Hybrid Treatment of Osteochondral Fracture of the Patella With Particulated Juvenile Cartilage and Fragment Fixation

Fletcher, Connor; Strickland, Sabrina

doi:10.1016/j.eats.2022.02.030

Cited by 1 publication

(1 citation statement)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Combined operative management results in improved PROMs; however, these scores are inferior to reports from the literature on MPFL reconstruction alone without cartilage damage [29, 34]. For the associated osteochondral defect, several management techniques have been reported including fixation, autologous chondrocyte implantation (ACI), and excision or debridement [5, 7, 8, 15, 18, 34]. Fixation may be used for intact osteochondral fragments of sufficient size and has been shown to result in excellent clinical and radiological outcomes [5].…”

Section: Discussionmentioning

confidence: 99%

Combined quadriceps medial patellofemoral ligament reconstruction and osteochondral fixation offers good patient-reported outcomes and low rates of recurrent instability for osteochondral defects secondary to acute patella dislocation

Scanlon

Raymond

Aujla

et al. 2023

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeChondral injuries secondary to traumatic patella dislocation are common, and a subgroup of these are significant defects with fragments amenable to fixation. There is a paucity of published evidence assessing patients managed with combined acute patellofemoral stabilisation and osteochondral fixation. The purpose of this study is to report the outcomes of patients with osteochondral injuries secondary to acute traumatic patella dislocation treated with combined early fragment fixation and MPFL reconstruction using a quadriceps tendon turndown technique which has distinct advantages for this cohort, including preventing chondral overloading and non‐violation of the patella bone. MethodsPatients who underwent combined quadriceps tendon MPFL reconstruction and osteochondral fixation were included. Patient demographics, defect characteristics, complications and reoperations were evaluated. Patients were assessed with Lysholm, Kujala, KOOS‐PF scores and satisfaction scale at follow up. Pre‐operative MRI was assessed for presence of radiological risk factors for patella dislocation and post‐operative MRI was used to assess cartilage quality with MOCART 2.0 score. ResultsA total of 19 patients (63.2% female) were included. The mean age was 17.4 ± 4.8 years and patients were followed up at a mean 15.8 ± 5.1 months post‐surgery. The mean defect size was 2.4 cm2 ± 1.3 cm2, with the most common defect location being the patella (13/19; 68.4%) followed by the lateral femoral condyle (5/19; 26.3%). At final follow up, the overall mean Lysholm, Kujala, and KOOS‐PF scores were 84.9 ± 11.1, 89.7 ± 5.8 and 80.6 ± 13.6, respectively. Seventeen patients (89.5%) were satisfied with their outcome. The mean MOCART 2.0 score at final follow‐up was 72.5. One patient required medial capsular plication with removal of a loose chondral body and microfracture and 3 knees required minor reoperations. ConclusionCombined acute osteochondral fragment fixation and MPFL reconstruction using a quadriceps tendon graft offers good radiological and patient‐reported outcomes with high satisfaction and low rates of recurrent patella dislocation. To our knowledge, this is currently the largest series of its kind in the literature and the results of this study provide a rationale for a combined approach using a quadriceps tendon graft for this cohort. Level of evidenceLevel IV.

show abstract