Trochlear Lesion Caused by Suprapatellar Intramedullary Nailing and Treated with Autologous Chondrocytes Implant

Intramedullary nailing remains the most common method of treatment for tibial shaft fractures. The suprapatellar technique has proven to be useful in gaining and maintaining alignment, especially in proximal one-third tibia shaft fractures. It has been adopted by many surgeons taking trauma call, because it requires less set-up time and allows the surgery to be done with less assistance. We present a case of a femoral trochlea lesion following the placement of a reamed suprapatellar intramedullary nail for fixation of a tibial shaft fracture.

An active 33-year-old male with no prior history of knee pain sustained a distal tibial shaft fracture and was treated with suprapatellar intramedullary nail fixation. Five months later, he underwent revision surgery with exchange nail placement and reaming via an infrapatellar technique for delayed healing of the fracture with subsequent successful healing. The patient, otherwise healthy, continued to experience persistent anterior knee pain with clunking and inability to arise from a flexed knee position approximately 18 months post-surgery. Magnetic resonance imaging and arthroscopic evaluation of the joint were performed, and a full-thickness cartilage lesion was identified in the central portion of the femoral trochlear groove.

The purpose of the present case is to bring awareness to the fact that the suprapatellar approach to intramedullary nailing tibial shaft fracture fixation can be accompanied by trochlear articular cartilage damage, which can be successfully treated with cartilage restoration.