Chondral fragment of the lateral femoral trochlea of the knee in adolescents

Uchida, Ryohei; Toritsuka, Yukiyoshi; Yoneda, Kenji; Hamada, Masayuki; Ohzono, Kenji; Horibe, Shuji

doi:10.1016/j.knee.2012.01.001

Cited by 25 publications

(39 citation statements)

References 7 publications

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“…All other reports of healing chondral fragments have been in adolescent patients (Table 1) and have discussed lesions of the lateral femoral condyle and trochlea. Uchida et al 23 reported that they required second-look arthroscopy in 2 of their patients due to the bioabsorbable pins backing out. Postoperatively, both Nakamura et al 18 and Lawrence et al 12 allowed their patients to return to sporting activities at 6 months.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee

Siparsky

Bailey

Dale

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Isolated chondral fractures of the knee are a rare and challenging problem, typically occurring with an acute traumatic event such as dislocation of the patella or ligamentous injury. Historically, repair of unstable chondral fragments without osseous attachment has not been recommended due to concerns about the limited healing potential of cartilage.Purpose:To describe a technique for fixation of large isolated chondral fractures of the knee and present 3 cases where large chondral fragments without osseous attachment were fixed successfully with chondral darts and biologic adhesive.Study Design:Case series; Level of evidence, 4.Methods:The senior author reviewed his case logs for all patients on whom he performed open reduction and internal fixation on large isolated cartilage fragments without osseous attachment. Three were extracted from his review. The clinical and radiographic outcomes were retrospectively reviewed.Results:Successful results and complete healing was obtained in all 3 patients. This procedure can be done in the setting of concurrent injury, such as anterior cruciate ligament tear, using single- or multistaged chondral repair and ligament reconstruction techniques.Conclusion:Isolated chondral fragment repair techniques provide the orthopaedic surgeon an additional option for treating these challenging injuries. Primary fixation can be accomplished for what have been historically considered “unsalvageable” fragments.

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Section: Discussionmentioning

confidence: 99%

Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee

Siparsky

Bailey

Dale

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Without bone attached, a purely cartilaginous lesion is thinner and presents more of a technical challenge for adequate fixation. 4,5 In addition, bone-to-bone healing is much more reliable than healing of cartilage to underlying bone. Few reports have described fixation of full-thickness articular cartilage lesions involving the articular femoral condyles.…”

mentioning

confidence: 99%

Adolescent Femoral Chondral Fragment Fixation With Poly-L-Lactic Acid Chondral Darts

Morris¹,

Weber²,

Morris³

2016

Orthopedics

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Large chondral injuries without attached bone are uncommon. This report describes a 14-year-old boy who had a unique stress reaction between the bone and the overlying cartilage, predominantly of the anterior lateral femoral condyle, during a week-long basketball camp, resulting in complete displacement of a 2.5 × 2.5-cm full-thickness articular cartilage lesion. There was a 6-day interval from the time of the injury to the first office appointment. Scheduling of magnetic resonance imaging and insurance approval took another week, and then surgery scheduling, including insurance approval and arranging for surgical supplies, took another week. Three weeks after the initial injury, the patient underwent diagnostic arthroscopy and open arthrotomy, and the cartilage-free fragment was returned to the donor site and fixed with poly-L-lactic acid chondral darts. Considerable delamination of the shoulders of the defect was noted on preoperative magnetic resonance imaging and at the time of surgery, suggesting an unusual prodromal stress reaction. Although there was no underlying subchondral bone on the free cartilage fragment, the injury healed. The patient had return of full knee range of motion and strength. Magnetic resonance imaging performed 3 months postoperatively showed healed cartilage. At 1 year of clinical follow-up, the patient had no clinical sequelae from the initial injury and had returned to competitive basketball. Prompt recognition of this injury pattern and subsequent surgical repair are necessary because the window of opportunity closes as fibrous healing occurs and the cartilage fragment deforms. The poly-L-lactic acid chondral dart system was instrumental to the success of this case.

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“…MRI is highly sensitive in the detection of ligamentous, capsular, cartilaginous, and bony injuries, and it offers reasonable interreader reliability in measuring baseline anatomical abnormalities associated with patellar instability. [116][117][118][119][120][121][122][123][124][125][126][127][128][129][130] Dejour defined "major" instability risk factors that can be identified on imaging including trochlear dysplasia, patella alta, patellar tilt, and the TT-TG distance (discussed later). 72,106,107 For all imaging modalities, interreader measurement of important angles and distances will vary to some degree.…”

Section: Diagnostic Imaging In the Evaluation Of Patellar Instabilitymentioning

confidence: 99%

The Pediatric Patella: Normal Development, Anatomical Variants and Malformations, Stability, Imaging, and Injury Patterns

Maloney

Stanescu

Ngo

et al. 2018

Semin Musculoskelet Radiol

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We discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic significance, genetic syndromes that alter the appearance of the patella, physiology of patellar tracking and stability, patellofemoral instability, and injury patterns and classification. Recognition of appropriate development on imaging prevents diagnostic error and unnecessary evaluation. Knowledge of the pertinent features of syndromes associated with morphological patellar abnormalities can aid in generating a succinct and relevant differential diagnosis. In patellofemoral instability, the patient's baseline anatomy, factors that predispose to instability, and the specific injuries that occur as a result are critical considerations for determining the course of treatment. Patellar sleeve fractures are unique to pediatric patients, and timely identification is critical to achieving an optimal treatment outcome.

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Chondral fragment of the lateral femoral trochlea of the knee in adolescents

Cited by 25 publications

References 7 publications

Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee

Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee

Adolescent Femoral Chondral Fragment Fixation With Poly-L-Lactic Acid Chondral Darts

The Pediatric Patella: Normal Development, Anatomical Variants and Malformations, Stability, Imaging, and Injury Patterns

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