectively, t = 10.77, P < 0.01 and t = 0.84, P < 0.05). At the last follow-up, the average IKDC score in the fixation group (82.52 ± 8.71) was significantly lower than that in the excision group (89.51 ± 7.19, t = 2.65, P < 0.01). There was no significant difference in VAS of pain and patients' satisfaction. There were 7 (16%) patients with recurrent dislocation.Conclusion:Excision of osteochondral fractures has equivalent or better outcomes compared to fixation in adolescent patients with patellar dislocations when these fractures do not involve the bearing surface.

Cartilage Restoration in the Adolescent Knee: a Systematic Review

“…In the internal fixation group (n = 33), 93.9% (n = 31) of measured patients were noted to be at least "satisfied" with their knee outcome Macmull In the microfracture group (n = 36), the mean Lysholm score and Tegner activity score significantly increased in 100% of patients (n = 36) (p < 0.05). IKDC and NAS-P scores significantly improved in 100% (n = 10) of measured patients Kang et al (2018) Internal fixation Medial patellar facet (14), lateral femoral condyle (11), both (4) ≤ 2 cm 2 (8) > 2 cm 2 (11)…”

“…In the internal fixation group (n = 33), 93.9% (n = 31) of measured For instance, in non-adolescent populations, it has been stated that ACI is ideally performed in patients with a lesion size of greater than 4 cm 2 ; however, techniques such as OCA transplantation may succeed irrespective of lesion size [26]. As a result, such considerations may be prognostic in determining the success of certain techniques in this sensitive population and must be considered in the future studies to ascertain appropriate guidelines [27]. The strengths of this systematic review stem from the rigorous methodology employed which includes a broad search strategy conducted on multiple databases, and a duplicate systematic approach to reviewing the literature.…”

“…Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. patients were noted to be at least "satisfied" with their knee outcome Kang et al (2018) Cartilage excision Medial patellar facet (14), lateral femoral condyle (3), both (2) ≤ 2 cm 2 = 14 > 2 cm 2 = 10 NR In the cartilage and excision drilling group (n = 24), 100% (n = 24) of patients reported satisfactory knee outcomes Fabricant et al 2018Internal fixation 56% (n = 5/9) of patients demonstrated satisfactory cartilage restoration on MRI examination…”

Surgical versus nonsurgical treatment of primary acute patellar dislocation

“…In this review, we conduct an up-to-date meta-analysis, including the latest randomized controlled trials and cohort studies [7–9] published in 2017 and 2018. The purpose of this review is to cover studies that compared outcome indicators for surgical and nonsurgical treatment.…”

Complex Patella Stabilization for Patella Instability

“…Первичный эпизод вывиха сопровождается гемартрозом, а при повторении -синовитом коленного сустава. Патологическое смещение надколенника приводит к повреждениям хряща латеральной суставной поверхности блока бедренной кости и/или фасетки надколенника, могут образовываться свободные хондромные тела и развиться блокады коленного сустава [13,14,15,16]. Далее, подводя свободную часть сухожилия к медиальному надмыщелку бедренной кости и фиксируя ее в изометрической точке интерферентным винтом или швами, мы создавали медиальную бедренно-надколенниковую связку.…”