2023 ISAKOS Biennial Congress ePoster
Open Flake Refixation With Significantly Better Radiological Outcome Than Debridement Following Acute Patella Dislocation And Concomitant Flake Fractures – Both Groups With Excellent Clinical Outcome
Yannick Ehmann, MD, Munich, Deutschland GERMANY
Lea Zuche, cand. med., Munich GERMANY
Andreas Schmitt, MD, Munich, Bavaria GERMANY
Daniel P. Berthold, Association.-Prof., Munich GERMANY
Alexander Otto, MD, Neufahrn, Bavaria GERMANY
Lukas Nawid Muench, MD, Munich GERMANY
Svenja Hoeger, MEd, Munich GERMANY
Marco-Christopher Rupp, MD, Munich, Bavaria GERMANY
Klaus Wörtler, MD, Prof., Munich, Bavaria GERMANY
Sebastian Siebenlist, MD, MHBA, Prof., Munich, Bavaria GERMANY
Julian Mehl, MD, Munich, Bavaria GERMANY
Department of Sports Orthopaedics, Technical University of Munich, Munich, GERMANY
FDA Status Not Applicable
Summary
Open refixation after sustaining acute patella dislocation with (osteo)-chondral flake fractures shows excellent clinical results and significantly better radiological results compared with debridement, even though the defect size is larger, showing that it is a good surgical option in the treatment algorithm.
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Abstract
Purpose
To investigate clinical and magnetic resonance (MR) imaging results of patients undergoing patella stabilization with either open flake refixation (oFR) or debridement (Deb) and concomitant soft tissue patella stabilization after sustaining primary, acute patella dislocation with confirmed chondral and/or osteochondral flake fractures. It was hypothesized that refixation will lead to better results than debridement at mid-term follow-up.
Methods
A retrospective chart review was conducted to identify all patients undergoing oFR or debridement after sustaining (osteo-)chondral flake fractures and concomitant soft tissue patella stabilization following primary, acute patella dislocation between 01/2012 and 09/2018 at the author’s institution. Patients were excluded if they were aged <14 years or >30 and had previous knee surgeries at the index knee. MR images were assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 kneescore. Clinical outcomes were assessed using the Tegner activity score, Kujala score, subjective IKDC score, and the KOOS score at a minimum follow-up of 24 months postoperatively. 29 patients were included in the study, with sixteen patients assorted to the oFR group and thirteen patients to the debridement group.
Results
Demographic data did not show significant group differences (oFR: 6 female, 10 males; age 26.9±5.6 years, FU: 57 months (27-97 months); Deb: 6 female, 7 male; age 24.5±5.1 years, FU: 63 months (29-96 months); n.s.). Defects in the oFR group were significantly larger (2.58 cm2 vs. 1.34 cm2; p=0.028), while defect location was similar in both groups (oFR: 12 x patella/ 4 x lateral femoral condyle; Deb: 10/3; n.s.). The MOCART 2.0 score showed significantly better results for the oFR-group (68.2±11.1 vs. 54.1±11.6, p=0.012). Both groups showed excellent clinical outcomes, with no statistically significant difference between both groups. (oFR-group vs. Deb-group: Tegner: 5.1±1.8 vs. 6.0±1.8; Kujala: 86.1±12.6 vs. 88.2±8.4; IKDC: 83.8±15.0 vs. 88.0±11.3; KOOS: 83.3±14.0 vs. 87.3±8.1; n.s.).
Conclusion
Open refixation of (osteo-)chondral fragments in patients after sustaining acute patella dislocation with (osteo)-chondral flake fractures shows excellent clinical results and significantly better radiological results compared with debridement, even though the defect size is larger, showing that it is a good surgical option in the treatment algorithm. Debridement shows excellent clinical results for smaller defect sizes, showing that patients that are not eligible for refixation or ACI and are treated with debridement can show excellent results.