Patellar osteochondral fractures are rare, predominantly affecting children and adolescents and usually resulting from direct shear impaction during patellar dislocation. We describe a simple, implant-free pullout fixation technique using nonabsorbable Ethibond sutures and report its application in three patients with acute displaced fractures. All patients underwent arthroscopic debridement, lateral retinacular release, and removal of nonrepairable tiny fragments, followed by open reduction and transpatellar Ethibond suture fixation of the main osteochondral fragment. Our treatment algorithm excises fragments <4 mm or irreparable multifragmentary pieces, whereas fragments ≥9 mm involving the articular surface are anatomically repaired. Postoperative bracing and structured rehabilitation resulted in radiographic union and complication-free recovery at 6 months, 1 year, and 3 years, respectively. Ethibond pullout fixation is cost-effective, technically straightforward, and eliminates hardware-related complications, serving as a practical treatment option for patellar osteochondral fractures. Longer-term follow-up with advanced imaging is warranted to confirm osteochondral congruity and exclude osteonecrosis.
Chang et al. (Wed,) studied this question.