Clinical outcomes after absorbable suture fixation of patellar osteochondral fracture following patellar dislocation

Abstract

Background: Osteochondral fracture (OCF) is one of the severe complications following a patellar dislocation. The appropriate fixation method for patients with OCF remains controversial. Methods: Eighteen patients who had undergone surgery after a patellar dislocation were recruited retrospectively. Patellar OCF was fixed with an absorbable suture in an unreported method. The medial patellofemoral ligament (MPFL) was repaired or reconstructed if necessary. The Lysholm and Kujala knee scoring systems were used to evaluate the knee function. Imaging examinations were used to confirm the fracture healing. Results: The mean period of follow-up was 36 months. All patients recovered well postoperatively without symptomatic complications. The Lysholm score and the Kujala score improved significantly from 37.6 (SD =6.8) and 45.9 (SD =6.4) preoperatively to 80.9 (SD =7.4) and 89.4 (SD =6.8) postoperatively at the latest followup, respectively. Imaging evidence including X-ray and MRI revealed good healing of the OCFs. Conclusions: This study showed satisfactory mid-term outcomes of OCF fixation using absorbable suture, which supports this method's potential to be a novel surgical method in the treatment of patellar OCF caused by a patellar dislocation.

Characteristics of Osteochondral Fractures Caused by Patellar Dislocation

“…23,25 If the fracture is treated surgically, the primary procedure is reduction and fixation of the OCF fragment into its original location using biodegradable pins or sutures. 8,10,28,29 If refixation is not possible, microfractures, subchondral drilling, or periosteal or abrasion chondroplasty may be considered. 9,24 Despite the theoretical basis of the biomechanics of injury mechanism, literature describing the anatomic characteristics of OCFs in the knee joint after patellar dislocation is limited.…”

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

“…However, this article differs from the present study in that it includes recurrent dislocators as well as adults. No redislocations were observed and good clinical outcomes were presented [18]. Pritsch et al described six cases of transpatellar suture OCF fixation with no complications in a twoyear follow-up; however, neither functional scores nor MRI were used [19].…”

“…Many different methods of fixation are described in the literature, including suture, bioabsorbable pins, and Herbert screw; transpatellar PDS suture proved to be effective and inexpensive in osteochondral fractures greater than 1 cm 2 within the weight-bearing area [11,18,19]. e suture method is suitable for young patients and is not associated with the risk of implant penetration to the joint and secondary need of its removal [6,11].…”

“…e suture method is suitable for young patients and is not associated with the risk of implant penetration to the joint and secondary need of its removal [6,11]. However, one disadvantage of the technique is that it offers questionable stability when used with large fragments; nevertheless, this problem can be solved through the precise placement of a sufficient number of sutures [13,18]. Although Herbert or bioabsorable screws may provide more compression than sutures, this approach becomes more challenging for smaller fragments.…”

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

“…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.…”