The risk of osteochondral fracture after patellar dislocation is related to patellofemoral anatomy

Aim. The aim of the study was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation following patellar dislocation. Methods. Our study group comprised 17 patients with patellar dislocation followed by osteochondral fracture of the articular surface of the patella. All patients underwent surgery where the fractured osteochondral fragments of the patella were attached using the transpatellar suture technique. The mean age at the time of surgery was 14.1 years, and the mean follow-up period was 7.5 years. Results. The results of the patellar compression test and the apprehension test were negative in all patients. The mean Lysholm and Kujala scores were 89.2 and 89.6, respectively. The MRI scan revealed healing of the fixed fragment and restoration of the articular surface in all patients. In 16 cases, subchondral bone of the fixed fragment area was described as irregular: its articular cartilage was narrowed and not homogenous. Progressive degenerative changes were observed in the patellofemoral joint at follow-up in three patients. Conclusions. By fixing osteochondral fragments, the patellar articular surface can be restored. The MRI scans show that the cartilage in the reconstructed surface is narrowed after a mean 7.5-year follow-up.

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Neglected Locked Patellar Dislocation in an Adult Female: Report of a Rare Case

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i05.2206 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Sumedh D Chaudhary ◽

Pratik R Gandhi ◽

Maruti R Koichade ◽

Suchit P Chavan ◽

Shreyas H Ghuguskar

Keyword(s):

Open Reduction ◽

Patellar Dislocation ◽

Soft Tissues ◽

Vertical Axis ◽

Successful Outcome ◽

Trochlear Groove ◽

Osteochondral Fracture ◽

Chondral Injury ◽

Wound Healing Problems

Introduction: Dislocation of patella is a very common injury which usually reduces spontaneously or can be reduced easily using gentle manipulation. Irreducible patellar dislocations are rare and usually result due to either rotation of patella along the horizontal or vertical axis or due to bony impaction. Neglected locked patellar dislocations are extremely rare injuries presenting additional challenges. Case Report: We are reporting a case of a 24-year female who presented to us 4 months after suffering a knee injury for which she received native treatment initially. On presentation, patient was able to walk with a limp and some discomfort but was unable to squat or sit cross-legged. Clinical examination revealed a patellar dislocation which was irreducible. On open reduction, the patella was found to be locked in the lateral gutter with rotation along its vertical axis and with an osteochondral fracture of its medial margin. There were a lot of fibrotic adhesions which required extensive release, following which the patella could be derotated and reduced into the trochlear groove. The medial retinaculum was repaired using transosseous sutures. Postoperatively, the patient developed wound edge necrosis which was managed with debridement and secondary suturing. At 1-year follow-up patient had almost full knee range of motion without any signs of patellar pain or instability and was able to squat and sit cross-legged. Conclusion: Unlike acute irreducible patellar dislocations which can be managed easily with open reduction, a neglected dislocation necessitates wider surgical exposure and a lot of soft tissue releases, which may jeopardize vascularity of the soft tissues leading to wound healing problems. Release of all adhesions while taking care to prevent further chondral injury, adequate lateral retinacular release, derotation of patella to relocate it into trochlear groove, and meticulous medial retinacular repair is essential for a successful outcome. Keywords

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Adolescent patellar osteochondral fracture following patellar dislocation

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-012-2179-z ◽

2012 ◽

Vol 21 (8) ◽

pp. 1856-1861 ◽

Cited By ~ 26

Author(s):

Byung J. Lee ◽

Melissa A. Christino ◽

Alan H. Daniels ◽

Michael J. Hulstyn ◽

Craig P. Eberson

Keyword(s):

Patellar Dislocation ◽

Osteochondral Fracture

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

Annals of Translational Medicine ◽

10.21037/atm.2019.03.52 ◽

2019 ◽

Vol 7 (8) ◽

pp. 173-173

Author(s):

Zu-Xi Li ◽

Huang-He Song ◽

Qing Wang ◽

Dun-Ming Guo

Keyword(s):

Clinical Outcomes ◽

Patellar Dislocation ◽

Absorbable Suture ◽

Suture Fixation ◽

Osteochondral Fracture

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Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03641-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Si Young Song ◽

Tae-Soung Kim ◽

Young-Jin Seo

Keyword(s):

Conservative Treatment ◽

Patellar Dislocation ◽

Osteochondral Fracture ◽

Medial Margin ◽

Significant Difference ◽

Functional Scores ◽

Central Ridge ◽

Group 2 ◽

First Time ◽

Group 1

Abstract Background There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment. Methods Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed. Results Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication. Conclusions First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type.

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