Direct Fixation of Acute Chondral-Only Fragments in Young Patients

IntroductionCartilage lesions of the knee frequently result from acute traumatic injuries and pose significant challenges, particularly in young and active patients. While many involve osteochondral lesions, isolated chondral defects also occur. Traditional treatment focuses on fixation when viable subchondral bone is present; however, managing chondral-only lesions remains controversial due to limited intrinsic healing capacity.MethodsA systematic review was conducted, screening over 300 studies since August 2023. Inclusion criteria required (1) English-language studies, (2) reports on isolated chondral fragment fixation, and (3) a minimum of 6 months of follow-up. Eighteen studies met these criteria. Data on patient demographics, lesion characteristics, fixation methods, clinical outcomes, and functional scores were extracted.ResultsA total of 76 patients (mean age: 14.3 ± 3.7 years) were analyzed. Males comprised 80.3% of the cohort. The mean follow-up was 40.3 months (range: 7-171), and the mean chondral fragment size was 4.28 cm². The most common lesion locations were the lateral femoral condyle (34.2%), trochlea (32.2%), patella (25%), and medial femoral condyle (8.6%). Healing occurred in 96% of cases, and 86% of patients returned to sports at an average of 10.3 ± 6.1 months. Younger patients (≤14 years) had a significantly higher RTS rate (OR: 5.8; P = 0.0427). Functional scores (IKDC, KOOS, Marx, Tegner) demonstrated excellent postoperative outcomes.ConclusionDespite prior concerns regarding chondral-only fixation, this study demonstrates high healing rates and favorable functional outcomes. Direct fixation is a viable strategy, particularly in adolescents and young adults. Further prospective trials are needed to validate these findings.