Osteochondral Fracture Associated With Patellar Dislocation: Surgical Treatment

Patellar dislocation can be associated with osteochondral fracture with fragments from the patella, femur, or both. These fragments may be excised or fixed.

An associated osteochondral fracture is the main indication to operate in cases of first-time patellar dislocation.

Using an arthrotomy, the osteochondral fragment can be retrieved and fixed using headless screws. To stabilize the patella, the medial patellofemoral ligament (MPFL) can be either reconstructed with an autograft (gracilis tendon) or repaired (when avulsed from the patella).

Fixing an osteochondral fragment promptly can restore the articular surface, avoiding patellofemoral or femorotibial incongruence, which could lead to pain, swelling, poor function, and progression to osteoarthritis. There were good functional results at follow-up, and patients returned to sport.

We recommend that patients with osteochondral fractures that alter the joint congruity be treated surgically after the first episode of patellar dislocation. MPFL repair or reconstruction should be added during the same time as the surgery, with the latter being preferable.

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