Hybrid Treatment of Osteochondral Fracture of the Patella With Particulated Juvenile Cartilage and Fragment Fixation

Acute patellar dislocation can result in osteochondral fracture of the patella, resulting in multiple osteochondral fragments, with only one fragment able to be fixated into the defect effectively. In these cases, we propose a hybrid procedure to repair the defect using the fixation of one of the osteochondral fragments and particulated juvenile articulate cartilage to fill the remaining defect in the patella. This technique maximizes the amount of native articular surface that we can preserve on the patella. The use of fragment fixation in combination with particulated juvenile articulate cartilage will help prevent further articular damage to the patella and reduce the risk of developing osteoarthritis in patients suffering from an osteochondral fracture as a result of acute patellar dislocation. Video 1 This video shows the combined MPFL and patellar cartilage repair using PJAC and fixation of osteochondral fragment after acute patellar dislocation in a 19-year-old male patient. The surgical procedure was performed on the left knee in full extension with the patient in the supine position. Initially, diagnostic arthroscopy was performed along with debridement of cartilage flaps and excision of the loose body. The arthrotomy was then carried out with a medial parapatellar approach. The medial retinaculum was separated from the capsule and tagged with a suture to aid the MPFL reconstruction. The patella was then everted to assess the defect and prepare the osteochondral fragment for fixation with 2 Smart Nails. The MPFL reconstruction was then addressed using 2 Q-FIX anchors at approximately the midpoint of the patella, and then the gracilis allograft was tagged, tying it down with the sutures from the anchors. Foil was then used to make a mold of the remaining defect in the patella. That foil mold was then filled with the particulated cartilage and tisseal. Before placement of the cartilage allograft, an incision was made posterior to the medial epicondyle, and a guide pin was placed for the femoral tunnel. The position of the wire was checked using fluoroscopy. The cartilage graft was placed in the remaining defect with tisseal at the base. Excess fibrin glue was removed, and once the tisseal was fully cured, the knee was put through flexion and extension to ensure that the graft was secure. The MPFL reconstruction was then completed fixing the gracilis allograft with a tenodesis screw to the femoral tunnel. (MPFL, medial patellofemoral ligament; PJAC,