Late Repair, One Year After a Knee Twisting Injury, of a Missed Femoral Trochlea Osteochondral Fragment, With Bioabsorbable Nails, in a 14-Year-Old Boy

Abstract

The authors report a case of a late repair of a missed, large, osteochondral fracture of the femoral trochlea in a 14-year-old boy due to lateral patellar dislocation after a twisting injury of the knee a year ago. The late—1 year after the knee injury—imaging assessment of the patient regarding radiograph images, CT scan, and MRI was misleading, misinterpreted, and failed to reveal this osteochondral fracture. The free osteochondral fragment was detected during diagnostic arthroscopy. Open reduction and fixation of the osteochondral fragment with bioabsorbable pins were done, and healing was achieved within an acceptable time. The patient's clinical and imaging examination with knee MRI, a year after the surgical treatment, was highly satisfactory. Fixation with bioabsorbable pins showed to be a worthwhile option in this case. The technique used was straightforward, with excellent short- and long-term results. Bioabsorbable pins may be used to restore successfully even an old, large osteochondral fracture in the immature skeleton.

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

“…In conclusion, the PEDro score resulted in 6.6/11, attesting to the acceptable quality of the methodological assessment (Table 1). [14,37,40,41,45,[52][53][54][55][56]58,61,62,66,67,[71][72][73] reported the presence of loose bodies. Overall, 11.5% (183 of 1589 patients) showed loose bodies.…”

“…Ten studies (236 patients) [15,37,[50][51][52]55,60,63,[66][67][68] evaluated the chondral lesions arthroscopically using the IRCS (Table 3). In the lateral patellar facet, 2.8% of lesions were grade I lesions, 2.8% grade II, 2.8% grade III, but none were grade IV.…”

Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic

“…While the only limiting factor for primary fixation of dislodged osteochondral fragments in adolescents appears to be the integrity of the fragment itself [31,32], primary fixation in adults after two weeks appears to be associated with poorer outcomes and is classically excised. As with most articular surfaces, fibrocartilage starts to form within ten days after the injury such that reduction of the osteochondral fragment becomes difficult or even impossible [33,34].…”

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.…”

“…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 …”