Osteochondral Fragment from the Lateral Femoral Condyle in an Adult after Patellar Dislocation: A Surgical Challenge

Osteochondral lesions of the lateral femoral condyle (LFC) following patellar dislocation are relatively rare and typically observed in the adolescent population. In adults, such injuries-especially involving a large osteochondral fragment from the posterolateral aspect of the condyle-are exceedingly uncommon and pose both diagnostic and therapeutic challenges.

We present the case of a 20-year-old male who sustained a traumatic right knee injury while playing basketball. Clinical examination and imaging revealed a large osteochondral fragment (2.5 × 2.5 cm) originating from the posterolateral aspect of the LFC, accompanied by a complete tear of the medial patellofemoral ligament (MPFL). Notably, the patient demonstrated generalized joint hypermobility (Beighton score 6/9) and patellar maltracking features, including patella alta and increased tibial tubercle-trochlear groove distance. The patient underwent combined arthroscopic and open surgical management. Diagnostic arthroscopy confirmed an intra-articular floating osteochondral fragment, which was removed, anatomically reduced, and fixed using bioabsorbable pins and headless compression screws through a lateral parapatellar arthrotomy. Concurrently, MPFL reconstruction was performed using a semitendinosus and gracilis autograft fixed with suture anchors and an endobutton system.

This case underscores the importance of high clinical suspicion for osteochondral injury in adult patellar dislocation, especially in patients with underlying joint hypermobility or anatomical predispositions.