2015 ISAKOS Biennial Congress ePoster #1909

Patella Luxation with Large Chondral Fracture

Libor Paša, Assoc Prof., MD, PhD, Brno CZECH REPUBLIC
Stanislav Kalandra, MD, Brno CZECH REPUBLIC
Jan Kuzma, MD, Brno CZECH REPUBLIC
Martin Kelbl, MD, Brno CZECH REPUBLIC

Trauma Depart. Of Medical Faculty of Masaryk Univerzity Brno. Czech Republic, Brno, CZECH REPUBLIC

FDA Status Not Applicable

Summary: Arthroscopic evaluation and refixation of chondral fragment with PDS transosseal stitches after patella luxation give very good results without necessity of other operation. Fixation by screws are possible to use but with problems with second operation for difficult screw removeing. Worse results give remove of fragments of cartilage without other articular surface therapy.

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Abstract:

Aim

Chondral fracture of patella or lateral femoral condyle is very often after patella luxation. The authors compare results of 3 groups of patients: 2 groups of patients had refixation of large chondral fragments of patella with PDS transosseal suture (group I) or with screw fixation (group II), 3rd group of patients were fragments removed (groupe III).

Material And Methods

Patella luxation is usually an injury of young people. Chondral fracture of patellae after luxation is quite often (48-72%). Chondral fragments are not usually possible to be seen on x ray picture. In cases of large chondral fragments which are not repaired the problems like pain in patello-femoral joint, limited motion, early arthrosis in young patients become very usual. The repair of chondral fragment is cruciate for femoropatellar good function in motion, without pain.
The authors operated 35 patients in 1/2008-12/2013 with large chondral fractures of medial facete of patella after luxation, 21 women, 14 men, at the age of 13-27 years. Only 3 patients had MRI before arthroscopy. The average size of the chondral defect was 28x17 mm. The authors fixed fragments to the patella by transosseal PDS stitches NoI, in 15 patients, in 11 patients fixed fragments with compression screws 2,0 mm, and in 9 patients the fragments were removed because it was not possible to repair chondral fracture for comminuted chondral defect. Fixation of chondral fragments were provided by arthrotomy in 21 patients, in 4 patients were done only by arthroscopic technique. In all cases there were sutures of ruptured medial retinaculum, in 14 cases we provided lateral release of patella for lateralisation more then 1/3 of patella.

Results

All patients were healed in 4 months after operation. In group I there were all patients with full range of movement and without subjetive problems. . In group II there were 7 patients with full range of movement and without subjetive problems, 2 patients had pain. One patient had patello-femoral pain, range of motion was S 0-0-110 in 10 weeks after operation. He had rearthroscopy of the knee with perfect healed cartilage but fibrous massive tissue in Hoffa pad. After removing this scar and rehabilitation he was without problems. Kujala score was 92 in average in group I, 88 in group II and 78 in group III in 1 year post operation.

Discussion

The chondral repair of chondral fracture is very important, especially in weight bearing joints. Refreshment of the subchondral bone and fixation of fragment by compression with PDS suture give excelent results. But removing of fragments without refixation brings long time problems like pain, swelling and limited of motion.

Conclusion

The arthroscopic evaluation and refixation of chondral fragment with PDS transosseal stitches after patella luxation give very good results without necessity of other operation. The fixations by screws are possible to be used but there could be problems with second operation for difficulty with screw removing. The removing of fragments of cartilage without other articular surface therapy give worse results.